Rheumatoid arthritis and Robotic radical surgery: Positioning and Anesthetic Challenges.

Robotic surgery is the future of minimally invasive surgery. Anaesthesiologists have to be prepared for the various challenges posed by robotic surgeries in terms of steep trendelenberg position, prolonged pneumoperitoneum and fluid restriction. Rheumatoid arthritis (RA) is a debilitating autoimmune inflammatory arthritis affecting almost every joint of the body. The various deformities due to RA can pose a challenge for proper positioning. It can also cause difficult venous cannulation, difficult airway, impaired respiratory function, multi-system involvement and propensity to cause neurovascular impingement. We present a case of severe rheumatoid arthritis with hypothyroidism posted for elective robotic radical hysterectomy and the anaesthetic challenges.