Laparoscopic Principles for the Robotic Surgeon, Part 4

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 careful tissue handling, a benefit with endless possibilities in the context of robotic surgery.

During our training, we focus on surgical anatomy – in essence, where to cut and where not to cut.  One of my favorite mentors often said, “If it’s not coming out, try not even to touch it.”  He really hit on the finer point of what separates a good surgeon from a great surgeon: handle the tissues in the surgical field with extreme care.

Here are some tips to minimize unrecognized collateral damage:

• Ensure good exposure at the beginning of each procedure.
• Gently mobilize the bowel in order to avoid the need for retraction.
• Develop a system to maintain good optics throughout the procedure.
• Minimize coagulation.
• Use a cutting current to cut when needed (don’t use a coagulation current for cutting).  Even better, just use scissors.

Surgeons often focus on a visual outcome.  However, as I often tell patients, the proof is in the pudding.  When it comes to surgery, the journey is truly as important as the end result.