Anesthesia considerations for robotic-assisted laparoscopic prostatectomy: a review of 1,500 cases

Prostate cancer is the second most common cancer in American men and new surgical techniques have led to less invasive options for prostate surgery. Innovations in robotic technology have enabled robotic systems to become a more common sight in operating theatres throughout the United States. Approximately 1,500 consecutive patients scheduled for elective robotic prostatectomy (RP) were reviewed. Patient demographics were recorded and significant intraoperative and postoperative events were reviewed. At our institution the mean age for patients undergoing RP is 60.3 (41–79) years; the mean body mass index is 27.3 kg m⁻². The mean operative time, defined as the time from the start of insufflation to closure is 177.5 (81–365) min and mean blood loss is 109 (50–750) mL. There was a 1.3% incidence of postoperative anemia (hemoglobin <10 g dL) where patients required blood transfusions (15/1,500). Three patients were diagnosed with postoperative pulmonary emboli and were treated with IV heparin with no additional sequelae. The most common anesthesia-related complication was corneal abrasions, which were seen in 3% of cases. One patient required postoperative mechanical ventilation because of laryngeal edema secondary to multiple intubation attempts from an unexpectedly difficult airway. Anesthetic and perioperative complications are rare for patients undergoing robotic-assisted laparoscopic prostatectomy at our institution. Our institution has performed more robotic prostatectomies than any other institution in the world and we review our experience delivering anesthesia for the first 1,500 patients undergoing this operation.