DOI: https://doi.org/10.36347/sjams.2026.v14i11.002

Pages: 1251-1257

Robotic-assisted surgery has significantly advanced the field of minimally invasive surgery by enhancing visualization, precision and surgeon ergonomics. These advantages have contributed to improved surgical outcomes and expanded the scope of complex procedures performed using minimally invasive techniques. However, the unique technical and positional requirements of robotic surgery pose several important anesthetic challenges that require careful anticipation and management. After docking of the robotic system, physical access to the patient becomes markedly restricted, particularly to the airway, intravenous lines, monitoring devices, and anterior torso. These limitations complicate routine adjustments and makes emergency interventions, such as airway rescue or cardiopulmonary resuscitation more difficult. Furthermore, robotic procedures often necessitate prolonged pneumoperitoneum and extreme patient positioning, most commonly steep Trendelenburg. These factors result in significant physiological alterations, including increased airway pressures, reduced pulmonary compliance, impaired gas exchange, elevated intracranial and intraocular pressures, and complex cardiovascular changes related to altered venous return and systemic vascular resistance. From an anaesthetic perspective, meticulous preoperative evaluation is essential, especially in patients with cardiorespiratory, neurological, or ophthalmic comorbidities. Intraoperatively, lung protective ventilation strategies, vigilant hemodynamic monitoring, judicious fluid management, and appropriate use of vasoactive agents are critical to maintain physiological stability. Equally important is the prevention of positioning related complications such as nerve injuries, facial and airway edema, and pressure related tissue damage.