Robotic surgery and patient positioning: Ergonomics, clinical pearls and review of literature

Robotic surgery has revolutionised patient management and opened newer doors for the anaesthesiologists regarding patient safety. Patient positioning and operation theatre (OT) configuration assumes unique importance for robotic surgery due to multiple factors. First and fore-most, the position cannot be changed once the robot is docked. Further, adequate surgical exposure requires extreme positioning and revamping of the existing positioning devices. In addition, there is restricted access to the patient and its antecedent problems. Last, but not the least, space restriction and protection of patient from the clashing robotic arms requires special devices and several unfavourable position modifications. Position related nerve palsies, pressure ulcers, port site necrosis, venous thrombosis and other injuries are on the rise in the recent years and appropriate measures may make it largely preventable. This article highlights the major positioning associated deficiencies and problems during robotic surgeries. It also attempts to find practical solutions for the same, and to define the best practices for robotic positioning using a thorough review of literature based on Medline, Embase, and Scopus databases search.