Left pancreatic resection, spleen-preserving, robotically assisted

Positioning is done in the supine position on the large vacuum cushion. The left arm can be positioned separately. The use of the cushion eliminates the need for additional supports.

Note:

The positioning is of particular importance due to the docking of the patient to the robot's manipulator. There is a risk of injury if the patient slips.

Caution:

Vacuum cushions may have leaks. Check again before sterile draping.

• The surgeon ideally sits at the console with the ability to also view the patient and table assistant.
• The surgical robot (Patient Card) is brought to the patient from the left side.
• The table assistant stands or sits on the right side of the operating table.
• Anesthesia is positioned at the head of the patient.
• The scrub nurse stands to the right of the table assistant.

Creation of a pneumoperitoneum using a Veress needle at Palmer's Point in the left upper abdomen. Due to the varying abdominal wall compliance, it is advisable to determine the optimal position of the trocars on the inflated abdomen with pneumoperitoneum. The robotic trocars are positioned on a line slightly curved cranially on the sides (smiley) 15 cm below the anticipated lower edge of the pancreas (usually below the navel).

Here, three 8 mm trocars and one 12 mm trocar are initially used with a reducer sleeve if robotic stapling is intended.

Note: A robotic 12 mm trocar is necessary for the robotic linear stapler. If stapling is to be done using the Endo-GIA through the assistant trocar, four robotic 8 mm trocars can also be used.

The trocars are inserted symmetrically with a distance of approximately 8 cm from each other. In the left lower abdomen, a 12 mm assistant trocar is inserted between trocar 3 and 4 about 3-4 cm caudal to the aforementioned trocar line.

Tip:

Strict attention should be paid to maintaining the 8 cm (hand width) distance between the Da Vinci trocars to avoid collisions of the robotic arms. Additionally, a 2-3 cm distance from the anterior superior iliac spine is important.