(About Robotic Instruments)
Instrument usage: Robotic instruments are inserted through small, minimally invasive incisions. A programmable manipulator manipulates specialized instruments to complete a surgical procedure.1 These instruments work under partially programmed control by the surgeon, can be modified by the surgeon, and can be controlled by a telemanipulator that mimics the surgeon’s exact or scaled hand movements.1 The needles, trocars, laparoscopes, and instrumentation that are used during robotic surgery are similar to those used for laparoscopic surgery. Robotics are commonly used general surgery, gynecologic surgery, urologic surgery, and cardiac surgery.
Key differences:
Verres needles and trocars, both sharp and blunt, are used to provide access and insufflation to create a working space.1 They come in different sizes and connect to CO2 tubing that allows the gas to flow at 1L to 2L per minute to create an intraperitoneal pressure of approximately 15 mmHg for the average adult.2 Fluid can be used in other body cavities to create working space, such as in the bladder or joints.
Robotic laparoscopes with cords have a 3-D binocular eyepiece that comes in multiple sizes and angles that attaches to a 3-D high-definition-capable camera to take photos and videos and allow the surgical team view the procedure.1 The console, either single or double, allows for communication between surgeons that are working together and control over video, audio, and ergonomic settings.2
Robotic instruments have an articulating wrist that rotates 360 degrees located near the tip of the instrument guided by electronics in the instrument base.1
There are a variety of instruments tips that are similar to laparoscopic instruments used during robotic surgery. They have electronics that can communicate and log each use of the instrument, the status of the instrument, and when it needs to be changed or repaired.2 Most of these instruments have 10 uses and can be manually marked to document the number of uses.
Clip appliers, stapling devices, and needle holders are manipulated through the robotic console.
Aspiration-irrigation systems are tubular instruments that irrigate and aspirate fluid. They can have a blunt tip or needlepoint tip.
Safety on the sterile field:
Needles and trocars on the sterile field should be handled as sharp instrumentation.
Scopes should be examined before use to be certain that the visibility is appropriate and that the light cord fits correctly.
It is important to wipe the tips of robotic instruments with a wet sponge between uses to remove any debris.
Instruments are moved by a pulley system within the robotic arms and it is important that the scrub personnel press the pulley to confirm that they are able to move freely.1
If a robotic procedure converts to an open procedure, the scrub personnel must release the robotic arms from the trocars and undock the robot to move it out of the surgical field.1
A sterile wrench to disengage the articulating arms should be included in the instrument set in order to convert to an open procedure in the case of an emergency.2
The robot has a rechargeable battery that can run for 20 minutes if there is a power failure and it is important to know where the override switch is to continue surgery.2
Instrument names:
Instruments are called by their use, such as “monopolar scissors” or “spatula,” or by the manufacturer’s name.
References:
1. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.
2. Phillips, Nancymarie. Berry & Kohn's operating room technique. Elsevier Health Sciences, 2016.