Cholecystectomy, Robotic-Assisted

• Patient placed in supine position on a vacuum cushion; left arm optionally abducted
• Operating table adjusted to 15° anti-Trendelenburg and tilted 5° left
• Robotic arms docked from the right or cranial-right position

Important Notes:

• Docking alignment is critical; without a table-motion function, undocking is required for table adjustments. Ensure vacuum cushion integrity before draping

Assistants and nursing staff position themselves to the patient’s left, while anesthesia is stationed at the head

The robot (Patient Cart) is positioned from the right or right cranial side and docked. The surgeon operates from the console, ideally with a view of the patient.

• Pneumoperitoneum: Established via Veress needle at Palmer’s Point. Aspiration and drop tests confirm position; inflated to 15 mmHg

Due to variations in abdominal wall compliance, it is advisable to determine and mark the optimal trocar positions on the inflated abdomen under pneumoperitoneum.

Note: Alternatively, the insertion of the first trocar can be performed openly, depending on the clinic’s protocol.

• Trocar Placement: Four robotic trocars inserted in a diagonal line below the costal margin, 15–20 cm from the target anatomy, spaced ~8 cm apart

The arms are connected to the robotic trocars (docked). First, the targeting maneuver is performed. Subsequently, the instruments are inserted under direct visualization and parked beneath the ventral abdominal wall.

Trocar Instrumentation (from right to left):

• Port 1: Bipolar forceps
• Port 2: Camera (30°)
• Port 3: Monopolar scissors, large clip applier
• Port 4: Tipup grasper

Caution: Ensure that the trocars are positioned with the wide black ring (remote center) aligned at the level of the muscular abdominal wall (remote control) to minimize shear forces during movement.