ABSTRACT
Trocar placement is critical when using a minimally invasive approach. There are differences in the trocar placement whether using the robotic platform or not, and these will be highlighted in the fi gures below. All procedures can be completed using four to fi ve trocars. If necessary, additional trocars may be placed if it would mean potentially avoiding a laparotomy incision. The steps to performing a hysterectomy are described in another chapter. Proper positioning of the patient is important. Steep Trendelenburg is necessary, so the patient must be secured to the operating
table using various methods. We routinely place the patient into steep Trendelenburg prior to scrubbing to ensure that there is no upward slippage of the patient and to test the patient’s ability to withstand this position. The robotic system is a fi xed system that does not have a feedback mechanism to alert the surgeon that the patient has moved against the patient cart. This may result in damage to the abdominal wall.
