Docking DaVinci step by step

• Positioning is done in lithotomy position (or more safely on spreadable straight leg supports), ideally on a large vacuum cushion or non-slip mat
• It is recommended to position both arms alongside the body (caution: cotton wrapping when positioning with a cloth sling), or to position one arm on the side of the robot
• For leg positioning, padded "boots" are recommended so that the legs can be moved separately and covered sterilely if necessary. Alternatively, the legs can be positioned in leg holders with fixation in these (Caution: compartment syndrome).
• The legs should be adjustable via the OR table control during the procedure
• Shoulder supports bilaterally to prevent the patient from slipping on the OR table
• For longer procedures, application of pneumatic compression cuffs for the legs for thrombosis prophylaxis
• Possibly attaching a cervical adapter

Note: It is important to consider the risk of injury to the patient from instruments if the patient slips. With coupled tables in the Xi system, intraoperative position changes are possible without uncoupling. If the "Table-Motion" technique is not available, the surgical robot must always be undocked and removed from the OR table before any position change.

Skin marking is performed approximately 20 cm away from the target anatomy (usually periumbilical). The three to four 8 mm robotic trocars are positioned in a straight, horizontal line (Xi) or a line slightly curved towards the operative site (X, SI). Ideally, there is a distance of 8 cm between each trocar (minimum 7 cm to maximum 10 cm). The 10 or 12 mm assistant trocar can be placed in the lower abdomen, cranial to the trocars, or as an additional trocar along the straight line, depending on the assistant's position at the operating table and the surgeon's preference (see figure).