Simple Trocar Placement for Robotic Liver and Pancreatic Surgery: Multiple Access Devices at 5-cm Single Umbilicus Incision with 2 Robotic Ports.

Abstract

Robotic trocars are recommended to be placed 6-8 cm apart, and assistant trocars are placed 7 cm away from the horizontal line of the robotic trocar placement. However, adhering to these rules may be difficult, particularly in lean patients. This study aims to demonstrate our standardized simple trocar placement, 5-cm single umbilicus incision + 2 ports for robotic liver resection (RLR) and robotic pancreaticoduodenectomy (RPD). During 2022-2024, patients undergoing RLR and RPD at The University of Tokyo were identified from a prospectively maintained database. Our standardized trocar placement consisted of multiple access devices at the 5-cm umbilicus incision, including two robotic trocars and one assistant trocar, and two other robotic trocars inserted to shape a hemi-circle around the surgical object. A total of 29 and 31 consecutive patients underwent RLR and RPD, respectively. The 5-cm single umbilicus incision + 2 ports method was used in 82.8% of patients undergoing RLR and 100% of patients undergoing RPD. No patients undergoing RLR developed hepatic insufficiency and bile leakage with the median postoperative hospital stay of 5 days. No patients undergoing RPD developed clinically relevant pancreatic fistula, delayed gastric emptying, and bile leakage with the median postoperative hospital stay of 8 days. Our standardized trocar placement technique is simple and widely feasible for lean-to-obese patients, allowing for RLR and RPD while minimizing incisions for patients.