Robotic Uro-oncological procedures in patients with cardiac compromise

Robotic oncologic surgery has become widely adopted in Urology and other surgical specialties. However, in patients with cardiac compromise, the physiological effects of pneumoperitoneum and surgical positioning require careful consideration. Robotic surgery involves carbon dioxide pneumoperitoneum and specific patient positioning. These can lead to reduced venous return, increased systemic vascular resistance, and reduced cardiac output. Patients with coronary artery disease, cardiomyopathy, or heart failure may experience worsening hemodynamics during surgery if not appropriately managed. 

Despite these challenges, robotic surgery offers important benefits: 

• Reduced surgical trauma 

• Less intraoperative blood loss 

• Shorter hospital stay 

• Faster postoperative recovery 

A 56-year-old gentleman from the United States presented to us with a unique scenario. He had an ischemic heart disease that required a By-pass surgery and also a localised Prostate cancer. Patient being an active professional needed a modality of treatment that would minimise his recovery period and also offer him a cure in one anaesthesia setting. After proper assessment and counselling the patient underwent the world's first Combined Robotic By-pass surgery with Robotic Radical Prostatectomy. Patient had an uneventful recovery and flew back to the US in 2 weeks. 

Another patient an 83-year-old gentleman was diagnosed to have prostate cancer. He was rejected for surgery at multiple centres in view of severe low ejection fraction of 25%. After a careful assessment by the anaesthetists and proper pre-operative planning the patient underwent Robotic Radical Prostatectomy. The procedure was completed in 72 minutes, and patient made a good recovery in the postoperative period. Patient was discharged on the 5th postoperative day. 

Key intraoperative considerations include: 

• Use of low pneumoperitoneum pressures (8–12 mmHg) 

• Gradual insufflation 

• Invasive hemodynamic monitoring in high‑risk patients 

• Careful fluid management 

• Close communication between anesthesiologist and surgeon 

 Robotic oncologic surgery can be safely performed in selected patients with cardiac compromise when meticulous perioperative planning and multidisciplinary coordination are implemented. Careful patient selection, optimization of cardiac status, and experienced surgical and anesthesia teams are essential for achieving favorable oncologic and perioperative