**6. Operating setup**

The first very important step is related to the positioning of the patient on the operating table. Given that the intervention can last a longer time in which the patient will sit in extreme positions. A Trendelenburg position sometimes accentuated at over 15 degrees for a long time requires effective cooperation with the anesthetic team, in terms of monitoring vital functions, cerebral edema, and last but not least the

**Figure 1.** *Patient positioning.*

#### *Current Topics in Colorectal Surgery*

existence of devices to prevent the patient from slipping by mounting shoulders, legs and arms, with protection of all pressure areas. The future positions of the robot's arms and the permanent possibility of the anesthetic team to have easy access to the airways must also be provided. The position of the table must be established from the beginning, because once the robot is fixed, the table cannot be changed (**Figure 1**). Recently the new table motion technology allowed robot and table movement in synchrony without having to undock the robot or reposition instruments.

The fourth generation of surgical robots, respectively da Vinci Xi, unlike the previous variants da Vinci S or Si, once fixed the position does not require its modification depending on the operating quadrant. After docking, the whole intervention can be done without the need for redocking, even if, for example, we perform splenic flexure mobilization first and after we go deep in the pelvis. The patient is placed in a modified lithotomy position, at least 15–20-degree Trendelenburg with the left side raised (**Figure 2**). The robot cart will be placed to the patient's

**Figure 2.** *Patient positioning 2015 Intuitive Surgical, Inc. with permission.*

**Figure 3.** *Operative setup for robotic rectal surgery.*

*The Robotic Approach in Rectal Cancer DOI: http://dx.doi.org/10.5772/intechopen.100026*

**Figure 4.** *Operative setup.*

left. The assistant surgeon will be positioned to the patient's right. The scrub nurse will be set together with surgical instrument table at the patient's feet on the right (**Figures 3** and **4**).
