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The surgeon controls the Da Vinci System, which translates his or her hand movements into smaller, more precise movements of the EndoWrist® instruments inside the patient's body. The Da Vinci technology allows surgeons to perform complex and routine procedures through 8 mm trocars, in a way that is similar to the laparoscopic approach.
The Da Vinci Xi® combines the functionality of a boom-mounted system with the flexibility of a mobile platform. The surgical cart can be placed at any position around the patient allowing for four-quadrant access.
We here see the trocars being placed in the patient's abdomen. These must be located about 6-7 cm away and their position varies depending on the type of surgery. In this case the surgical procedure is a sigmoidectomy. We also place a 12 mm trocar for the assistant surgeon to observe the surgical field during surgery. Once the trocars have been placed, we place the patient in the position where he or she will remain throughout the surgery and then proceed to introduce the robot.
The patient-side cart is placed at this time in the surgical field by the nursing team. It includes four robotic arms that carry out the surgeon's commands.
The first thing to do is connect the 3D endoscope to position the robot. The laser targeting system takes the guesswork out of the positioning of the patient cart. Once attached, we point the scope at the target anatomy and the Xi positions the boom.
We then proceed to the docking phase, in which the robot arms are placed in trocars and instruments are inserted to perform the procedure. A full range of Endowrist instruments is available to the surgeon while operating. These instruments are designed to have seven degrees of motion. Each instrument is designed for a specific task, such as clamping, cutting, coagulating, dissecting, suturing and manipulating tissue. Quick-release levers speed instrument changes during surgery.
The surgeon then moves to the console to proceed with the surgery. The surgeon operates comfortably seated at a console while viewing a high definition, 3D image inside the abdominal cavity. A view of the operating field is available to the entire OR team on the vision cart monitor.
The surgeon's fingers grasp the master controls below the display with hands and wrists naturally positioned relative to his or her eyes. The system seamlessly translates the surgeon's hand, wrist and finger movements into precise, real-time movements of surgical instruments. We can also use mono or bipolar energy with the instruments.
It is important to look at the movement of the hands. Practice and learning allow us to make increasingly precise movements properly controlling the controls in an ergonomic position without any awkward postures. In these images we can see the difference between adequate control of the controls and inadequate control, losing posture and creating clashes between the controls if the correct position is not maintained.
In conclusion, our experience to date is positive. What is most remarkable about robotic surgery is what the future may hold. Telemedicine, long-distance operations, single-incision ports among others are possibilities provided by robotics. The plan for our team is to continue to acquire experience in this highly promising field.
