Search

Robotically assisted thoracic surgery (RATS) to date is performed as a small proportion of thoracic surgical procedures and only at a few centres, but is rapidly gaining more widespread interest. In this article, we present our anesthetic perspective of planning and performing RATS and highlight specific points to consider when managing these patients.

The da Vinci Surgical System is a robotic surgical system made by the American company Intuitive Surgical. Approved by the Food and Drug Administration (FDA) in 2000, it is designed to facilitate surgery using a minimally invasive approach, and is controlled by a surgeon from a console. Robotic surgery has gained popularity worldwide recently in different surgical domains, the mastering of robotic manipulation by the surgeons has been a challenging when it first emerged but training and practice led to improvement in both the efficiency and efficacy of surgical techniques. The idea of anesthesia for robotic thoracic surgery could be frightening to anesthetists who have never done it before, but learning the technical difficulties and the specific considerations will help building the confidence towards a safe anesthetic management. In this overview we will discuss the interaction between the robot and the patient, patient position, anesthetic management, expected complications and troubleshooting them.

Pericardial cysts are rare entities, they have an incidence rate of 1:100,000 which constitutes about 7.6% of all mediastinal masses (6). The differential diagnosis includes other solid tumors and cysts of the mediastinum, diaphragmatic hernia or tumors, aneurysms of the heart or great vessels (1). Although TTE can differentiate many of the causes of mediastinal masses, loculated pericardial effusion with a similar clinical picture can be difficult to differentiate on transthoracic echocardiography (8). Radiological examination with CT or MRI has been described to differentiate in difficult cases. In emergency situations, TEE examination could be a useful option as it can help differentiating a malignant from a benign pericardial cyst, check the extent of involvement of underlying myocardium or adjacent structures and assess the anatomical abnormalities or effects on different heart chambers. In our case we describe a case of a huge pericardial cyst which had affected the patient haemodynamics in a tamponade like picture, the intra-operative TEE assessment helped appreciating the compression effect on the right heart chambers and the intravascular resuscitation needed to counteract the external pressure of the pericardial cyst. The echocardiography also helped the decision making of performing the procedure on CPB.