Anesthesia considerations for robotic surgery in gynecologic oncology.

Robot-assisted gynecologic surgery is performed with a pneumoperitoneum and prolonged maximum Trendelenburg position which can result in adverse physiologic effects. The purpose of this study was to assess the feasibility of robot-assisted gynecologic oncology procedures and to identify anesthesia-related peri-operative adverse events. This is a case series performed on the first 133 patients who underwent a robot-assisted gynecologic oncology procedure at a tertiary care facility. Data was collected from electronically archived patient charts and from a prospective surgical database. Patient demographics were recorded and significant intra-operative and post-operative adverse events were reviewed. Robot-assisted surgery for gynecologic oncologic surgery with the use of extreme Trendelenburg in all patients was safely and successfully performed across a wide range of ages, American Society of Anesthesiologists physical status scores and body mass indices. Although most patients developed various degree of facial edema, only 5% of patients had a delayed extubation. Transient intra-operative hypoxemia (O2 saturation < 90%) occurred in 3.75% (5/133) of patients and hypercapnia (CO2 > 45 mmHg) in 18% (24/133). The mean duration of surgery was 254 min and median hospital stay was 1 day. Anesthetic and peri-operative complications are rare for patients undergoing robot-assisted gynecologic oncology surgeries despite the prolonged use of maximum Trendelenburg positioning and pneumoperitoneum. Although there are new anesthetic challenges, these surgeries were safely performed in a wide range of patients with minimal blood loss, short hospital stay and no significant cardiopulmonary complications.

Sarcoma post-embolization for presumed uterine fibroids.

BACKGROUND: Uterine artery embolization has increasingly been used in the last decade as a conservative treatment approach for uterine fibroids. Rarely sarcomas have been diagnosed shortly after uterine artery embolization. It remains unclear whether a change in diagnostic work-up is required prior to uterine artery embolization in order to avoid missing sarcomas and delaying definitive treatment. CASE: A 45 year old underwent uterine artery embolization for symptomatic uterine fibroids. Six months later, following progressive symptoms, she underwent surgery which revealed an endometrial stromal sarcoma. This manuscript raises the issue and reviews the existing literature concerning the need of tissue diagnosis prior to uterine artery embolization. CONCLUSION: Assessing the risk of malignancy by taking into account the clinical symptoms, physical exam, and imaging findings is essential prior to uterine artery embolization.