When patients are choosing a surgeon, they often look for those with the best outcomes. Safety, on the other hand, is a presumed prerequisite. “Safety first” is ingrained into a surgeon’s mind starting in the early days of training. In fact, it’s part of the Hippocratic Oath (“first do no harm”). However, robotic surgery has some particular safety requirements:
- Patient positioning. Robotic procedures are sometimes lengthy. Positioning should be as neutral as possible to avoid collateral injuries during an otherwise successful surgery. The final position (including table angle) should be viewed prior to draping.
- Ergonomics. The safety of the surgeon and the surgical team should not be ignored, as this factor can influence patient safety. Considerations include table height and video monitor locations.
- Good vision. I prioritize a clean lens, good smoke evacuation, and thoughtful camera control.
- Good exposure. Some surgeons fear the risk of additional dissection to mobilize adjacent structures out of the way. This conscious effort can help avoid an inadvertent injury later in the procedure. Of course, using equipment that ensures stable gas pressure and expansion of the abdomen is paramount.
- Communication. Since the robotic surgeon is separated from the rest of the operative team, two-way communication should be both easy and encouraged.
- Checklists. These lists facilitate making all of the necessary equipment and procedural steps reproducible from case to case.
Of course, using a thoughtful (not just a skillful) technique is essential. This element includes gentle tissue handling, careful instrument exchanges (under direct vision), and judicious use of cautery.