Table 2.

Patient positioning: summary of challenges and management considerations

Consideration	Consequence	Management
Heavy and bulky robot	Can contact the head of the patient if not positioned correctly	Make sure that the face of the patient is visible during surgery
Arms are tucked by the sides of patient	No access to arms once the robot is docked	•Ensure IV is working well after arms tucked •Consider second IV after induction •Invasive lines only in high-risk patients
Steep Trendelenburg: physiologic consequences	•Downward/cephalad movement of the diaphragm by abdominal contents in conjunction with pneumoperitoneum •⇓Pulmonary compliance •⇓Functional residual capacity •⇓Tidal volumes •⇑Peak and plateau airway pressures •Exacerbates V/Q mismatch •⇓Vital capacity •⇑ Intracranial pressure •⇑ Cerebral blood flow •⇑ Intraocular pressure	Careful preoperative assessment regarding ability of patient to tolerate positioning such as patients with • severe underlying lung disease (ie, COPD) • severe obesity • glaucoma
Steep Trendelenburg: physical consequences	•Displacement of the ETT →mainstem intubation •Reflux of stomach acid •Upper airway, periorbital, and brain edema •Postoperative corneal abrasion and vision loss •Trunk shifting during positioning •High venous pressures in ear lobe	•Ensure face visibility •Consider orogastric tube for long surgeries •Ensure ETT is well secured •Limit the amount of CO2 insufflation to decrease upper extremity venous congestion •Goal-directed fluid management •Ensure proper eye protection to avoid corneal abrasions •Ensure pressure points are padded •Most adjuncts (such as shoulder braces) have been associated with neuropathic injury •Placement of the pulse oximeter on the finger

Abbreviations: ETT, endotracheal tube; IV, intravenous; V/Q, ventilation perfusion ratio.