The indications for SIRC 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 [10]. Certain relative contraindications for SILC include patients with severe acute cholecystitis, BMI ≥ 35 kg/m², previous upper abdominal surgery, suspected bile duct stones and intrahepatic duct stones, suspected malignancy, and ASA class ≥ 3 [11–13]. Some of these contraindications have been alleviated by the da Vinci Si single-site cholecystectomy platform because of improved triangulation and surgeon experience with the platform. SIRC is increasingly being performed in patients with higher BMI, cholecystitis, and previous upper abdominal surgery, all with good results [14].

There are three major components to the da Vinci Surgical System. Two components are not sterile and located away from the table: Surgeon Console (SC) and Vision Cart (VC). The patient-side cart (PSC) component is covered with sterile drapes and docked at the operating room table. The SC gives the surgeon control of the instrumentation and visualization of the operative field. The VC contains supporting hardware and software such as the optical light source, electrosurgical unit, and optical integration. The PSC has four articulated mechanical arms, which control the instruments that are docked to the ports. Efficient use of the robotic system is best utilized with dedicated personnel. As previously discussed in Chapter 14, our structure consists of a robotic nurse manager, equipment specialist, circulating nurse, and scrub nurse. The nurse manager coordinates equipment and personnel several days in advance, the equipment specialist will set up the robotic subcomponents, and the circulating nurse is responsible for patient care and any additional equipment during the operation. The bedside scrub nurse must be proficient at instrument exchanges and basic bedside problem solving. This structure has been successful in achieving a mean SIRC docking time of 4.9 ± 2.8 min [14].

The patient is positioned supine on the operating table with the right arm tucked and left arm at 90°. The surgeon and assistant initially start on the patient’s left or right side according to surgeon preference. The instrument table and scrub nurse are positioned near the feet. The PSC robotic component will always be over the patient’s right shoulder, and the position of the electronics cart and surgeon console can be altered depending on room limitations. Typically the SC is to the patient’s left and the VC is to the patient’s left or right.