Anesthetic Concerns for Robot-Assisted Laparoscopy in an Infant

In Brief A 2-mo-old infant with biliary atresia was scheduled for laparoscopic Kasai with robot assistance. Before surgery, a practice trial maneuvering the cumbersome robotic equipment was performed to ensure rapid access to the patient in case of emergency. IV access, tracheal intubation, and arterial line placement followed inhaled anesthesia induction with sevoflurane. Robotic setup took 53 min and severely limited patient access. No adverse events occurred during the procedure requiring the removal of the robotic equipment, and the patient was discharged after a stable postoperative recovery. Advance preparation is required to maximize patient safety during robotic surgery. IMPLICATIONS: The robotic surgical system for pediatric laparoscopy severely limits the anesthesiologist’s access to the patient and requires advance preparation to ensure patient safety. We present the anesthetic management of the first successful robot-assisted laparoscopic Kasai procedure in an infant.