**3. Set up**

Correctly completing the set-up process is extremely important to a successful surgery, as it allows instruments to be in their proper place to allow for maximum movement. When using the Intuitive Gelport™, there will be an arrow which needs to point towards the target anatomy when placed in the abdomen. This aligns the port entries of the Gelport.

**Figure 1.** *Intuitive Gelport(™).*

After placement in the abdomen, the ports are placed in the following sequence:

The camera port is placed first in the top port site as indicated by the blue arrow (**Figure 1**).

(The camera port is placed first in the top port site as indicated by the blue arrow).

#### **Figure 2.** *The left trocar and Gelport are shown prior to insertion.*

**59**

(**Figure 2**).

**Figure 4.**

**4. Robot positioning**

ment triangulation.

**5. Operating**

*Robotic Laparoscopic Single-Site Surgery DOI: http://dx.doi.org/10.5772/intechopen.96226*

This is followed by the shaded left curved trocar (Xi system) in the left outside port site indicated by the blue arrow, or the #2 curved trocar (Si System)

The shaded right curved trocar is then placed in the right lateral port site indi-

Last, the assistant port is placed in the port site on the left side of the camera

Another important step is the positioning of the Da Vinci surgical system itself. The Xi system, which has better range of motion, can be angled on either right or left side facing towards the patient's hip and the overhead boom is rotated into place. If using the Si system, the robot must be positioned directly between the patient's legs leaving enough space for the bottom assistant. The right and left arms of the Si system are bent at the first joint and locked into place to allow for instru-

Begin by placing your preferred uterine manipulator. At our institution we commonly use the Delineator™ from CooperSurgical™. Following this, your attention turns to the abdomen to identify the best position for the 2.5 cm incision that will be placed. This incision can be directly within the umbilicus or directly above or below the umbilicus. Typically, the lines of the umbilicus are used, and a vertical incision is most commonly made directly through the umbilicus. This allows for concealment of the incision line creating a superior cosmetic effect. Another common incision is a "U" incision cut either inferior or superiorly made. Great care

cated by the blue arrow or the #1 curved trocar (**Figure 3**).

port as indicated by the blue arrow (**Figure 4**).

*Gelport is shown with the assistant port indicated by the blue arrow.*

**Figure 3.** *The right trocar and Gelport are shown prior to insertion.*

*Single Port Gynecologic Laparoscopic and Robotic-Assisted Surgery*

(**Figure 1**).

blue arrow).

After placement in the abdomen, the ports are placed in the following sequence: The camera port is placed first in the top port site as indicated by the blue arrow

(The camera port is placed first in the top port site as indicated by the

**58**

**Figure 3.**

**Figure 2.**

*The right trocar and Gelport are shown prior to insertion.*

*The left trocar and Gelport are shown prior to insertion.*

#### **Figure 4.** *Gelport is shown with the assistant port indicated by the blue arrow.*

This is followed by the shaded left curved trocar (Xi system) in the left outside port site indicated by the blue arrow, or the #2 curved trocar (Si System) (**Figure 2**).

The shaded right curved trocar is then placed in the right lateral port site indicated by the blue arrow or the #1 curved trocar (**Figure 3**).

Last, the assistant port is placed in the port site on the left side of the camera port as indicated by the blue arrow (**Figure 4**).
