Laparoscopic Principles for the Robotic Surgeon, Part 3

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We continue our look at special technical considerations of robotic and laparoscopic surgery, particularly as they differ from open-incision surgery. As we discussed last month, robotic surgery is merely a type of laparoscopic surgery, sharing the same principles and potential pitfalls. This month we will focus on ergonomics. Whatever improves the surgeon’s experience can often benefit patient outcomes.

Here are the key components of robotic and laparoscopic surgery ergonomics:

  • Proper operating table height – The surgeon and all assistants should be able to perform most, if not all, of their duties in a relaxed position.
  • Unobstructed view of monitors, instruments, and access ports.
  • Proper video monitor position – The goal is 20-30 inches from the viewer, just below eye-level.
  • Camera control ­– A lot of mental fatigue can result from poor (or lack of) camera movement. Whether performing a laparoscopic or robotic procedure, the surgeon is the ideal person to control the camera movement. In general, the area of interest should be kept centered. However, the surgeon may need to place the area of interest at the edge of the screen in order to “look around” a structure. When a lot of surgical movement is required, the camera should lead slightly (i.e. look where you’re going).
  • A decision to sit or stand – Of course, sitting relieves fatigue of the legs and feet. However, when a lot of head movement is required, standing will reduce the risk of chronic injury to the neck and the upper back.
  • Appropriate instrument handles ­– Different types of handles are more appropriate for different angles of approach.
  • Proper footwear with good padding, support, and grip.

Try to find little ways to make things easier on yourself. Minimally invasive surgery already has enough challenges.