Ports placement in lap. and robot liver resection
The following is a review of poor placement during minimally-invasive hepatectomy both laparoscopic and robotic approaches are reviewed to provide an understanding of some of the basic principles utilized during poor placement for tumors in multiple locations traditional anatomic kepada cross-sections are performed along three standard planes depending on the type of planned resection these planes are based on the intra paddock vascular. Anatomy and may be adjusted based on individual patient factors such as tumor location and body habitus. The anticipated location of these claims ultimately guides the placement of ports during laparoscopic hepatectomy the kusa or cabochon ultrasonic surgical aspirator is our preferred surgical energy device for use during laparoscopic hepatectomy. However the following recommendations pertain to any device used for parenchymal. Trench section during right-sided hepatectomy it is ideal for the kusa to be in plain of the hepatic dissection however this should not be collinear with the camera as instrument collisions and inaccurate. Fertilization may occur we prefer to place the camera port slightly to the left of this plane in this case in the parent local position for luck. Tamiya protected me. The kusa working port is placed between the right lateral instrument port and the camera port slightly further away from the liver this allows the operator who is positioned on the patient's right side more ergonomic instrument handling our standard practice is that the first assistant is position. Batum to the patient's left while the second assistant or Scopus may either be on the right or between the patient's legs. Proper placement of the assistant. Port is critical for the successful completion of the laparoscopic hepatectomy. These diagram will review the approximate assists. Important position during and hepatectomy x' with the five millimeter port generally being used for suction and retraction while the twelve. Norman report is generally used for handheld phantom liver retractor.
A small stab incision is utilized for placement of a trans abdominal. Pringle catheter when desired as has been described previously post arrows superior located tumors pose a particular challenge during laparoscopic expect me to the lack of access and visibility. During the operation our team has developed an intercostal approach with the ports placed between the ribs during exhalation to help avoid injury to the lung. Due to the small size of the port and use of carbon dioxide insufflation. An indwelling chest tube is routinely not needed while not required the use of an articulating laparoscope can prove useful during laparoscopic a protecting me particularly in the posterior superior paddock segments this video demonstrates the use of a flexible laparoscope during a segment eight partial hepatectomy how an AIDS visualization of the deeper liver purnama and vasculature the robotic platform offers several potential advantages over standard laparoscopy particularly early in a surgeon's minimally-invasive hepatectomy experience the articulating risks of the robotic instruments with multiple degrees of freedom more closely mimics standard open techniques the magnified stereoscopic camera also allows from proof visualization without the need for additional surgeon eyewear while the robotic platform may not provide measurable improvements over stand aleppo rasca being in experienced hands it may decrease learning curve when performing minimally invasive hepatectomy current robotic platforms. Don't offer a flexible. 3d laparoscope which may limit visualization during hepatectomy for certain tumors additionally the most commonly used surgical energy device for parenchymal transection the harmonic scalpel does not currently possess indoor wrists like function thus limiting its ease of use additionally the relative length of the robotic harmonic. Scalpel is shorter than that of its laparoscopic counterpart no robotic. Cousteau is currently available.
However in some instances one may be utilized by a bedside assistant during robotic hepatectomy. Much like in laparoscopic hepatectomy. The placement reports during robotic hepatectomy is dependent on the exact location of the tumor within the liver. General principles are as follows the camera port should be positioned 10 to 20 centimeters away from the target. Anatomy with subsequent robotic working ports spaced roughly 8 centimeters apart along a line perpendicular to that between the camera and the target anatomy ports can be placed closer or further away from the target anatomy depending on other internal factors however they should be at least 2 centimeters away from the ribs and in a manner not to obstruct the view of the camera assistant ports are classically placed 5 to 10 centimeters away from the robotic ports as to minimize extracorporeal collisions. Multiple assistant ports may also be used and subscribed here by Julie. Nadi and colleagues which may slightly alter the placement of the robotic cannula our group has reported standard positioning for robotic port placement during the right hepatectomy shown in panel a and let that. Patek t'me shown in panel B. The primary difference is the location of the camera which is ideally placed along the resection line to optimize visualization throughout the hepatic resection professor. Wu and colleagues have also reported similar report positions for robotic right and left have attacked me here with the camera. Placed in position see an assistant. Port placed in position a in several instances and particularly for tumors in anterolateral locations. We utilize this foot like physician. Assistant ports can be placed in fearly to the cranial place robotic ports to enhance organ on ik's and access for the assistant during the procedure for tumors and posterior superior locations and our costal approach can also be utilized. This is similar to our approach during laparoscopic appendectomy and allows excellent access to lesions in this difficult location in a dagger attraction of the hepatic programa cannot be achieved easily without the robotic or assistant instruments or groupers reported a trans abdominal retraction method whereby retraction sutures are placed in the hepatic parenchyma and through the abdominal wall where they can be adjusted via extracorporeal clamps this obviates the need for additional ports and easily adjusted throughout the procedure minimally-invasive hepatectomy offers substantial benefits to the patient and improving technology is making the technique available to an increasing number of surgeons whether approaching the procedure laparoscopically or robotically basic principles of visualization access instrument limitation must be considered during poor placement patient specific adjustments two-port location can and should be made on a case-by-case basis in order to optimize the approach during each resection.
