ISPUB.COM The Internet Journal of Anesthesiology Volume 8 Number 2 1 of 4 Anesthetic Considerations With Telemanipulative Robot- Assisted Laparoscopic Cholecystectomy Using The Da Vinci System A El-Dawlatly, G Khairy, A Al-Dohayan, A Alsaigh, A Abdulkarim, W Alotaibi Citation A El-Dawlatly, G Khairy, A Al-Dohayan, A Alsaigh, A Abdulkarim, W Alotaibi. Anesthetic Considerations With Telemanipulative Robot-Assisted Laparoscopic Cholecystectomy Using The Da Vinci System. The Internet Journal of Anesthesiology. 2003 Volume 8 Number 2. Abstract Background: A surgical telemanipulation system provides surgeons with tools to perform totally endoscopic laparoscopic surgery with several degrees of freedom of motion. The aim of this report is to identify the anesthetic considerations and the duration of surgery using the da Vinci operation robot for laparoscopic cholecystectomy. Patients and Methods: The computerized database (in the department of surgery) and the medical records of 14 patients who underwent robotic- assisted laparoscopic cholecystectomy with CO2 insufflation under general anesthesia were studied. The study period covered one year from April 2003 until March 2004. Surgery and anesthesia times were identified. Results: The average time taken to set up the robot was 67±6 minutes. The average surgical time was 207±64 minutes. The average anesthesia time was 220±10 minutes. The average recovery time was 12±8 minuntes. The intraoperative average BIS figure was 43±4. The hemodynamic data were within normal ranges. The intraoperative average heart rate and mean blood pressure readings were 67±7 beat/min and 72±8 mmHg respectively. The average intraperitoneal CO2 insufflation pressure was 14±6 mmHg. All patients tolerated the procedure well. Conclusions: We believe that with robot-assisted surgery the anesthesiologist has to modify the anesthetic technique to be compatible with prolonged surgical hours with minimal side effects. Also, the anesthesiologist has to understand the risks and the possibility of technical difficulties encountered with robot-assisted surgery. We think that the cost of the system presents a major limiting factor for its widespread use in the field of surgery. INTRODUCTION The introduction of laparoscopic surgery has many advantages to patients. These procedures are ultimately aimed at reducing patient morbidity, length of hospital stay and overall costs. The surgical telemanipulation system provides surgeons with tools to perform totally endoscopic laparoscopic surgery with several degrees of freedom of motion. Using the device, surgeons can manipulate small instruments, which are inserted through small incisions, while being away from the patient achieving many of the technical manoeuvres previously possible only with open exposure. Minimally invasive surgery is not a new concept. Laparoscopic cholecystectomy has been performed for almost twenty years. However, it has only been recently that technology has progressed to the point of allowing procedures to be performed using a telemanipulative system. Robot cardiac surgery is now well established with better instrument control and improved performance versus standard “hands-on” surgical technique ( 1 , 2 ). The use of robots in surgery presents the anesthesiologists with significant challenges and requires careful patient screening and intraoperative amangement to assure patient safety. The