Seamon Leigh G, Cohn David E, Valmadre Sue, Richardson Debra L, Jayjohn Lynda A, Jenson Cathy, Lee Keri, Travis Janet, Nickerson Edward, Fowler Jeffrey M
The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Perioperative Nursing, The Ohio State University College of Medicine, Columbus, OH, USA.
J Robot Surg. 2008 Jul;2(2):71-6. doi: 10.1007/s11701-008-0090-x. Epub 2008 Jun 10.
Limited data exist regarding description and technical aspects of operating room (OR) set-up, port placement, and instrument selection for robotic gynecologic oncology procedures. The objective of this manuscript and video is to show the established protocol steps at our institution for setting up a robotic hysterectomy and comprehensive lymphadenectomy (dVH-LND) for endometrial cancer. OR preparation of the robotic system prior to patient entry and set-up is demonstrated. The patient is placed in low-lithotomy on an OR table that includes a beanbag and a gel pad that is taped securely for additional stabilization. The arms/shoulders are padded to decrease injury risk and the chest is padded with foam to protect the patient from robotic arm movements. The patient is prepped widely from mid-nipple line to beyond the mid-axillary line and draped. Vaginal instrumentation includes an end-to-end anstomosis (EEA) sizer and pneumo-occluder. Port preferences, placement, and instrument selections are also demonstrated. Using a four-arm robotic system, the camera port is placed midline, approximately 20-27 cm above the pubic symphysis. Robotic ports (RP) for arms #2 and #3 are placed 8-12 cm left lateral to and 15-30° down from the camera port at approximately the level of the umbilicus. A 12 mm laparoscopic assistant port and RP#1 are placed 8-12 cm right lateral to the umbilicus and in the same position as RP#3 and #2, respectively. An additional 5 mm port is placed beneath the costal margin. This method requires only a single docking and one instrument exchange. The bedside assistant stands on the right and is essential for exposure, manipulating the uterus, passage of suture, and troubleshooting potential problems. In addition, port closure technique and methods to remove a large uterus are discussed. We have successfully completed over 70 dVH-LND for endometrial cancer using this protocol. Establishing a systematic routine for OR set-up and port placement in robotic surgery for gynecologic oncology is important for patient safety and allows for efficient use of OR time.
关于机器人妇科肿瘤手术的手术室（OR）设置、端口放置和器械选择的描述及技术方面的数据有限。本手稿和视频的目的是展示我们机构为子宫内膜癌进行机器人子宫切除术和全面淋巴结清扫术（dVH-LND）的既定方案步骤。展示了在患者进入手术室之前对机器人系统的准备和设置。患者置于手术台上的低截石位，手术台配有一个豆袋和一个牢固粘贴的凝胶垫以提供额外的稳定性。手臂/肩部进行了 padding 以降低受伤风险，胸部用泡沫进行 padding 以保护患者免受机器人手臂运动的影响。患者从中乳头线广泛备皮至腋中线以外并进行铺巾。阴道器械包括端端吻合器（EEA）尺寸测量器和气动封堵器。还展示了端口偏好、放置和器械选择。使用四臂机器人系统时，摄像头端口置于中线，耻骨联合上方约20 - 27厘米处。2号和3号臂的机器人端口（RP）置于摄像头端口左侧8 - 12厘米处，在脐水平位置向下15 - 30°。一个12毫米的腹腔镜辅助端口和RP#1分别置于脐右侧8 - 12厘米处，与RP#3和#2处于同一位置。在肋缘下方放置一个额外的5毫米端口。此方法仅需一次对接和一次器械更换。床边助手站在右侧，对于暴露、操作子宫、缝线通过以及解决潜在问题至关重要。此外，还讨论了端口关闭技术和取出大子宫的方法。我们使用该方案已成功完成了70多例子宫内膜癌的dVH-LND。为妇科肿瘤机器人手术建立系统的手术室设置和端口放置常规对于患者安全很重要，并能有效利用手术室时间。
