OR Setup and Patient Preparation

Operating Room Configuration
The following figure shows an overhead view of the recommended OR configuration for a da Vinci^® Low Anterior Resection [Figure 1]:

 

 

• Patient-side assistant is on patient’s right side.
• Scrub nurse is at the lower right side of the table.
• Main assistant monitor is located at the patient’s feet.
• It’s useful to have a second monitor on the left side of the table across from the assistant.
• Sterile back tables (instruments) are located at the patient’s right knee.

NOTE: Configuration of the operating suite is dependent on the room dimensions as well as the preference and experience of the surgeon.

 

 

Patient Positioning

• Patient is supine in modified lithotomy position with legs in adjustable stirrups (Yellowfin^® or SAM^® III stirrups, www.allenmedical.com).
• Legs are abducted and slightly flexed at the knees.
• Patient's arms are alongside the body to lessen possibility of shoulder injury.
• Pad pressure points and bony prominences; secure body position with vacuum-mattress device, especially lateral on the right side.
• Carefully secure patient to the table to avoid any shifting with the Trendelenburg position.
• Patient is tilted right side down; adjust the angle during initial exposure step (see section 5a “Initial Exposure”).
• A nasogastric or orogastric tube and urinary catheter are placed.
• A body warmer to prevent patient hypothermia can be applied.
• Sequential compression devices can be applied to the legs for DVT prophylaxis.
• After positioning, padding, securing and preparing the patient in the supine position, the table is then placed in a Trendelenburg position, whereby the steepness should be adjusted per exposure needs during the initial exposure step (see "Initial Exposure" video) [Figure 2].
  
  

   

  Figure 2

Next: Port Placement