[Anesthesia management of laparoscopic radical cystectomy and orthotopic bladder surgery with a robotic-assisted surgical system].

OBJECTIVE

To summarize anesthesia management of laparoscopic radical cystectomy and orthotopic bladder surgery with a robotic surgical system.

METHODS

In the study of 10 cases of bladder cancer, the robot-assisted radical cystectomy+expand lymphadenectomy+orthotopic bladder surgery with 60 degrees of Trendelenburg surgical position, was inserted into the manipulator under the video system monitor positioning, to complete the removal of the diseased tissue dissection and orthotopic ileal neobladder intra-abdominal. The respiratory parameters, hemodynamic parameters, arterial blood gas analysis were monitored and the waking time, intake and output, and intraoperative concurrent recorded.

RESULTS

All the patients were operated successfully. The intraoperative blood loss was (342.9 ± 303.4) mL; the peak airway pressure increased after trendelenburg and high pneumoperitoneum; the mean arterial pressure heart rate and central venous pressure increased compared with the endotracheal intubation 15 minutes after two cases of the disease popularity abdominal end-expiratory CO2 partial pressure more than 50 mmHg, and PaCO2 higher than 60 mmHg in the arterial blood gas. When the respiratory parameters were adjusted, the hyperventilation showed no improvement, and when the pressure was reduced to less than 15 mmHg, the pneumoperitoneum improved; when metabolic acidosis occured in 2 patients, sodium bicarbonate post-correction was given; during surgery, 2 patients potassium rose to more than 5.5 mmol/L, gluconate and insulin were given; 5 patients developed multiple subcutaneous emphysema, of whom 1 was confined to the chest and abdomen, and 1 showed significant sense of gripping the snow from face to feet, associated with hypercapnia and temperature drop; the wake time (withdrawal to the extubation time) was (94.2 ± 35.6) min.

CONCLUSION

Robot-assisted radical cystectomy + orthotopic bladder surgery is a newly-performed clinical surgery. Because of the huge machines, long time pneumoperitoneum and over-head-down, it is prone to acid-base balance and ion imbalance, thus increasing the difficulty and complexity to anesthesia management. It's necessary to further summarize the impact on the respiratory, hemodynamic, and nervous system.