Robotics

The da Vinci robotic system is a heavy, bulky instrument and needs a large OR. The proper positioning of its three components in the room is crucial to minimise the need to move it around the room. As a general rule, the robotic arms are placed on the same

Fig. 3. Position of robotic arms during left colon dissection Fig. 4. Position of robotic arms during lower rectum dissection side of the patient as the lesion (Figs. 3,4), so for surgery of the left colon and rectum the arms are placed on the patient's left side. The vision cart is positioned at the patient's feet so that the assistant and scrub nurse have an optimal view. The master console is at the patient's side, about 10 feet away to allow enough space for the robotic arms, the scrub nurse and the assistant to move. With the console in this position, the surgeon also has complete visual control of the surgical field and robotic arms. All the instruments are prepared in the room before the patient's arrival. After anaesthesia has been induced the robotic arms are wrapped with sterile plastic sheets and moved up to the operating table. The assistant stands at the patient's right side.

left colon rotates towards the left and the mesentery containing the vessels fuses with the fascia of Gerota and the retroperitoneum. The plane that originates from this fusion is virtually avascular. This plane must be followed and enables the left colon to be mobilised with its mesentery, vessels and lymph nodes. The inferior mesenteric vein (IMV) can be recognised at Treitz ligament level, where it enters underneath the pancreatic tail (Fig. 5). The inferior mesenteric artery originates from and forms an acute angle with the distal part of the aorta (Fig. 6); it can be recognised by opening the pre-aortic plane, where the mesenteric nervous plexus surrounds the

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