Anaesthesia considerations for robotic splenectomy: A short communication

• Author Details:   
• Jami Yasaswini ^*

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Robotic splenectomy has emerged as an advanced minimally invasive technique, offering superior surgical precision, reduced intraoperative blood loss, and faster postoperative recovery compared to open or conventional laparoscopic approaches. In patients with hematological disorders such as beta thalassemia major, anesthetic management becomes particularly challenging due to the presence of chronic anemia, iron overload, potential cardiac dysfunction, and risks associated with repeated transfusions. Preoperative optimization is crucial and includes correction of anemia, evaluation of cardiac function, assessment of transfusion-related complications, and appropriate immunization against encapsulated organisms. Anticipation of blood loss necessitates preparation of cross-matched blood and platelets, with careful attention to iron chelation history and baseline organ function. Intraoperatively, general anesthesia with balanced agents ensures hemodynamic stability. The physiological consequences of pneumoperitoneum—including elevated intra-abdominal pressure, increased airway resistance, and reduced venous return—must be closely monitored and managed. Steep reverse Trendelenburg positioning, commonly used for splenic exposure, can further compromise respiratory and cardiovascular parameters. Additionally, robotic docking restricts access to the patient’s airway and intravenous lines, necessitating pre-docking verification of all monitoring and access points. Invasive arterial pressure monitoring and extended IV lines are recommended. Positioning-related nerve injuries are avoided with adequate padding and limb protection. Postoperative care focuses on effective analgesia through multimodal approaches, such as intravenous paracetamol, opioids, and local anesthetic infiltration at port sites. Early initiation of thromboprophylaxis with low molecular weight heparin is advised once hemostasis is ensured. Close monitoring for infection, thrombosis, and pulmonary complications is essential, especially in asplenic individuals. Robotic splenectomy in patients with beta thalassemia major demands a comprehensive anesthetic strategy encompassing preoperative optimization, intraoperative vigilance, and postoperative support. Multidisciplinary coordination is key to ensuring safe outcomes in this high-risk population undergoing robotic-assisted procedures.