Robotic Hysterectomy

Anesthesia Implications

Position: Lithotomy, Trendelenburg, arms tucked
Time: 1-2 hours (average)
Blood Loss: High (200 – 500 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes

Manipulation of the uterus and surrounding structures can cause a vagal response, with a drop in heart rate/blood pressure. Notify the surgeon if this gets severe. Administration of 0.2 – 0.4 mg of Robinul can often remedy the problem.

Don’t be tricked when the robot is undocked. You’re not through. The uterus will be extracted through the vagina. At this juncture the patient will usually be taken into “less trendelenburg” which, is usually almost supine. The bed will also be raised to accommodate the surgeon.

Have the bed remote ready – the surgeon will require several position changes.

Protect the eyes. Equipment likes to collect towards the head. It’s not uncommon for equipment to be inadvertently set on the patient’s face. There’s a couple solutions out there: You can place a round foam pillow with the center removed on the patients face or use goggles designed specifically to protect the eyes. Having the heating blanket a little higher on the patient can also do the trick.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.

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A hysterectomy is the surgical removal of the uterus.