Gastrectomy, subtotal, robotically assisted

The patient is positioned in a supine position on the large vacuum cushion. The left arm can be positioned away from the body. The use of the cushion eliminates the need for any additional supports. The table assistant sits to the left of the patient. The video tower is positioned on the right at torso height. Anesthesia is located at the head of the patient, and the surgical nurse is to the left of the table assistant. The patient is placed in a 15-degree reverse Trendelenburg position before docking.

Caution: Positioning is of particular importance due to the docking of the patient to the robot's manipulator. There is a risk of injury to the abdominal wall if the patient slips.

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

The four robotic trocars are positioned on a line slightly curved cranially at the sides (smiley) 15 cm below the anticipated course of the transverse colon (always below the navel). The trocars are inserted symmetrically with a distance of 8 cm between each. The third trocar from the patient's right side is a robotic 12 mm trocar, while the other three are 8 mm trocars. In the left lower abdomen, a 12 mm assist trocar is placed between trocars 3 and 4, 3 to 4 cm caudal to the aforementioned trocar line. The patient is positioned in a moderate foot-down position (15 degrees anti-Trendelenburg).

Caution: The trocars must be positioned with the wide black ring at the level of the muscular abdominal wall (so-called Remote Center) to minimize shear movements in the abdominal wall and prevent injury during movement.