The patient is placed in supine position on a beanbag. Obese patients are taped over the chest to avoid sliding. Reverse Trendelenburg position of about 5-10 degrees and left side down about 5 degrees is helpful. It is important to always visualize the elbow of arm 3 on the platform because it may hit over the face or the shoulder of the patient. On right-sided lesions, the platform may enter on the right side; however, on hepatic flexure or proximal transverse lesions, the best approach is to dock from the right shoulder in an imaginary line between the right shoulder and the left iliac crest.

The patient is placed supine on the operating room (OR) table, making sure that the short side to the table is toward the patient’s head. The patient is secured to the table with the Opt-Shield SUPINE (BCG Medical, San Diego, CA), device to prevent sliding, and the table is airplaned right side up (roughly 15-20 degrees) there. There is no need for Trendelenburg or reverse Trendelenburg, although sometimes these positions are used to expose the duodenum, depending on the location of the transverse colon (Fig. 5-1). The robotic platform is brought over the right side at around the level of the axilla. Rotating the boom on the robotic platform allows for access to all four quadrants of the abdomen regardless of the robot docking location. The operating surgeon should sit at a location where he or she can see the robotic arms to correct external arm collisions, if necessary. Targeting of the lesion is performed following manufacture guidelines and optimal position of the arms is performed by the system to avoid collisions.

Routine placement of the OR table is perpendicular to the anesthesia cart. Once the system is docked and the patient position is set, the platform cannot be moved; movement may cause an irrecoverable fault to occur that may require the rebooting of the entire system. Figure 5-2 shows the placement of the patient in relationship to anesthesia. Robotic docking is done from the right shoulder and Figures 5-3 and 5-4 show the docking from the view of the surgeon and the nursing staff, respectively.

The patient is positioned supine on the OR table to prevent sliding. All pressure points are checked and corrected. The operating surgeon sits at a location in the room where he can visualize the robotic arms and can communicate using line of sight with the surgical assistant. The OR table is airplaned right side up slightly to displace the small bowel to the pelvis and the left upper quadrant exposing the duodenum and vascular pedicle. Anesthesia is usually located at the head of the table.