Introduction:
Before any procedure, the robot has to be prepared for surgery. It includes the connection of all necessary parts, such as sterile drapes and connectors needed for surgery and the calibration process. These steps are conducted by a core team of scrub nurses specifically trained in handling the robot while the patient is in preparation for surgery. Currently, the only available system for laparoscopic surgery is the da vinci surgical system, developed by Intuitive Surgical (Sunnyvale, CA, USA). Any robotic procedure is performed by a team of surgeons and nurses. It includes the console surgeon, patient side assistant surgeon and the scrub nurse. Although console surgeon is the leader of the team, a trained assistant surgeon is of paramount importance as he / she is the person responsible for robot docking, instrument change, manipulation of laparoscopic instruments, application of hemostatic instruments / clips, lavage and aspiration, specimen extraction, drainage and closure of abdominal wall. A trained scrub nurse is also important in draping the robotic arms, attaching the optics, instrument changes and undocking of the robot.
DA VINCI OR CONFIGURATION
This topic includes the optimum positioning of the following components in the operating room so as to allow for maximum functionality:
- Surgeon Console Positioning
- Patient Cart Positioning
- Vision Cart Positioning
da Vinci Surgeon Console Position
The Surgeon Console is placed outside of the sterile field. It should be oriented in such a position so that the surgeon has a clear view of the operative field, vision cart and able to communicate directly with the assistant surgeon and the scrub nurse.
da Vinci Surgeon Console Positioning:
For moving or positioning the surgeon console, only the handle on the back of the console is used. It should never be pushed or pulled by the console body or armrest to maneuver the console into place. Wheel locks located on the rear wheels of the surgeon console should be locked after positioning of console for the surgery.
da Vinci Patient Cart Positioning
The Patient Cart is placed in the sterile field. It should be draped in a separate area in the room prior to moving it into place for surgery. This should an area of the room where it will not easily come into contact with non-sterile objects or impede traffic. Once the patient cart is draped, and the patient is positioned, prepared, draped and ports are placed. Then use the patient cart motor drive to help move the cart into the sterile field. The Patient Cart brakes are designed to automatically engage when the motor drive is not in use.
da Vinci Motor Drive Operation:
The motor drive interface consists of the following components:
- Throttle
- Throttle enable switch
- Shift switches
To operate the motor drive:
- Ensure that the Patient Cart is powered on.
- Ensure the shift switches are in the drive position.
Throttle enable switch to be held and throttle rotated away from the operator or towards him / her depending on the intended direction of movement.
- The Cart Power LED will flash green whenever the throttle enable switch is activated.
- The drive speed of the cart can be controlled rotating the throttle to different extent in each direction.
The motor drive will not engage whenever cannulae or instruments are installed on the System. A yellow LED on motor drive interface labelled “Cannula installed: Cart Drive Disabled” will indicate when cannuale or instruments are installed and motor drive is non-operational. This has been done for safety purpose.
Shift Switches
The patient cart can be moved without the use of the motor drive (for example, during a power loss) by rotating the shift switches (Figure 3B) to the neutral (N) position. The cart can then be moved manually. When the cart has been moved, shift switches should be placed in the drive (D) position to set the Patient Cart brakes. For patient safety, the shift switches must be kept in the drive (D) position so that the motor drive remains engaged during surgery.
da Vinci Vision Cart Positioning
The Vision Cart of da Vinci robot is placed adjacent to the Patient Cart, just outside of the sterile field, to allow the Patient Cart Operator to see the component displays.
- The Vision Cart should be close enough to the Patient Cart to allow unrestricted camera cable movement during surgery.
- Wheel locks are located on the rear wheels of the Vision Cart. These should be locked after the cart is positioned for surgery
World Laparoscopy Hospital, Cyber City, DLF Phase II, Gurugram, NCR Delhi, 122 002, India
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