Perioperative management of complete robotic renal autotransplantation: The first case in Japan

We report perioperative management of the first case in Japan of complete robotic renal autotransplan-tatioa This procedure was applied to a 38-year-old woman with ureteral stenosis. Anesthesia was induced by propofol and rocuronium with oxygen, and maintained by sevoflurane with remifentanil in 40% oxygen balanced with air. We gave dopamine for keeping renal perfusion pressure and steroid for avoiding ischemia-reperfusion injury. Longer procedure could be expected because of vascular and ureteral anastomosis by totally robot assistance, we had to pay special attention to posture related complicatioa Although past report showed that no position change was performed throughout nephrectomy and autotransplantation, we decided to switch from right-side lateral to head-down dorsosacral position at the end of nephrectomy. Layout of surgical table, anesthetic machine and biomonitor had to be adjusted following postural change in order to keep robot surgical system sterilized. Preoperative precise discussion and simulation of surgical procedure among surgeons, anesthesiologists and nursing staff was important factor for the success of this procedure without any major complicatioa.