Anaesthetic management of a patient undergoing robotic partial nephrectomy in a solitary kidney

Abstract

Patients with a solitary kidney undergoing nephrectomy represent a uniquely high-risk group in whom anaesthetic management directly influences renal and overall perioperative outcomes. With the increasing use of robotic-assisted techniques such as the da Vinci Surgical System, anaesthesiologists must address procedure-specific physiological challenges of pneumoperitoneum and lateral positioning, restricted access after docking, and potential warm ischemia - all of which may compromise renal perfusion. Preoperative assessment must focus on renal reserve, optimization of volume status and risk stratification for acute kidney injury. Intraoperative management included balanced general anesthesia with endotracheal intubation, invasive arterial pressure monitoring and strict haemodynamic control to maintain adequate mean arterial pressure. Ventilatory adjustments were made to counteract the physiological effects of carbon dioxide pneumoperitoneum.