Recent technological advances have made many surgical procedures possible with minimally invasive techniques, including urologic robotic surgeries. These techniques have improved patient satisfaction and recovery times, leading to reduced morbidity. However, it is important to recognize that these procedures are not without risk and require a careful preoperative assessment in order to minimize complications. During the preoperative assessment, the goal is to identify patients at intermediate or high clinical risk for adverse events and whether modifable medical conditions exist. In addition, we evaluate the surgical urgency and assess whether the delay in an untreated underlying urologic disease will pose a greater risk over an untreated non-urological clinical condition. In general, a thorough preoperative evaluation includes a full review of the patient’s medications, in addition to any cardiac, pulmonary, thromboembolic, or bleeding risks. Also, an assessment of delirium and frailty may be benefcial in the prediction of the elderly patients’ outcome. Postoperative complications related to robotic surgeries can include cardiopulmonary events related to insufflation and decompression, postoperative ileus, and increased intraocular pressure in the steep Trendelenburg position.

Before information about and a discussion of the elderly segment of the global population is presented, it is important to consider what is meant by the terms elderly, old age, aging, and the like. The term elderly has no precise meaning, and past and current researchers throughout the globe have viewed the elderly population many different ways. Aging as a process has both biological and social components and must be seen from the perspectives of upward shifts in life expectancy, the growth of the older population, as well as how societies view old age. From a biological perspective, for a number of years, demographers and others have been interested in both life expectancy at various ages and lifespan, the hypothetical length of life that would be realized if disease was eliminated. Life expectancy calculations rely on death rates specifc to various ages, and often there is interest in examining death rates by cause of death or in calculating life expectancy if death due to one or more causes was eliminated (e.g., cancer). During the twentieth century, researchers from many scientifc and social science felds focused on understanding why life expectancy was increasing as well as identifying the implications of increasing life expectancy on population size, population composition, and the changing social structure of populations. The cause-of-death transition during the nineteenth and twentieth centuries was comprised of falling death rates due to infectious and parasitic diseases along with increased death rates due to cancer and heartrelated causes. These studies continue today, particularly as the age structures of the world and individual nations show that relatively rapid aging is ubiquitous.

A 70-year-old woman presents to the emergency department complaining of right lower quadrant pain for 4 days. Her examination shows a palpable mass in the right lower quadrant. A CT scan shows a large distended appendix measuring 4 cm in diameter, without periappendiceal fat stranding (Fig. 1.1). The diagnosis of appendiceal mucocele is made. An open appendectomy is performed without spillage of any contents. Pathology revealed mucosal hyperplasia without signs of atypia. The patient was scheduled for routine post-appendectomy follow up.