Laparoscopic Principles for the Robotic Surgeon, Part 2
As we discussed last month, robotic surgery is merely a type of laparoscopic surgery, sharing the same principles and potential pitfalls. We continue our look at how we can make this exciting technology safe and successful.
As with any type of surgery, proper patient selection is essential. Here are the key components:
- Proper procedure for the diagnosis.
- Appropriate level of complexity for a surgeon’s current skills and experience.
- Alternative plans for more complex patients (e.g. obese, prior surgeries, complex pathology).
- Assessment of special anesthetic needs as it pertains to body weight and cardiac and lung function.
Patient positioning requires particular care with robotic procedures, particularly those lasting longer than an hour. Here are some important points:
- Properly pad all pressure points.
- Place all joints and neck in as neutral of a position as possible.
- Use anti-slip material (e.g. foam, gel pad) between your patient and the operating table on as much surface area as possible.
- Avoid any method that uses pressure over a small area to secure your patient.
- Ensure that movement of all robotic arms avoids contact with your patient’s limbs and head.
- Always check final position prior to placing any drapes, blankets, or body warmers. A small change in table position can cause a significant shift in your patient’s position, thereby causing an unrecognized risk if obscured by coverings.
