What is the purpose of each incision site in daVinci (robotic assisted) laparoscopic surgery for a total hysterectomy with bilateral salpingo-oophorectomy?

daVinci Robotic Port Placement for Total Hysterectomy with Bilateral Salpingo-Oophorectomy

In daVinci robotic-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy, a standard four-port configuration is used: one 12mm umbilical port for the camera, two 8mm lateral robotic instrument ports for the surgeon-controlled robotic arms, and one 12mm assistant port for suction/irrigation, specimen manipulation, and suture passage. 1, 2, 3

Standard Port Configuration

Camera Port (12mm)

• Umbilical or supraumbilical placement for the three-dimensional endoscopic camera system 1, 2
• Provides high-resolution 3D visualization of the entire surgical field 2, 4
• May be extended for specimen removal when transvaginal extraction is difficult (e.g., large uterus, severe obesity) 4

Robotic Instrument Ports (Two 8mm ports)

• Placed laterally in the lower abdomen, typically 8-10 cm lateral to the camera port and slightly inferior 1, 2
• Controlled directly by the operating surgeon from the remote console 3
• Used for:
  • Articulated instruments with seven degrees of freedom for precise dissection 2
  • Lysis of adhesions around the uterus and adnexa 1
  • Uterine vessel ligation and pedicle control 2
  • Bladder dissection and peritoneal incisions 2
  • Suturing of the vaginal cuff 1, 2
  • Removal of bilateral fallopian tubes and ovaries 3, 5

Assistant Port (12mm)

• Placed in the lower abdomen, typically in the right or left lower quadrant 1, 2
• Used by the bedside surgical assistant for:
  • Suction and irrigation 2
  • Uterine manipulation and retraction 1
  • Specimen retrieval 2
  • Suture passage and needle introduction 1
  • Placement of vaginal sponges or instruments 2

Surgical Tasks by Port

Hysterectomy Component

• Robotic arms perform bladder mobilization, uterine artery ligation, cardinal and uterosacral ligament division, and colpotomy 1, 2
• Assistant port provides uterine manipulation, countertraction, and specimen extraction 1, 2

Bilateral Salpingo-Oophorectomy Component

• Robotic arms dissect the infundibulopelvic ligaments, ligate ovarian vessels, and separate adnexal structures from surrounding tissue 3, 5
• Assistant port assists with retraction and specimen removal 3

Vaginal Cuff Closure

• Robotic arms perform precise intracorporeal suturing with enhanced dexterity compared to conventional laparoscopy 1, 2
• Assistant port passes suture material and provides needle drivers when needed 1

Advantages of This Port Configuration

• Enhanced surgical precision through articulated instruments with tremor filtration and motion scaling 2, 4
• Superior visualization with 3D imaging compared to standard laparoscopy 2, 4
• Improved ergonomics for the surgeon at the console, reducing fatigue during complex procedures 2
• Facilitates advanced laparoscopic tasks including suturing, knot tying, and adhesiolysis that are technically challenging with conventional laparoscopy 1
• Particularly beneficial in obese patients where conventional laparoscopy may be limited 6, 4

Common Pitfall to Avoid

Inadequate port spacing (less than 8 cm between ports) causes robotic arm collision and limits instrument range of motion, significantly prolonging operative time 1, 2. Proper triangulation with the camera port at the apex ensures optimal instrument maneuverability throughout the procedure 2.