A small stab incision is utilized for placement of a trans abdominal. Pringle catheter when desired as has been described previously post arrows superior located tumors pose a particular challenge during laparoscopic expect me to the lack of access and visibility. During the operation our team has developed an intercostal approach with the ports placed between the ribs during exhalation to help avoid injury to the lung. Due to the small size of the port and use of carbon dioxide insufflation. An indwelling chest tube is routinely not needed while not required the use of an articulating laparoscope can prove useful during laparoscopic a protecting me particularly in the posterior superior paddock segments this video demonstrates the use of a flexible laparoscope during a segment eight partial hepatectomy how an AIDS visualization of the deeper liver purnama and vasculature the robotic platform offers several potential advantages over standard laparoscopy particularly early in a surgeon's minimally-invasive hepatectomy experience the articulating risks of the robotic instruments with multiple degrees of freedom more closely mimics standard open techniques the magnified stereoscopic camera also allows from proof visualization without the need for additional surgeon eyewear while the robotic platform may not provide measurable improvements over stand aleppo rasca being in experienced hands it may decrease learning curve when performing minimally invasive hepatectomy current robotic platforms. Don't offer a flexible. 3d laparoscope which may limit visualization during hepatectomy for certain tumors additionally the most commonly used surgical energy device for parenchymal transection the harmonic scalpel does not currently possess indoor wrists like function thus limiting its ease of use additionally the relative length of the robotic harmonic. Scalpel is shorter than that of its laparoscopic counterpart no robotic. Cousteau is currently available.
However in some instances one may be utilized by a bedside assistant during robotic hepatectomy. Much like in laparoscopic hepatectomy. The placement reports during robotic hepatectomy is dependent on the exact location of the tumor within the liver. General principles are as follows the camera port should be positioned 10 to 20 centimeters away from the target. Anatomy with subsequent robotic working ports spaced roughly 8 centimeters apart along a line perpendicular to that between the camera and the target anatomy ports can be placed closer or further away from the target anatomy depending on other internal factors however they should be at least 2 centimeters away from the ribs and in a manner not to obstruct the view of the camera assistant ports are classically placed 5 to 10 centimeters away from the robotic ports as to minimize extracorporeal collisions. Multiple assistant ports may also be used and subscribed here by Julie. Nadi and colleagues which may slightly alter the placement of the robotic cannula our group has reported standard positioning for robotic port placement during the right hepatectomy shown in panel a and let that. Patek t'me shown in panel B. The primary difference is the location of the camera which is ideally placed along the resection line to optimize visualization throughout the hepatic resection professor. Wu and colleagues have also reported similar report positions for robotic right and left have attacked me here with the camera. Placed in position see an assistant. Port placed in position a in several instances and particularly for tumors in anterolateral locations. We utilize this foot like physician. Assistant ports can be placed in fearly to the cranial place robotic ports to enhance organ on ik's and access for the assistant during the procedure for tumors and posterior superior locations and our costal approach can also be utilized. This is similar to our approach during laparoscopic appendectomy and allows excellent access to lesions in this difficult location in a dagger attraction of the hepatic programa cannot be achieved easily without the robotic or assistant instruments or groupers reported a trans abdominal retraction method whereby retraction sutures are placed in the hepatic parenchyma and through the abdominal wall where they can be adjusted via extracorporeal clamps this obviates the need for additional ports and easily adjusted throughout the procedure minimally-invasive hepatectomy offers substantial benefits to the patient and improving technology is making the technique available to an increasing number of surgeons whether approaching the procedure laparoscopically or robotically basic principles of visualization access instrument limitation must be considered during poor placement patient specific adjustments two-port location can and should be made on a case-by-case basis in order to optimize the approach during each resection.