Table 4.

Pneumoperitoneum: summary of challenges and management considerations

Consideration	Consequence	Management
Long continuous insufflation with cold gas	Hypothermia	Ensure that the patient has a warming air blanket before docking
	Venous air embolism	•Removal of pneumoperitoneum •Undock robot •Hyperventilation with oxygen •Place the patient on left lateral decubitus •Leave the patient in Trendelenburg position •Consider aspirating with central venous catheter
	•Subcutaneous emphysema •Pneumothorax, pneumomediastinum, pneumopericardium	•Vigilance
Pneumoperitoneum: physiologic consequences	•Fluid shifts and changes in venous return/preload and afterload may lead to hemodynamic compromise •⇑ LV filling pressures •⇓Cardiac output •⇑SVR and MAP •⇓Renal, splanchnic, and portal flow→ •⇑Renin-angiotensin system →⇑ vasopressin	•Careful patient selection •⇓Urine output, goal-directed fluid therapy
	Hypercarbia and respiratory acidosis	Consider pressure-controlled ventilation

Abbreviations: LV, left ventricular; MAP, mean arterial pressure; SVR, systemic vascular resistance