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Abstract(s)
O uso dos sistemas cirúrgicos robóticos aumentou consideravelmente na última década, principalmente na urologia e ginecologia. A cirurgia robótica tem os benefícios da técnica laparoscópica aliados a menores complicações pós-operatórias e movimentos mais precisos.
O sistema robótico disponível é o sistema da Vinci, composto por um corpo com braços robóticos, uma consola cirúrgica, e um sistema de imagem em alta definição e a três dimensões. Atualmente a prostatectomia radical robótica é o procedimento mais realizado.
Do ponto de vista do médico anestesiologista, a cirurgia robótica apresenta alguns desafios. Os doentes propostos para este procedimento são maioritariamente idosos, com patologia cardiovascular e co-morbilidades. Durante a cirurgia o tamanho do robot condiciona o acesso ao doente. Além disso, este procedimento implica um posicionamento extremo do doente e um pneumoperitoneu com pressões mais elevadas que na laparoscopia. Estas condições produzem alterações fisiopatológicas cardiovasculares, pulmonares, cerebrovasculares e oculares que devem ser consideradas, e associam-se a complicações pós-operatórias que podem ser controladas.
Dado o crescente número de procedimentos com recurso ao robot da Vinci torna-se pertinente rever os procedimentos anestésicos, tomando como exemplo concreto a prostatectomia radical.
The use of robotic surgical systems has increased considerably in the last decade, particularly in urology and gynecology. Robotic surgery has the benefits of laparoscopy combined with minor postoperative complications and more precise movements. The available robotic system is the system da Vinci, composed of a surgical cart with robotic arms, a surgical console, and an optical three dimensions tower. Currently robot-assisted laparoscopic radical prostatectomy is the most commonly procedure performed. From the perspective of the anesthesiologist the robotic surgery represents a challenge. Patients proposed for this procedure are mostly elderly with cardiovascular disease and co-morbidities. During surgery, the bulky equipment interferes with the access to the patient. Moreover, this procedure involves an extreme position of the patient, and a higher pressure pneumoperitoneum that laparoscopy. These conditions produce cardiovascular, pulmonary, cerebrovascular and eye pathophysiological changes that should be considered, and are associated with postoperative complications that can be controlled. Given the growing number of robotic surgeries using da Vinci, becomes relevant to review the anesthetic procedures, taking as a concrete example of radical prostatectomy.
The use of robotic surgical systems has increased considerably in the last decade, particularly in urology and gynecology. Robotic surgery has the benefits of laparoscopy combined with minor postoperative complications and more precise movements. The available robotic system is the system da Vinci, composed of a surgical cart with robotic arms, a surgical console, and an optical three dimensions tower. Currently robot-assisted laparoscopic radical prostatectomy is the most commonly procedure performed. From the perspective of the anesthesiologist the robotic surgery represents a challenge. Patients proposed for this procedure are mostly elderly with cardiovascular disease and co-morbidities. During surgery, the bulky equipment interferes with the access to the patient. Moreover, this procedure involves an extreme position of the patient, and a higher pressure pneumoperitoneum that laparoscopy. These conditions produce cardiovascular, pulmonary, cerebrovascular and eye pathophysiological changes that should be considered, and are associated with postoperative complications that can be controlled. Given the growing number of robotic surgeries using da Vinci, becomes relevant to review the anesthetic procedures, taking as a concrete example of radical prostatectomy.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Keywords
Prostatectomia Procedimentos cirúrgicos robóticos Anestesiologia Anestesia