Robotic Assisted Hysterectomy
A hysterectomy is a procedure where the uterus is removed. Often the fallopian tubes and/or ovaries are included in this procedure. If so, it would be scheduled as a robotic assisted hysterectomy, bilateral salpingectomy, bilateral oopherectomy.
hysterectomy = removal of uterus
salpingectomy = removal of fallopian tubes
oopherectomy = removal of ovaries
This is my set up for an da Vinci Xi hysterectomy. If you’re using a different da Vinci system, for the most part it will be the same, but you will need more supplies for the camera.
Robotic Assisted Hysterectomy | Mayo Stand
#11 knife
Verres Insufflation Needle
3 ml syringe (put 1.5 ml NaCl for drop test)
Metz (this surgeon did a mini-cut down)
Robotic trocars (1st with obturator)
Local
Raytecs
Grasper ( silver handled)
Maryland dissector
Hook scissors
Suction tip
Not pictured: Air seal- I wanted to confirm which size before opening (see my note!).
Robotic Assisted Hysterectomy | Back Table
Instrument tray: extra robotic instruments, laparoscopic needle holder, needle board (so it doesn’t get pushed off accidentally with the robotic instruments), basic instruments in bottom left corner of tray
Front of tray: 2 da Vinci needle drivers, da Vinci Maryland, da Vinci scissors
Beside tray: Fred (counted as 3 pieces!) gowns
Robotic Assisted Hysterectomy | Dirty Table
Prior to placing the robotic trocars, the surgeon will need to insert a uterine manipulator. There are a few different types you can use (Rumi, Zumi, Acorn, etc). This surgeon preferred the Zumi, which is not opened until after the surgeon assesses the patients uterine cavity. After the procedure this surgeon (like most) will perform a cystoscopy to ensure they don’t need to phone a friend AKA a urologist. If you work in the OR, you get it!
Instruments: Auvard weighted spec, right angle retractor, tenaculum, uterine sound, uterine dilators. There is a preloaded Vicryl to secure the Zumi to the cervix. To the right are the drapes (only drapes for legs), items needed for cystoscopy, and the additional D&C instrumentation.
INTRAOPERATIVE TIP
INTRAOPERATIVE TIP
Do NOT break down the robotic set up until the surgeon confirms both ureters are working! In the event that there is not urine flowing from one or both ureters, you may need to redock the robot and take a look around and potentially reach out to the urologist on call. RN: do not start to undrape the robot until the confirmation is done!
INTRAOPERATIVE TIP
INTRAOPERATIVE TIP
da Vinci scope (warmer attached) with initial gowns. Also, the scope should not be left on this wrap, it should be switched out to a back table cover. There’s no way to ensure sterility if the wrapper isn’t checked for holes.
Not Pictured- Ring stand: bipolar/monopolar cords, suction/irrigation, air seal tubing, drapes
Robotic Assisted Hysterectomy | Robot Settings
Typically the robot will dock from the patient’s left or right. This is sometimes based off of the room set up, but also where the air seal AKA, assist port, will be placed. If you place the air seal on the patient’s right and also have the robot docking from the right, the assist will be in a poor position to be helpful through the case, they will be getting hit with the arms of the robot and potentially straddling the robot base just to be close to the patient. Most of the time the robot should dock opposite of where the assist port will be placed. On the robot you will select “pelvic” anatomy and whatever laterality you will be docking from. The robot can be pretty intimidating when you are first learning, but once you know what all the buttons do and have gotten your hands on it and know how it moves, it’s pretty simple!
