AST Guideline - Perioperative Role and Duties of the Surgical Technologist During Robotic Surgical Procedures

10 G. Throughout the procedure, the CST removes and exchanges instruments and endoscopes from the arms, and guides both items into the sheaths as needed and requested by the surgeon. (S. Walsh, personal communication, July 21, 2012) (1) To remove an instrument, the CST verbally confirms with the surgeon the wrist of the instrument is straight; the CST squeezes the release levers and pulls the instrument out. 7 The CST then performs the steps as outlined above for the insertion of the next instrument. The S systems offer a guided tool change where the next instrument is inserted and placed to a depth of 1 mm short of the previous instrument position. 7 (2) Verbal communication between the CST and surgeon is always important, but it is of particular importance during robotic surgical procedures during the insertion and exchange of the endoscope and instruments to avoid movements that could damage the items and/or injure the patient. The system is equipped with an audio intercom that allows the surgeon to clearly communicate with the CST and circulator while still looking into the viewer of the surgeon console. 9 (3) When exchanging instruments the CST should clean the tips of the instruments with instrument wipes. (4) When the CST exchanges an endoscope, the end is cleaned when indicated and a de-fogging agent should be applied prior to insertion into the patient. H. When needed during gynecological procedures, the CST may manipulate/move the uterus for visualization as required and directed by the surgeon. I. When needed during genitourinary procedures, the CST may apply traction to the Foley catheter and/or replaces the catheter as required and directed by the surgeon. J. To facilitate removal of tissue or an organ from a body cavity, the CST may grasp and insert the Endo Catch™ or Endobag™ as required and directed by the surgeon. 2. When the surgical procedure is completed, the instruments are removed first followed by the endoscope. A. The arms are disconnected from the trocars and the patient cart undocked from the patient. The motor drive of the patient cart will not be activated until all the instruments and endoscope with camera are removed, and all the arms disconnected. B. The surgeon re-enters the sterile field to extend a trocar incision to deliver the specimen retrieval bag. C. The CST must have the suture for fascial closure of the extended incision and 12 mm trocar incisions. The 5 and 8 mm trocar openings usually do not require fascial closure. D. If another robotic procedure is scheduled, the system does not need to be turned off. Guideline VIII The CST should be prepared to work with the robotic team troubleshooting system technical errors. 1. The CST should exhibit knowledge of the systems internal capabilities to assist the team in troubleshooting. A. The system has the ability to store memory of past technical errors.