SUMMARY

The use of robots in surgery is likely to increase because of its enhanced precision and control. Its minimally invasive nature is better tolerated in terms of reducing the stress response, overall pain, tissue trauma, and length of hospital stays, as well as hastening recovery from surgery and improving cosmetic results.^[82]

Anesthesiologists need to be aware of this fast-changing field and how it affects anesthetic techniques and their delivery. Initially, robotically assisted surgical thoracic procedures increased the duration that patients are under general anesthesia. Concomitantly, the duration of one-lung ventilation has been taken to new time extremes, which has given us insight into the respiratory physiology of prolonged one-lung ventilation. As surgeons gain expertise with robotically assisted surgery, operative times will shorten dramatically to the point of traditional open surgery. The inability to move the patient while the robot is engaged to the patient will be a challenge when attempting to alter cardiac filling pressures by gravity, causing pharmacologic agents to be used more often. Anesthesiologists have experienced working in locations that are remote from the patient's airway. It should come as no surprise that robotically assisted surgery of the upper body will also provide that challenge. Improved monitoring methods will be needed to make remote anesthesia safe and practical. Perhaps the "minimally invasive" revolution will advocate earlier patient recovery and the increased implementation of regional anesthetic techniques. The extent of the surgical stress response may be attenuated, ultimately minimizing the inflammatory response. We have entered a new age of practical robotic applications that will ultimately improve surgical care. As with all new innovations, we must progress but with optimistic caution.