機器手臂輔助腹腔鏡前列腺全切除的麻醉照護

Anesthetic Care of Robotic-Assisted Laparoscopic Radical Prostatectomy

達文西機器手臂手術是結合電腦操控式的機械手臂與3D視覺影像系統，可提供外科醫師清晰的視野並提升手術能力且克服微創手術的侷限性。在泌尿科的領域，它幾乎完全接管了前列腺全切除手術。由於接受前列腺切除術的病人平均年齡偏高，其所患有的慢性病會影響麻醉照護計畫，極度頭低腳高的截石臥位加氣腹更加威脅病人的麻醉安全。所以麻醉前審慎評估以降低麻醉風險，提升麻醉照護的安全與品質。此文章中描述了機器手臂輔助前列腺全切除的麻醉生理變化，並提供我們在麻醉照護此類病人的臨床經驗。

The da Vinci Surgical System combines a 3D video system and computer-controlled robotic arms, providing surgeons with a clear surgical view, improving surgical techniques and overcoming the limitations of minimally invasive surgery. In the General Urology Division, it is nearly always used in radical prostatectomy procedures. Most patients who have a radical prostatectomy are seniors, and the chronic diseases they suffer may influence their anesthesia. Moreover, the lithotomy with a steep Trendelenburg position along with pneumoperitoneum endangers patients’ safety during anesthesia. As a result, we should take the patients’ conditions into account more carefully in order to decrease the risks of anesthesia, and promote the safety and quality of anesthesia, thereby ensuring better anesthesia management. In this article, we describe the anesthetic physiological changes during radical prostatectomy undertaken with the help of computer-controlled robotic arms, and provide our experiences of taking care of those patients who undergo this type of surgery.