Port placement in robotic renal surgery from Henry Ford and Kuala Lumpur

A structured process for achieving optimal port placement for robotic transperitoneal renal surgery
From the World Congress of Endourology
Source: UroToday


M.J. Fumo1, K.K. Badani
, S. Kaul , A. Shrivastava , S. Dusik-Fenton , F. Ogunfitidimi , S. Murali
, N. Ashani , K. Arumunga , R.H Littleton , J.O. Peabody , R.M. Sahabudin
, A.K. Hemal ,M. Menon


1Vattikuti Urology
Institute,
Henry
Ford
Hospital,
Detroit,
MI,

Institute of
Urology and
Nephrology, 2
Hospital Kuala Lumpur


Introduction:

The DaVinci robotic
system has the advantages of 3D imaging, magnification, and precise
movements with many degrees freedom; however, it is hampered by size
making optimal port placement essential to prevent loss of range of motion
from robotic arms colliding with each other or the patient’s body. We seek
to clarify optimal port placement for transperitoneal renal surgery.

Conclusion:
Robotic
port placement for renal surgery can be optimized to eliminate loss of
range of motion. Placing the camera port laterally and robotic ports
antero-medially resulted in considerable flexibility of robotic movement.


I came to similar conclusions as this team did as regard to port placement after several cases. The ports for robotic renal surgery are different than for laparoscopic surgery.Â
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I found the camera you planned on using was also important. The 30 degree down camera works best in this position. If the angle of the patient is 60 degrees instead of 90 it would put the 0 degree camera in the same position relative to the patient.Â
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I place my ports more in a straight line, with the upper 8 just below the costal margin and use at least 8 cm of space, preferably 10.Â
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I also have been using the daVinci S since March and with the S, collisions are not much of a problem and port placement is much more forgiving. I think when more urologists have access to the S, more of us will perform more renal surgery with robotics.Â

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