Four factors contribute to the success of the robotic assisted surgery
1. Anatomy and awareness of the site to be operated
2.Planning the procedure after understanding it
3.Surgical skills of the surgeon
4. Most important-proper patient positioning and port placements.
The purpose of patient positioning and port placements are maintaining the safety of the patient, avoiding compression injuries, enabling maximum mobility of the robotic arms, which will facilitate a smooth and efficient surgery
The goal is the same as in open surgery – good exposure of the target and its surroundings to conduct adequate oncological clearance with safety and since its minimally invasive we need to place ports in such a way that same goal is achieved as in open surgery . Oncological clearance should be the same whether its open or robotic. Only the access is different. The advantages of robotic machines are 1. Magnification enabling better visualisation and better handling of the tissues 2. Tremor free filtration makes instruments steady unlike in Laparoscopy where instruments can shake a bit. 3. Pain is lesser with minimal cuts 4. Can dissect in deeper and vital area with ease. 5. Lesser post op morbidity from all the above.
One should remember that every patient is different and every structure can be different. Hence always space your ports after FIRST inspecting the target inside the abdomen or thorax.
The 4th generation robot has 8mm camera which is better for the patient as its smaller in width compared to other robots and its little longer with ability to access wider area. Insert the camera and the insert the other ports in such a way that robot with its arms are placed like a mother around its child.
Different organs need to be accessed in different manner and different port placements. We elaborate here from trans oral to trans anal to trans thoracic and trans thoracic onco surgeries.
Trans Oral Thyroidectomy- The camera port is in the middle and the two ports are placed on the sides taking care not to damage the mental nerve. Once we develop a plane we insert an axillary port for a progress or cardieere to help in traction or counter traction. In our initial 15 cases we avoided axillary port but it helps in better dissecting the planes and retracting the lobe up.
