Robotic Pediatric Urologic Surgery-Clinical Anesthetic Considerations: A Comprehensive Review.
Nazih Khater, Seth Swinney, Joseph Fitz-Gerald, Ahmad S Abdelrazek, Natalie M Domingue, Sahar Shekoohi, Farnad Imani, Tahereh Chavoshi, Ali Moshki, Kimberly L Skidmore, Alan D Kaye
Author Information
Nazih Khater: Department of Urology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. ORCID
Seth Swinney: Department of Urology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. ORCID
Joseph Fitz-Gerald: Department of Urology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Ahmad S Abdelrazek: Department of Urology, Mayo Clinic, Rochester, MN, USA.
Natalie M Domingue: School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA. ORCID
Sahar Shekoohi: Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. ORCID
Farnad Imani: Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. ORCID
Tahereh Chavoshi: Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. ORCID
Ali Moshki: Pain Research Center, Department of Anesthesiology and Pain Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. ORCID
Kimberly L Skidmore: Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. ORCID
Alan D Kaye: Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA. ORCID
Minimally invasive robotic approaches have become standard in many institutions over the last decade for various pediatric urological procedures. The anesthetic considerations for common laparoscopic and robotic-assisted surgeries are similar since both require the insufflation of CO to adequately visualize the operative area. However, few studies exist regarding anesthesia for robotic procedures in children. We hypothesized that pediatric patients undergoing robotic urologic surgeries would require specific anesthetic strategies, especially given the inherently longer durations of these procedures. This study aimed to evaluate anesthetic considerations, current robotic procedures, optimal patient positioning, and port placement for robotic-assisted surgery in pediatric patients. A comprehensive literature review of all published manuscripts from PubMed, EMBASE database, and Google Scholar was performed, focusing on robotic procedures involving pediatric patients, anesthesia for pediatric urology patients, and related topics from 1996 to 2023. Forty published manuscripts were identified and reviewed in depth. In pediatric cases, insufflation pressures and volumes are lower due to the laxity of the abdominal wall. However, the increase in intra-abdominal pressure and absorption of CO may result in disproportionate changes in cardiopulmonary function. Specific patient positioning for robotic approaches may further compound these physiological changes. Correct patient positioning is essential to facilitate surgery optimally and safely. Understanding the physiological changes that can occur during a pediatric patient's robotic urologic surgery allows for safer anesthesia management.
