Anesthetic types and techniques in robotic surgery: a systematic review

Introduction: In the context of robotic surgery (RS), approximately 1.5 million robotic surgeries have been performed worldwide in the last decade. Different anesthetic techniques can modify coagulation factors. Studies have investigated the effects of established anesthesia types on procoagulant, anticoagulant, and fibrinolytic factors in prostate cancer patients undergoing robotic surgery. Objective: It was to present a systematic review of the main approaches to anesthetic practices and types in robotic prostate surgery. Methods: The PRISMA Platform systematic review guidelines were followed. The search was conducted from March to May 2025 across the Scopus, Embase, PubMed, ScienceDirect, Scielo, and Google Scholar databases. Study quality was assessed using the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 136 articles were found. A total of 64 articles were fully evaluated, and 31 were included in this systematic review. Considering the Cochrane risk of bias tool, the overall assessment resulted in 12 studies with a high risk of bias and 15 studies that did not meet the GRADE criteria. The reported scientific evidence points to some potential benefits of robotically assisted surgery compared to open surgery and laparoscopic surgery. Outcomes related to reduced blood loss and consequent reduced need for blood transfusions, as well as the preservation of sexual function, appear to be the most significant advantages over comparators. Improved urinary continence and shorter hospital stays due to lower perioperative complication rates are also noted in the studies. Furthermore, a single spinal injection of morphine and bupivacaine provided adequate analgesia in the early postoperative period and reduced the need for additional IV opioids in patients undergoing RALP. Despite this, the anesthetic techniques, total intravenous anesthesia with target-controlled infusion and balanced inhalation anesthesia, appear to significantly increase the risk of thrombosis in prostate cancer patients undergoing LRP, particularly when the robotic device was used, encouraging the use of perioperative thromboembolic prophylaxis in these patients. Finally, in robotic cystectomy, anesthesiologists should consider the changes in the cardiopulmonary system that occur when patients are placed in the Trendelenburg position and when pneumoperitoneum is created.