Name:
Single Port Robotic Surgery: General Principles and Troubleshooting
Description:
Single Port Robotic Surgery: General Principles and Troubleshooting
Thumbnail URL:
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Duration:
T00H09M35S
Embed URL:
https://stream.cadmore.media/player/28bab023-8250-49f2-ab8e-926e54af5013
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/28bab023-8250-49f2-ab8e-926e54af5013/SP Troubleshooting_version3.mp4?sv=2019-02-02&sr=c&sig=MtF8Jpkd2dyeL1Yt50mHS8M69Rym47CSa8sznakjis4%3D&st=2025-07-20T05%3A00%3A17Z&se=2025-07-20T07%3A05%3A17Z&sp=r
Upload Date:
2023-12-06T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 Introduction Slide.
SPEAKER: This video will discuss general principles and troubleshooting during single port robotic surgery. The most common misconception about the single core platform, or SP for short, is that it is a multi-port platform experience through a single incision. However, it is most appropriate to consider the SP as a distinct tool in the urologists armamentarium, as this video will demonstrate.
SPEAKER: We will highlight eight of the most common issues that arise during SP surgery and discuss principles of the platform along the way.
Segment:2 Issue #1: Smaller Vision Field.
SPEAKER: Let's start with the smaller vision field. More frequent camera movement is required using the SP. The camera has two sets of articulations-- a fixed articulation known as Camera Adjust and a distinct end moving articulation called Camera Control.
SPEAKER: This first clip demonstrates the Camera Adjust. Notice that the entire arm is moving, but the position of the camera has not moved relative to the arm. The Camera Control articulation allows the head of the camera to move relative to the arm. There is a camera setting that wings out the camera, and the instrument arms out like a snake, giving it its name "Cobra mode." While this position can be achieved by manually moving each arm, the SP has a button for this specifically.
SPEAKER: There is also the option to straighten all arms. You can see a combination of these two articulations in this example during a radical prostatectomy.
Segment:3 Issue #2: Smaller Working Space.
SPEAKER: Let's move to working in smaller spaces. When the limits of the instrument arms have been reached, the Relocate function will allow the entire boom of the robot to be moved.
SPEAKER:
Segment:4 Issue #3: Difficult Traction.
SPEAKER: Downward traction from the 6 o'clock arm may not always be appropriate. In order to prevent arm crossovers, the Relocate function can also be used to rotate the boom 180 degrees.
SPEAKER: The lateral working arms will need to be exchanged. This function can be performed at the console or manually by the surgical assistant at bedside.
Segment:5 Issue #4: Spatial Orientation.
SPEAKER: Maintaining spatial orientation may be difficult. It is important to utilize the Navigator function found on the bottom of the screen.
SPEAKER: Thinking about each instrument arm in a quadrant of the space will help prevent instrument crossover and clashes. Notice that the arms are lit blue during movement. The color will turn red if the limits of the instrument are reached, indicating the need to relocate or adjust accordingly. If the reach limit of the instrument arms have been met, the entire boom may need to be brought in by the surgical assistant.
SPEAKER: Appreciate the location of each arm to prevent iatrogenic injury during this maneuver.
Segment:6 Issue #5: Articulation Distance.
SPEAKER: Understanding the distance needed for instrument articulation is crucial when working in smaller spaces. A 10-centimeter distance is required to deploy each instrument arm.
SPEAKER: Each arm will bend at an elbow length of 5 centimeters. Keeping the trocar extracorporeally as a floating dock will allow working in the smaller spaces. In this example of an extraperitoneal radical prostatectomy, a modified Alexis O retractor called the SP Access Port Ring is inserted after removal of the spacemaker.
SPEAKER: The port balloon is then attached, insufflation is initiated, and the robot is docked.
SPEAKER: Notice how the floating dock allows for adequate articulation distance.
Segment:7 Issue #6: No Assistance.
SPEAKER: In many cases, having no assistant port through a separate incision may be possible. Returning to the previous example of an extraperitoneal radical prostatectomy, a 5-millimeter air seal was placed through an adjacent fascial incision.
SPEAKER: This seal was then used for insufflation. A flexible suction, called a ROSI, was passed through the air seal and maneuvered by the surgeons third arm.
Segment:8 Issue #7: Bleeding.
SPEAKER: In situations of bleeding, the third arm can be utilized for tamponade while preparing to address the situation, as seen in this example during a nephrectomy. Additional port sites can be placed as appropriate.
SPEAKER: Here, the addition of another port site allows the bedside assistant to introduce an Endo GIA stapler with a vascular load.
Segment:9 Issue #8: Resistance to Instrument or Camera Insertion.
SPEAKER: Lastly, the surgical assistant can meet resistance when inserting instrument arms.
SPEAKER: This is due to the instrument colliding with the skin or fascial layers of the small incision. The surgeon should retract the camera to visualize the instrument and can guide the arms intracorporeally under direct vision.
SPEAKER: When the camera is unable to be guided intracorporeally after cleaning, the surgical assistant should pull upward traction on the SP access port while the surgeon moves the camera using the Camera Control function.
Segment:10 Summary Table.
SPEAKER: This table summarizes each point discussed in this video.
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