**8. General tips and tricks**

As discussed previously, there are some inherent disadvantages in the robotic single site system. The purpose of this section is to offer some practical advice to help overcome these limitations

1.Performing surgery with the robotic laparoscope in the 30 degree up position (as opposed not 30 degree down) dramatically increases the ability of the surgical assistant to aid in the operation. Thirty degree up places the robotic laparoscope in a more vertical position. This provides easy access to the abdominal cavity via the assistant trocar. In this position, when the assistant places an instrument, it presents to the surgeon right between the single site trocars in the middle of the operative field. The major advantage of this positioning is that it allows introduction of advanced energy into the operative field in a functional manner (**Figure 12**).

*Fundamentals of the Robotic Assisted Laparoscopic Single Port System and Utility in Minor… DOI: http://dx.doi.org/10.5772/intechopen.96588*

**Figure 12.** *Single site trocars cross within the robotic port.*

• 5 mm Cadiere Grasper

• 5 mm Curved Scissors

• 5 mm Fundus Grasper

• 5 mm Crocodile Grasper

• 5 mm Maryland Bipolar Forceps

*Single Port Gynecologic Laparoscopic and Robotic-Assisted Surgery*

• 5 mm Permanent Cautery Hook

• 5 mm Wristed Needle Driver

energy may pose an unnecessary risk.

tissue when the hook is pulled free.

field in a functional manner (**Figure 12**).

**7.1 Tips and tricks**

**8. General tips and tricks**

help overcome these limitations

**24**

• 5 mm Fenestrated Bipolar Forceps

While this appears to be a wide array of instruments, in reality, most single site surgery is performed primarily with the bipolar forceps, unipolar hook, and wristed needle driver. The bipolar forceps functions as a grasper. As a result, unless extra tension is needed for traction, most of the other graspers will be used infrequently. Without unipolar power, the scissors become less valuable. The scissors are probably most useful only when operating near bowel or other situations where unipolar

The unipolar hook is an instrument relatively unfamiliar to gynecologic surgeons. As a result, there is a learning curve associated with its use. However, most

1.When transecting tissue with the hook, constant tension is required.

Otherwise, the hook will tend to over-cauterize the tissue and stick to it. This not only makes the surgery look awkward but tends to cause bleeding from the

As discussed previously, there are some inherent disadvantages in the robotic single site system. The purpose of this section is to offer some practical advice to

1.Performing surgery with the robotic laparoscope in the 30 degree up position (as opposed not 30 degree down) dramatically increases the ability of the surgical assistant to aid in the operation. Thirty degree up places the robotic laparoscope in a more vertical position. This provides easy access to the abdominal cavity via the assistant trocar. In this position, when the assistant places an instrument, it presents to the surgeon right between the single site trocars in the middle of the operative field. The major advantage of this positioning is that it allows introduction of advanced energy into the operative

experienced surgeons readily adapt to it without much difficulty.

• 5 mm Curved Needle Driver


However, retrieval can be difficult and frustrating. Often the needle can get caught in the trocar tip, become dislodged from the grasper holding it, and fall back into the abdominal cavity. One solution is to anchor the used needles into the peritoneum in the midline of the anterior abdominal wall. Multiple needles can be stored in this manner, When the procedure is completed, the needles can be placed in a laparoscopic bag. Once the robotic port is removed, the bag can be retrieved through the umbilicus with the needles in it.

The base of the umbilicus is then recreated. One or two 2–0 Vicryl sutures on a non-cutting needle are then used to tack the middle of each half of the incision to the fascia. A non-cutting needle is used to avoid inadvertently cutting the fascial

*Fundamentals of the Robotic Assisted Laparoscopic Single Port System and Utility in Minor…*

*DOI: http://dx.doi.org/10.5772/intechopen.96588*

*With the laparoscope in the 30 degree up position, the surgeon's assistant has easy access to the operative field.*

*Skin flaps are created bilaterally by sharply detaching the skin from the fascia until no tension remains.*

*When the assistant places an instrument, it presents directly between both single site trocars.*

**Figure 13.**

**Figure 14.**

**27**

