Laparoscopic Principles for the Robotic Surgeon, Part 5

We continue our look at special technical considerations of robotic and laparoscopic surgery, particularly as they differ from open-incision surgery. This month we will wrap up our series with a discussion of injury prevention as it pertains to robotic surgery.

Here are some of the things that we discussed earlier in this series:

  • Proper patient selection
  • Patient positioning
  • Gentle tissue handling

Proper visualization is paramount to a safe and successful procedure. Many surgeons are timid when it comes to bowel mobilization in fear of injury to these structures. In reality, proper exposure will actually reduce the likelihood of bowel injury. Early mobilization will prevent the need for bowel manipulation during a time when your focus is elsewhere.

The use of energy devices is very different in robotic surgery as compared to traditional open surgery. For instance, the behavior of electrical currents in a closed system (the insufflated abdomen) is very unique. Formal training per the manufacturer’s recommendations for each device is mandatory. The fact that only part of the surgical field is visible at one time adds to the danger.

As we have discussed in this series, robotic surgery is merely a type of laparoscopic surgery, sharing the same principles and potential pitfalls. An understanding of these principles can lead to a patient’s full realization of the benefits of robotic surgery.