Anesthetic management of a morbidly obese patient with endometrial cancer during robot-assisted laparoscopic surgery

BACKGROUND: The number of robot-assisted surgeries being performed has increased in recent years, even in patients with risk factors, such as obesity, owing to advancements in medical technologies. We here report the anesthetic management of a morbidly obese woman who underwent robot-assisted surgery. CASE PRESENTATION: A 44-year-old woman (height, 165 cm; weight, 147 kg; body mass index, 54 kg/m(2)) was scheduled to undergo robot-assisted laparoscopic hysterectomy for endometrial cancer. Preoperative weight loss and rehearsal of positioning during induction of anesthesia and surgical procedures greatly contributed to the surgical success. Monitoring of oxygen reserve index in combination with SpO(2) was useful for appropriate airway and respiratory management. During anesthesia induction, the ramp position using a special commercially available cushion facilitated manual mask ventilation and tracheal intubation. Lung-protective ventilation using a limited tidal volume with moderate PEEP was applied during the robot-assisted surgical procedure. CONCLUSION: We successfully managed anesthesia without any complications.