Anesthetic management for laparoscopic surgery and robotic surgery

The advent of minimally invasive surgery has provided many benefits to patients including less trauma, less pain, quicker recovery, and shorter hospital stays. A typical example of a minimally invasive surgery technique is laparoscopic surgery. Intraperitoneal insufflation of carbon dioxide is a routine procedure for creating pneumoperitoneum for accurate visualization and operative manipulation during laparoscopic surgery. However, pneumoperitoneum resulted in ventilatory, respiratory, and hemodynamic changes. Along with these changes, the patient position for the operation complicated anesthetic management. An understanding of these pathophysiologic consequences associated with laparoscopic surgery is important in anesthetic management. Robotic surgery was developed to alleviate the disadvantages of laparoscopic surgery. The advantages of computer-assisted robotic surgery include improved operative field visibility with a three dimensional imaging system and improved control of fine movement. However, the huge size of the robot itself unavoidably invades the anesthetic work space and may impair access to the patient. In addition, repositioning of a patient is almost impossible once the robot has been stationed for surgery. With the innovation of scientific technology, new surgical and anesthetic techniques are being developed for patient care. Anesthesiologists need to be aware of this fast changing surgical field and scientific technology and how it affects anesthetic management.