Peer-reviewed article
Anesthetic adaptations for robotic-assisted pediatric surgery in a resource-constrained setting: a case report.
Aspi MTB, Nuñez JPM ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a medical case report describing anesthetic management during a robotic-assisted surgical procedure for a child in the Philippines. It documents the technical and physiological challenges of providing anesthesia during advanced surgery in a resource-limited hospital setting. The report focuses on clinical adaptations made to ensure patient safety during the procedure.
Key points
- First pediatric robotic-assisted choledochal cyst excision performed at a Philippine tertiary hospital
- Anesthetic challenges included altered respiratory and hemodynamic physiology, hypothermia risk, and limited patient access after surgical docking
- Adaptive strategies included redundant monitoring, extended precordial stethoscope, improvised padding, and microwave-warmed intravenous fluids
- Surgery was uneventful with careful preoperative assessment and vigilant monitoring
- Authors conclude that pediatric robotic surgery is conditionally feasible in resource-limited settings with meticulous preparation and adaptive strategies
Limitations
This is a single case report describing one surgical procedure, so it cannot establish general effectiveness or safety patterns. It provides no comparative data on outcomes or complications relative to conventional surgical approaches.
Abstract
Introduction Robotic-assisted pediatric surgery enhances visualization and dexterity but poses anesthetic challenges in low-resource settings. These challenges are compounded by prolonged operative times, pneumoperitoneum, and restricted patient access. This report describes the first pediatric robotic-assisted choledochal cyst excision performed at a Philippine tertiary hospital, highlighting anesthetic considerations and adaptive strategies in a resource-constrained environment. Presentation of the case A female child with a 2-year history of intermittent epigastric pain and no comorbidities was diagnosed with a choledochal cyst and scheduled for elective robotic-assisted excision. General anesthesia was supplemented by redundant monitors and intravenous accesses, an extended precordial stethoscope, improvised padding, cling-wrap insulation, and microwave-warmed intravenous fluids. Atracurium infusion ensured deep paralysis, while ventilatory adjustments countered the effects of pneumoperitoneum. The surgery was uneventful. Discussion Anesthesia was complicated by altered respiratory and hemodynamic physiology, the risk of hypothermia, the need for paralysis, and limited access after docking. Careful preoperative assessment, vigilant monitoring, redundancy, and evidence-supported improvisation mitigated these risks. This case illustrates the disparity between advanced surgical technology and limited anesthetic infrastructure in developing countries. Conclusion This case highlights the conditional feasibility of pediatric robotic-assisted surgery in a resource-limited setting when performed on a carefully selected patient. Safety under such constraints depends on meticulous preparation, anticipation of physiologic challenges, monitoring redundancy, and adaptive anesthetic strategies. As robotic surgical platforms become increasingly adopted in developing countries, strengthening perioperative infrastructure and support systems remains essential to ensure patient safety.