Tricks of the trade: standardized operative setup for robotic-assisted HPB procedures

Abstract

Background: One limitation for adoption of robotic-assisted HPB procedures is the perceived difficulty in initial operative setup. In this presentation, using a combination of video and diagrams we describe our standard technique for robotic setup, which at our institution is with the da Vinci Si® (Si) and the da Vinci Xi® (Xi). The vast majority (>95%) of all robotic-assisted HPB procedures at our institution are performed using these standard setups. Technique: Bed, Robot, and Patient Positioning - For the Xi, the patient is positioned supine with both arms out. The bed is turned at a 45-degree angle from anesthesia, and the robot approaches in a side docked fashion for best overall range of motion. For the Si, the patient is positioned supine with left arm out and right arm tucked. The bed is turned at a 90-degree angle to anesthesia, and the robot is docked directly over the patient's head for best overall range of motion. The one exception to these standardized positions occurs when operating exclusively in the right posterior sector without hilar dissection when the patient is placed in a modified left lateral decubitus position. Port Placement - For both the Xi and Si, we gain access with a 12 mm umbilical port site which is transitioned to an assistant port and eventual extraction site. The 4 robotic ports are then arranged in horizontal fashion supraumbilically for maximum range of motion. For procedures limited to the right posterior sector, robotic ports are placed along the right costal margin.