Robotics

Robotic-assisted surgery is likely to gain increasing acceptance. It has the potential to allow precise movements in small spaces, thus increasing the potential for port-access surgery. It also has the potential for remote surgery (telesurgery). The current generation of robots used for cardiac surgery has three arms: one holds a stereoscopic camera and the other two hold specially designed instruments. A control unit contains a stereoscopic viewer that allows the surgeon to view the field in three dimensions. Two control handles allow manipulation of the instruments, and pedals allow the surgeon to switch control between the instruments and the camera.

Anesthesia for these procedures is similar to that for other port-access cardiac surgery procedures. Double-lumen endotracheal tubes, external defibrillator pads, TEE, and lateral positions may all be necessary for the procedure. The robot component of the system is large, and once the arms are locked to the trocars, the operating table cannot be moved. Challenges for anesthesiologists include coordinating their care with that of others in the operating room and maintaining the ability to resuscitate the patient in the circumstances dictated by the patient's position and use of the robot.