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

9 B. The patient cart is moved into position (referred to as “docking”) by the circulator using the motor drive aligning the patient cart tower, arms and anatomy. 8 (1) When docking the patient cart, the team should assist the circulator in avoiding hitting, pinching, or pushing against the patient’s arm, body, or leg. 7 C. The camera arm is the first arm to be connected to the patient by locking the camera trocar mount to the camera trocar. 7, 8 The CST should not use the camera clutch to move the camera arm as this will limit the ROM of the camera. The camera setup joint buttons must be used to move the camera arm into position and the camera clutch to fix the arm in place. D. Next, the instrument arms are attached to the robotic trocars. Snap mounted devices are used to place the instrument arms. Just as with the camera arm, the port clutch is used to move the instrument arms and the instrument clutch used for establishing the final trajectory. (1) When all arms are connected, the surgical team should confirm each arm for proper working distance and ensure the arms are not applying pressure on the patient; the team members should verbally confirm these two items. (2) When the first instrument arm is connected the motor drive brakes of the patient cart automatically lock to keep the cart from moving. For safety purposes, a yellow LED on the motor drive labeled “Cannula installed; Cart drive disabled” will light up when the first instrument arm is connected and the motor drive brakes are locked. 16 E. Prior to the insertion of the endoscope the CST must prevent fogging of the lens. The CST can perform one of two methods to prevent fogging of the lens. (1) Place the end of the endoscope that contains the lens in a basin of body temperature sterile water while setting up the sterile back table. (2) Use a commercial product such as FRED™ (fog reduction/elimination device); the product should be used per manufacturer’s instructions. F. The CST assists by inserting the endoscope and instruments into the arms while the surgeon has direct visualization of the ends of the sheaths at the surgeon’s console. (1) During insertion of the endoscope and instruments the CST must be careful not to puncture the sterile drapes covering the arms. (2) The CST inserts the endoscope by placing the lens into the sheath and locking it into the camera trocar mount. The CST then advances the endoscope through the sheath into the surgeon’s view of the surgical field using the camera clutch button. (3) Prior to inserting the EndoWrist® instruments, the CST should verbally confirm with the surgeon that the wrist is straight and not at an angle to avoid damage to the instrument. The CST places the instrument tip into the sheath and slides the instrument housing into the adapter. Next, the CST advances the instrument through the sheath into the surgeon’s view of the surgical field using the instrument clutch button. The endoscope and each instrument are placed into the patient by the CST while the surgeon views the surgical field at the surgeon console.