Robotic procedures have offered surgeons a minimally invasive approach for many procedures that were traditionally approached only through a more invasive technique. There have been several iterations of the da Vinci robotics system, but this chapter concentrates on the Xi model. This model features a boom deployment system that enables the bedside component access to almost any quadrant of the operating field when brought in from any position around the table. This chapter reviews the three robotic components: the vision cart, the bedside module, and the surgeon’s console. It also goes over basic room setup and instrumentation.
As with any minimally invasive procedure, advanced imaging systems are necessary. The robotics vision cart will hold some essential pieces of equipment that the surgeon should be familiar with in case trouble shooting becomes necessary during a procedure (FIGURE 1). On top of the vision cart is the TV monitor. This is on a boom arm and can be positioned to the surgeon’s preference. The monitor also has a telestrator feature, where someone can use his or her finger to draw on the screen, and these markings will transfer to the surgeon’s view in the console and then can be erased as needed.
The next component of the robotics tower is the endoscopic controller. This contains both the visual components that make the three-dimensional (3D) imaging possible and the light source for the camera (FIGURE 2). The electrocautery generator is also located on the vision cart. This will be the energy source used for electrocautery for the procedures. Finally, other components for transmitting operations, recording procedures, or other purposes can be added to the vision cart as needed.
The patient cart consists of three components: the boom, the control panel, and the four universal arms (FIGURE 3). Each will assist in positioning the arms optimally to complete the desired procedure. The boom is adjustable in both length and height. It can be rotated to just under 180 degrees to reach different anatomic areas. Under the boom center is a targeting laser, which should be used to position the boom over the camera trocar. The camera arm can then be docked, the camera inserted, and targeting can be performed that will position the other robotic arms in optimal position to reach the desired surgical area.
Control of the boom is available through the control panel (FIGURE 4). This is used to select the desired body cavity and area of operation and to steer the patient cart into position at the bedside. Once the patient cart is in the desired position at the bedside, the positioning joystick can be used to deploy the boom and adjust the height and depth and maneuver the boom to help with the laser targeting of the ...