ABSTRACT

Figure 16.3 Trocar setup for robotic procedures. The peritoneal cavity is entered according the surgeon’s preferred technique as described earlier. The camera trocar is placed approximately 18-25 cm cephalad to the symphysis pubis. The exact distance will depend on the planned procedure, patient height, and length of patient abdomen. If paraaortic lymphadenectomy is not planned, 18-22 cm is suffi cient; otherwise, the trocars must be placed higher, at 23-25 cm. An extra long 12-mm trocar is recommended. Trocar sites 1 and 2 are the robotic-specifi c trocars. Trocar 3 is also a robotic trocar if using the fourth arm of the system. This site can also be used as an assistant port instead of robotic port, if desired. Trocar 4, if needed, is an assistant port, and any commonly used 12-mm laparoscopic port is placed. Trocars 1 and 2 are placed 8-10 cm lateral to the camera port and approximately 15° caudad. Trocar 3 can be placed either on the left or right side, depending on where the assistant stands. It should be placed opposite to the assistant. There are alternative trocar setups and positioning. Surgeons should determine which works best for them. However, placing two of the robotic trocars on the right side of the patient will then allow the surgeon to have opposing graspers during the procedure. This is extremely helpful when having to manipulate and position tissue, especially bowel. All of the ports are placed prior to docking the robot and under direct endoscopic visualization. Care must be taken to ensure the skin and fascial defects are snug enough to maintain pneumoperitoneum.