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Objective: We present our experience of anesthetic challenges faced during setting up of a robotic thoracic surgery program in India.
Method: Between June 2011 to December 2011, we set up a robotic thoracic surgery program at a newly commissioned super speciality hospital. A successful VATS program was already in place. Our anesthetic team was well versed with one lung ventilation and bronchoscopy.
Results: Successful isolation of the lung on the surgical side was achieved in all cases. In two cases intraoperatively half way through the procedure the lung reinflated and bronchoscopy in lateral position was required to manipulate the tube back into correct position. One case of a robotic thymectomy had sudden cardiopulmonary arrest suspected due to tension pneumothorax. This happened due to malfunctioning of the insufflators and raised intrathoracic pressure. The situation was overcome with pharmacological manipulation and release of co2. Further, by VATS the left pleura needed to be opened. Eventually, a small anterior thoracotomy was done to complete the thymectomy. The patient recovered with these maneuvers and the remaining surgical procedure was successfully completed. The patient had no postoperative morbidity.
Anesthetic challenges in robotic thoracic surgeries include positioning, being at the foot end of the patient to enable the robot to dock from the head end need for two anesthetists; one at the machine end & other at the head end for airway manipulation & lung isolation.
All patients were successfully extubated on table. Myasthenic patients needed one day ICU care. Lobectomies were recovered in the recovery room for 6 hours prior to transfer to room. Patients having lobectomy, resection of mediastinal masses were given extrapleural analgesia with continuous infusion for two days.
Conclusion: Anesthesia for robotic thoracic surgery is challenging and presents specific complications requiring urgent intervention. Previous experience with thoracic anesthesia is mandatory prior to embarking on this program.