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

5 Preoperative Guidelines Guideline IV The CST must have a thorough understanding of the two robotic components, the patient and vision carts, to be able to participate in setting up the components when scrubbed in or as an assistant circulator. 1. The following are brief descriptions of the patient and vision carts that the CST is involved with moving, setting up, and draping; the CST is referred to the Intuitive, Inc. publications for detailed information. The following information applies to the S HD, Si, and Xi da Vinci models. A. The patient cart contains the camera and instrument arms, and touchscreen monitor. (1) The S HD, Si, and Xi systems have a camera arm and three numbered instrument arms. (2) Each arm is equipped with a clutch button that assists with all movements of the arms as well as insertion and withdrawal of instruments. To activate the clutch, the CST depresses the button and the arm can be moved; if the button is not depressed, the CST will meet with resistance and the arm will return to its original position. 7 a. There is a clutch button exclusive to the camera and instrument arms located at the top of each arm used to adjust the final positioning of the arm during the docking procedure as well as to insert and withdraw the endoscope and instruments. (3) The are several accessory items that must be sterile that are positioned when draping each arm; the items are: a. Camera sterile adapter b. Camera arm sterile adapter c. Instrument arm sterile adapter d. Camera trocar mount e. Instrument arm sterile adapter – this has a limited use life and only reused 50 times f. Instrument arm sterile adapter – can only be used once (4) The touchscreen monitor is coordinated with the surgeon console; it displays the system status icons and text messages for the CST and circulator to view. 1 The monitor can also be mounted on the vision cart. 7 (5) The patient cart is moved with the use of a motor drive that provides for easily docking the cart to the OR table and trocars. (6) The connections for cables are located on the back of the cart. B. The vision cart contains the light source, camera focus controller and storage bin, and video processing equipment; additionally, a telemonitor may be placed on the cart. 15 (1) For the S HD system, the light source is a sterile bifurcated cable that is attached to the endoscope to illuminate the right and left channels; the Si system uses a single light source cable. 7 (2) The endoscope is connected to the camera head and the camera head is also connected to an automatic focus control that is connected to the surgeon console. The optical channels of the camera are connected to chip camera control units (CCU) to produce the three-dimensional image at the surgeon console. 1