- Positioning: Supine position with legs spread on a vacuum cushion. The cushion ensures stability, reducing the need for additional supports
- After trocar placement, the table is tilted to a 15° – 30° Anti-Trendelenburg position to optimize access
- Robot Docking:
- The Xi system offers flexibility in the docking position, typically from the left
- For X or Si systems, the cart is docked cranially from the right
- Team Positioning:
- Surgeon: At the console, ideally with a view of the patient and assistant
- Assistant: Positioned between the legs, sitting or standing
- Scrub Nurse: On the right side of the patient
- Anesthesiologist: At the patient’s head, on the right side
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Patient Positioning and Operating Room Setup
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Pneumoperitoneum, Trocar Placement, and Docking
Soundsettings Pneumoperitoneum Creation:
- Use a Veress needle at the Palmer point in the left upper abdomen.
- Establish an insufflation pressure of 12–15 mmHg
- Alternatively, employ Optiview technique
Trocar Placement:
- Total Ports:
- Four 8 mm robotic ports in a linear arrangement, 15–20 cm from the target anatomy (infraumbilical)
- Two 12 mm laparoscopic ports:
- Assistant trocar (caudal between robotic ports 2 and 3)
- Pringle maneuver trocar (caudal between robotic ports 1 and 2)
- Spacing: Approximately 8 cm between each port
- Position robotic trocars at the level of the muscular abdominal wall (aligning the broad black ring, the “Remote Center”)
Initial Instrument Configuration:
- Robotic ports (from right to left):
- Port 1: Monopolar curved scissors
- Port 2: Camera
- Port 3: Bipolar forceps
- Port 4: Prograsp forceps
Docking the Robot:
- Dock the camera arm first (port 2)
- Execute Targeting (Xi system) to align robot arms with the surgical target
- Dock the remaining arms, ensuring 1 fist-width spacing between them
- Insert instruments under direct visualization via the assistant trocar
Key Precautions and Tips
Trocar Stability:
- Ensure the “Remote Center” aligns with the muscular abdominal wall to minimize shear forces during instrument movement
Instrument Placement:
- Use the assistant trocar and camera to inspect trocar alignment and verify instrument positioning before proceeding
Preventing Patient Movement:
- Double-check the vacuum cushion for leaks before sterile draping
- Secure arms during docking to avoid injury if the patient shifts
Control Checks:
- Before docking:
- Mark trocar points and ensure proper spacing
- Introduce the camera manually for inspection
- After docking:
- Verify arm alignment and positioning of instruments
Pre-Docking Checklist
Perform a small incision in the left upper abdomen for Veress needle placementEstablish pneumoperit
Perform a small incision in the left upper abdomen for Veress needle placementEstablish pneumoperit
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