Port Placement for Robotic Renal Surgery

Abstract

Beyond the skills of the surgeon, the key to the success of a robot-assisted laparoscopic procedure is good patient positioning and proper port placement. An optimal port placement is necessary to access the targeted organ at best, to avoid patient injury due to the bulky nature of the robot, to minimize collision arm to arm, and to minimize intraoperative range-of-motion limits. Regarding renal surgery, the kidney robot-assisted transperitoneal approach has gradually taken the place of standard laparoscopy. However, the retroperitoneal approach is increasingly used, particularly for posterior or lateral renal tumors. Regardless of the approach, the positioning of the trocars for kidney surgery depends on the robotic device (Si, X, or Xi da Vinci® surgical system), the patient’s morphology, the location of the tumor, and the preferences of the surgeon. In principle, four 8-mm da Vinci trocars are used, with a 12-mm assisting port and sometimes a second 5-mm assisting port. It is recommended to insert all the ports carefully under direct visual control.