da vinci robot poll

[mikethern]

Does your O.R. have a Da Vinci robot yet?

[poopsiebear]

We have the robot for 3+ years and we use it everyday in either urology or thoracic service. We average about 10 cases a week.

In Urology, we do mostly prostatectomies and some pyeloplasties. Our 1st robotic prostatectomy took over 8 hours, now we can do 3 cases in a day and be done be 5 p.m.

In Thoracic, we use the robot for a lot of our VATS, from mediastinal node dissection to lobectomy to IVOR Lewis Esophagectomy.

[Uro-DaVinci]

Glad to see some posting action! How about sharing things you have learned. Take positioning for a robot prostate...what is you usual set-up? We use lithotomy with th patient ultimately placed in a very steep head down position. We have had some patient slipping problems if all things are not done exactly correctly. Some neuropathies have resulted. We pad the inside of the Yellofins with foam, strap them down and the put foam on the outside of the Yellofins to further protect the patient. We used to put foam on the bottom and the top of the legs inside the fins but ended up with some pressure problems especially as the patients have on SCDs. We use foam (eggcrate) under the right arm, a gel pad around the left arm and eggcrate on top of it. Both arms are tucked at the sides with the draw sheet. Eggcrate is placed under the sacrum as well This works most of the time however with morbidly obses patients we do have problems getting the positioning to work securely and without cutting off circulation to the arms. Any suggestions? How do you folks do it? What equipment do you use? Lessons learned? Thanks!!

[haras regnurps]

nope, and I don't believe that we will be either. They should be available at major centers don't think I want every urologist that goes to a weekend program using one on me or my family. You need a surgeon that is already exceptional in laprascopic surgery applications too....................

[mikethern]

nope, and I don't believe that we will be either. They should be available at major centers don't think I want every urologist that goes to a weekend program using one on me or my family. You need a surgeon that is already exceptional in laprascopic surgery applications too....................

Um, no, actually robotic surgery is much easier than conventional laparoscopy. It's intuitive like a video game. That's why the company that makes them is called Intuitive Surgical. The whole point of robotic surgery is to make laparoscopy much easier.

If I ever need a prostatectomy, I will definitely get a robotic prostatectomy, for the same reason I would get a lap chole instead of an open chole.

[poopsiebear]

Positioning for a prostatectomy is definitely a team effort. We usually use 5 pieces of eggcrate foam for each case. We completely wrap each arm with foam from axilla to 2-3 inches pass the fingers and secure it with 3 pieces of tape. We put a small piece behind each knee on top of the yellow fin, and a special cut one for the chest. The patient is also on a bean bag and after the foam is placed and secured, we use 2 rolls of tape to secure the patient to the bed.

[heather2084, BSN]

Does anyone know of any devices specifically made for positioning for robots or any case where you want to keep the pt from slipping off the head of the bed? We currently put eggcrates aroudn the shoulders and one across the chest, then criss cross tape over the eggcrates to keep the pt in place. I'm thinking that there must be a better way. I know for lap banding, they have leg straps that keep the pt in place, so I was wondering if they had something made in a similar fashion that would work for the shoulders.

please share how your positioning is done.

[TraciBdarn]

We've got one ...

and get this.. a few weeks ago.. I couldn't figure out why a hysterectomy/BSO was on the schedule for 8 hours!!!!! You got it.. DaVinci!.. I was amazed!!!! I really wanted to meet the patient and ask her why the heck she agreed to an 8 hour robot surgery instead of a traditional open or even a vag hyst that would take.. oh .. 1/8th the time..

[rnmi2004]

I'm not an OR nurse, but I work on the post-surgery floor. Our hospital has one and it is used for prostates and hysts; so far we've seen higher complications rates. Obviously our surgeons haven't had enough experience with it, and yet there are patients out there still willing sign up to be guinea pigs.

[Always Learning, RN]

Does anyone know of any devices specifically made for positioning for robots or any case where you want to keep the pt from slipping off the head of the bed? We currently put eggcrates aroudn the shoulders and one across the chest, then criss cross tape over the eggcrates to keep the pt in place. I'm thinking that there must be a better way.

As this thread is over 1 year old you have probably already found out about these but:

Arthrex or Dyonics shoulder holders, same people that make the yellow fins/allen stirrups. They are foam padded U shaped supports that attach to the bed at the shoulders. We use extra foam at the shoulders as well as pad the stirrups. I pad the bed with eggcrate foam under the blanket and use the lumbar laminectomy (pink foam) arm cradles to tuck the arms at the side taking care to pad the IV hub sites and keep the fingers wrapped with towels and away from the bed break. I also make sure that the bed is not moved unless I have my hands over the patients hands when the tailgate is being moved.

Any tips you have learned about improving turnovers or have you found any particularly useful equipment, supplies, techniques?

Thanks,

Always Learning, RN

[bjsmsn]

Regarding positioning for Da Vinci robot gyn cases, we originally used the 'u'shaped shoulder supports that attached to the bed, but patients developed brachial plexis injuries secondary to the supports and the apparent pressure of their shoulders against the supports. So we went to the eggcrate foam across the chest and the tape over the eggcrate. The anesthesia provider stated that for this to be effective, the tape would have to be so tight that it would impede chest expansion during the case indicating that even this would not keep the patient on the bed. My main concern was that the patient was placed directly on a mattress sized gel pad with no sheet over the top. The thought behind this was that the patient would "stick" to the gel pad and that and the tape over the eggcrate would keep her in place. My first concern was the possibility of shearing injury to the back and hips of the patient as gravity would 'pull' her body towards the head when she was put in Trendelenberg position, but that the skin that was stuck to the gel pad would remain in place causing a separation of tissue along the horizontal plane, thus the shearing effect. I would appreciate any thoughts and ideas out there. Thanks

[Libitina]

Yes, we have a Da Vinci robot. It's used for gynae oncology, uro-gynae and urology atm.

As we've only had it for coming up to a year we're still getting used to it and it still takes at least twice as long to perform any given procedure. That has, however, come down from 3x as long

[Rose_Queen, BSN, MSN, RN]

We have three. One dedicated solely to gyn, one dedicated solely to cardiothoracic, and one that is gyn, uro, and general. We've been doing hysterectomies, nephrectomies, prostatectomies, thoracotomies, mammary takedown followed by MIDCAB, thymectomies, bowel resections, and gall bladders.