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Robotic Hysterectomy

Anesthesia Implications
Position : Lithotomy, Trendelenburg, arms tucked
Time : 1-2 hours (average)
Blood Loss : High (200 - 500 ml)
Maintenance Paralytic : Yes

Anesthetic Approaches

1GETT
The Anesthesia:

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.

The Surgery:

A hysterectomy is the surgical removal of the uterus.