Intra-abdominal

Question 1

List six advantages of robot assisted surgery from the patient perspective:

Answer 1

1) smallest possible incision
2) less surgical stress
3) less pain
4) faster recovery
5) shorter hospital stays
6) improved overall satisfaction

Question 2

State seven advantages of robot assisted surgery from the surgeons perspective

Answer 2

1) less intraoperative blood loss
2) improved ergonomics
3) enhanced and magnified 3 dimensional view of surgical field
4) superior manual dexterity
5) decreased fatigue
6) filtering of resting hand tremor
7) shorter learning curve

Question 3

There are major anesthetic management considerations and challenges with robot assisted surgery list and describe seven major anesthetic considerations during robot assisted surgery

Answer 3

1) risk of thromboembolism due to lengthy procedure and trendelenburg position (use stockings)
2) maximize protection over pressure areas to avoid nerve injury and protect face from direct pressure
3) difficulties inherent in patients having prolonged surgery in trendelenburg position are present: increased mean arterial pressure in brain, increased cerebral blood volume, decreased cardiac output and perfusion to lower extremities, decreased perfusion to vital organs.
4) potential common peroneal nerve damage due to lithotomy position
5) difficulties with peritoneal insufflation are present: decreased compliance, increased airway pressure, increased ventilation perfusion mismatch, and hypercapnia
6) blood pressure reduction may be necessary secondary to resultant increase in systemic vascular resistance because of the pneumoperitoneum
7) urine output may be decreased and generally responds to fluid challenge

Question 4

describe the obturator reflex

Answer 4

more issue in TURBT than TURP
laterally located urinary bladder tumors may lie near the obturator nerve. every use of the cautery resectoscope results in stimulation of the obturator nerve producing violent contraction of the ipsilateral thigh muscles and consequent adduction of the thigh

Question 5

list 2 anesthetic techniques to abolish the operator reflex during transurethral resection of a bladder tumor

Answer 5

TURBT procedures are more commonly performed with general anesthesia and neuromuscular blockade or neuraxial anesthesia to T9-T10 providing adequate anesthesia and preventing the obturator reflex