The indications for MPRC are similar to those of traditional laparoscopic cholecystectomy . These include symptomatic cholelithiasis, cholecystitis, acalculous cholecystitis, symptomatic gallbladder polyps or polyps greater than 10 mm, porcelain gallbladder, and biliary dyskinesia [11].

The three components of the da Vinci Surgical System are the Surgeon Console (SC), Vision Cart (VC) and Patient-side Cart (PSC). The SC is positioned away from the operative field and controls the instrumentation and visualization of the operative field. The VC is also positioned away from the operative field and contains supporting hardware and software, such as the optical light source, electrosurgical unit, and optical integration. The PSC is the only component docked within the operative field and is covered with sterile drapes. It has four articulated mechanical arms that control the instruments that are docked to the ports.

The efficient use of any system requires the coordination of all personnel involved. At our institution, we have achieved very efficient robotic docking times with organization and training of operating room personnel. Our structure consists of a robotic nurse manager, equipment specialist, circulating nurse, and scrub nurse. This structure is not limited to robotic cases but applies to any specialty cases. The robotic nursing supervisor specifically overseas all robotic cases to ensure the appropriate personnel and equipment are assigned to the room several days in advance. The equipment specialists are responsible for setup and troubleshooting of all laparoscopic and robotic equipment across multiple rooms. In our robotic rooms, they are responsible for the location of all robotic components and positioning of robotic equipment during the operation. The circulating nurse is responsible for additional equipment used during the operation. The scrub nurse is responsible for instrument exchange at the patient’s bedside. Using this system, we achieved an average docking time of 5 min [8, 12].

The patient is placed supine on the operating room table. After intubation, the elbows should be properly padded and secured in the adducted position. The bed is angled 45° with the head moving to the patient’s right. The right arm is tucked, so the PSC can eventually be positioned over the patient’s right shoulder. The scrub nurse and sterile instrument table are generally positioned near the foot of the bed. The SC is placed away from the operating room table. The VC can be positioned to the left or right, away from the sterile field (Fig. 2.1).