Toupet Fundoplicatio for GERD, Robot-Assisted

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  1. Positioning and Setup

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    Positioning and Setup 2

    Patient Positioning:

    • Supine position on a large vacuum cushion. The use of the cushion eliminates the need for additional supports
    • Padding for extremities and pressure-prone areas
    • A protective bar is recommended to shield the patient from robotic arms
    • After trocar placement, tilt the operating table to:
      • 15° Anti-Trendelenburg
      • 5° Right tilt (tilt right)
    • The robotic arms are docked to the patient

    Cautions:

    • Ensure secure positioning due to the risk of abdominal wall injuries if the patient slips while docked to the robot
    • Verify the vacuum cushion for leaks before sterile draping

    Setup Details:

    • Surgeon: Operates from the robotic console with visibility of both the patient and the table assistant
    • Table Assistant: Positioned on the patient’s right
    • Anesthesiologist: At the patient’s head
    • Patient Cart: Approaches the patient from the left side
    • Scrub Nurse: Positioned to the right of the table assistant
Pneumoperitoneum, Trocar Placement, and Docking

Pneumoperitoneum Creation:Use a Veress needle at Palmer’s Point (left upper abdomen)Establish insuf

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