Anaesthetic considerations for robotic-assisted cardiac surgery

Introduction Robotic-assisted surgery is increasingly being used in various surgical specialities to decrease blood loss, surgical stress and to improve cosmesis. Over past two decades it has become popular in cardiac surgery as well. Various cardiac surgical procedures like valve surgery, coronary artery surgery and congenital repair procedures can be done with robotic help. Anaesthetic management in these procedures is also challenging that involves fast tracking, knowledge of thoracic and cardiac anaesthesiology. Conclusion In conclusion, robotic assisted cardiac surgery has a promising future. With the development of 3D technology cardiac surgery can be done with good clinical results. Anaesthetic considerations should aim for one lung ventilation, haemodynamic stability, fast tracking and good analgesia. Introduction From the earliest days of cardiac surgery till date, surgical approach has been through traditional routes such as sternotomy or thoracotomy. The need for reducing the overall mortality and morbidity has led to newer innovations and ideas in minimally invasive cardiac surgery. Robotic-assisted cardiac surgery (RACS) is one such modality which has developed in the past two decades. Roboticassisted procedures are increasingly used in various surgical specialities, with the aim to decrease blood loss, decrease surgical stress and at the same time improve cosmesis. Since its inception, RACS has found its role mainly in coronary artery bypass grafting (CABG) surgery, mitral valve repairs (MVR) and atrial septal defect (ASD) closures1–3. Of late, procedures such as Maze procedure for atrial fibrillation, intracardiac tumour resection and some congenital heart surgeries such as patent ductus arteriosus (PDA) ligation and transatrial repair of Tetralogy of Fallot have also been done with robotic assistance. Continued improvements in surgical telemanipulation systems and intelligent robotic-enhanced instruments have made it possible to perform RACSs with pin-point precision. This review focuses on anaesthetic considerations in RACS. The anaesthesiologist dealing with such patients should have knowledge of cardiac/thoracic anaesthesia and intraoperative transesophageal echocardiography (TEE). History History of robotic-assisted surgeries dates back to mid-1980s when PUMA 60 robot was used for taking neurosurgical biopsy4. PRODOC and ROBODOC were used later in urology and orthopaedic surgeries. ROBODOC was the first robotic system approved by Food and Drug Administration (FDA)5. Use of robots in cardiac surgeries started in 1998 when Carpentier et al. performed first robot-assisted MVR6. Loulmet et al. performed the world’s first totally endoscopic robotic CABG (TECAB) in 19987. * Corresponding author Email: [email protected] Institute of Critical Care and Anesthesiology, Medanta–The Medicity, Gurgaon, Haryana, India Figure 1: Robotic system–surgeon’s console. Robotic system Currently approved robotic systems include the AESOP system (ComputFigure 2: Robotic arms.