Surgical technique
The patient was placed in the lithotomy position. The abdominal surgery
area was sterilized with Aner’s
iodine, and the vulva and vagina were sterilized with iodophor. The
surgical area was covered with operation towels routinely. We chose the
position where about 3-4cm above the umbilicus as the approach location
of the robotic camera port, and the camera port used a 12mm Trocar
puncture cannula. An 8mm puncture
cannula was placed through the intersection of the vertical line along
the body axis along the left anterior superior iliac ridge and the
horizontal line through the umbilicus, which served as the robotic arm 2
approach. The symmetrical point on the right side served as the robotic
arm 3 approach. The middle point of the camera port and the arm 3
puncture position was the arm 1 entry port, and an 8mm puncture cannula
was used. Similarly, we set a
puncture approach used by a
surgical assistant (Asst.) between the camera port and the arm 2
puncture port, which also used a 12mm cannula (Fig. 1C). Monopolar
Curved Scissors were often used in arm 1, Fenestrated Bipolar Forceps in
arm 2, and ProGrasp Forceps in arm 3. The assistant used atraumatic
grasping forceps, curved forceps, or aspirator according to
intraoperative needs. And the puncture positions of other departments
were carried out based on their surgical habits (Fig. 1C, D, E, F). The
number of puncture ports and surgical body position may change because
of intraoperative needs (Fig. 1B).
On the basis of the patient’s primary diagnosis, the surgical procedures
were performed according to surgical principles in NCCN guidelines and
other medical standards. For example, for cervical cancer patients,
radical hysterectomy with bilateral pelvic lymph node dissection were
performed. And endometriosis patients were performed with endometriosis
lesions excision. If metastases or complications occurred, the related
non-gynaecological organs should be partially removed or completely
repaired.