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

7 c. The patient cart is initially placed away from the OR table and draped; it is moved into the sterile field once the patient has been positioned and draped. C. When connecting components to the main power outlet(s) extension cords must not be used. 2. The CST should confirm all necessary supplies and instruments have been “pulled” prior to transporting the case cart into the OR. Items to confirm include the endoscopes; endoscope sterile adapter; camera arm sterile adapter; drapes for the camera and instrument arms; endoscopic light cable Veress needle; two 12 mm sharp trocars with sheaths; and three 5 or 8 mm sharp or blunt (surgeon’s preference) trocars with sheaths. 3. The CST should perform all other routine duties that are completed prior to any type of surgical procedure including opening sterile supplies and instruments to establish the initial sterile field on the back table; perform the surgical scrub; gown and glove self; set up the sterile back table. A. The CST should carefully inspect all instrumentation for proper functioning and defects with specific attention to the EndoWrist® instruments. 4. The CST and circulator work as a team in draping the instrument and camera arms. The drapes must not be positioned too tightly as this will impede the range of motion of the robotic arms. 7 A. It is recommended the CST and circulator practice as a team draping the arms prior to working together during surgical procedures. (1) The draping of the arms is a complex process and demands close observation by the two team members to make certain there are no breaks in sterile technique. Prior practice aids in creating a team that can anticipate the actions of each other as well as facilitate positive communication skills. B. The CST and circulator should follow the steps for draping the patient cart as provided by Intuitive Surgical, Inc. and manufacturer of the specialty drapes. The following is a brief outline of the steps of the draping procedure. (1) All cables are first connected: system, focus control, optical channels, and power. The system can then be turned on and it will perform a self-test to confirm system operability. During the self-test, the circulator must not move the arms or any other part of the system or it will activate a fault. (2) The circulator positions the instrument and camera arms to as to allow enough room for draping by the CST. (3) The arms are removed from stow position and the home sequence initiated. The CST and circulator should verbally confirm they heard three audible beeps when the homing sequence has completed. (4) The instrument arms should be completely covered by the sterile drape. Each arm is separately draped; therefore, the CST must have three drapes on the back table. 9 Each arm should be fully extended while draping to allow the CST to easily slide the drape over the arm. 1 Standing in front of an arm the CST places the drape over the arm and the circulator assists by grasping the inside of the drape to help pull through. As each arm is draped, the CST should slightly move the arm to the side to prevent contamination of the drape by the non-draped arms. The trocar mount of the S systems is permanently attached and must be covered by the drape.