**5.2 Patient cart**

*Liver Disease and Surgery*

**5.1 Surgeon console**

**5. The robotic assisted surgery components**

As discussed above a surgical robot consists of three separate components all of which are integral to the safe execution of robotic liver surgery. A summary of each

The surgeon console is the component of the robotic system where the operating surgeon sits and performs liver surgery. It is sometimes also termed the workstation. The surgeon console is located outside the immediate surgical field (**Figure 3**) and with the newer robotic systems there are dual surgeon consoles that also allow training robotic surgeons to be assisted and mentored during their learning curve. Before commencing surgery the operator is able to adjust the physical parameters of the console to ensure appropriate ergonomics. The operator is afforded a three dimensional view of the surgical field using the viewer (**Figure 4A**). The screen also provides details of the instruments that are in use in the patient cart, the type of energy systems that are applied to these instruments and also provide real-time alerts to the operator to pre-empt potential problems and suggest troubleshooting options. There is also an option to adjust the screen view to accommodate several images at the same time such as the surgical field alongside two other displays accommodated by auxiliary inputs. This setup ensures that the manoeuvres made by the surgeon are safer, more precise and steadier. Instruments and the endoscope are manipulated and manoeuvred using the finger controls that replicate tremor free movements within the abdomen (**Figure 4B**). The surgeon is able to control two robotic arms/instruments simultaneous. At base of the console the surgeon has various controls that allow the operator to manoeuvre the 3D endoscope with the camera pedal and the EndoWrist® instruments during surgery (**Figure 4C**). The toggle pedal allows the operator to switch between different robotic arms whilst the foot-clutch allows the finger controls to be reset without any movement of the instruments in the abdomen. There are also pedals at the base of the console that allow the application of electrocautery through desired robotic instruments. Using

*The surgeon console. (a) The 3D viewer at the top of the surgeon console allow the operator to obtain an optimal view of the surgical field whilst being provided with contemporaneous information on instruments and energy devices. (b) Finger switches allow the operator to control the 3D endoscope, robotic instruments and allow advanced surgical manoeuvres such a suturing. (c) The base of the console allow the operator to control the endoscope in conjunction with the finger switches, switch between robotic instruments using the toggle pedal* 

*and allow electrocautery through the robotic instruments (both monopolar and bipolar).*

component is given below using the da Vinci Xi® system as an example.

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**Figure 4.**

The patient cart is the component of the robotic system that is in direct contact with the patient and hence is required to be sterile draped prior to surgery. The patient cart consists of 4 robotic arms and makes up the surgical component of the robotic system. The patient cart has a display panel that allow for selection for the type of surgery to be undertaken (e.g. upper abdominal and pelvic) and needs to be selected prior to surgery. Once robotic ports have been inserted in an satisfactory manner (see below) the patient cart is manoeuvred into position using the handles (**Figure 5A**) and by utilising a spot laser in the helm of the cart the appropriate arm intended for the endoscope is positioned under the laser. This improves the position of the four robotic arms. A second assisting surgeon is stationed at the patient-side cart, in order to aid in the replacement of the robotic instruments and utilising assistant ports.

The 4 robot arms are latched deriving from a remote centre and fixed in space. This connection allows the surgical instruments and the endoscope to move freely reducing the force exerted on the patient's body to a minimum. Once the endoscope is engaged further instruments can be inserted in through other robotic ports after completion of docking (see below) and engaged in the remaining three robotic arms. Each robot arm has a port clutch at the base that allows docking of the robot port and for the instrument to swivel in a circular fashion and an instrument clutch at the base the allows the instrument to in and out of the abdomen to the desired length (**Figure 5B**). Pressing buttons on the instrument and replacing them with the desired instrument accomplish instrument changes—the robotic system allows the new instrument to be moved to within 3 mm of the position of the original instrument.
