Robotic Surgery and Nursing

Robotic Surgery and Nursing
Preface
Contents
Part I
	1: Development History of Surgical Robots
	2: Instructions for Use of Da Vinci Surgical Robots
		2.1	 Overview of Da Vinci Surgical Robot System
			2.1.1	 Main Components of Da Vinci System
				2.1.1.1	 Surgeon Console
				2.1.1.2	 Patient Surgical Platform
				2.1.1.3	 EndoWrist
				2.1.1.4	 Image Processing Platform
			2.1.2	 Da Vinci-e Surgery System
			2.1.3	 Overview of Surgeon Console
				2.1.3.1	 Masters
				2.1.3.2	 3D Viewer
				2.1.3.3	 Touchpad
				2.1.3.4	 Left and Right-Side Pods
				2.1.3.5	 Footswitch Panel
			2.1.4	 Overview of Patient Surgical Platform
				2.1.4.1	 Setup Joint
				2.1.4.2	 Instrument Arms
				2.1.4.3	 Camera Arms
				2.1.4.4	 Drive Motor
			2.1.5	 Overview of Image Processing Platform
				2.1.5.1	 Core Components
				2.1.5.2	 Light Source
				2.1.5.3	 Endoscope
				2.1.5.4	 HD 3D Camera
				2.1.5.5	 HD CCD
				2.1.5.6	 Touchscreen
				2.1.5.7	 Cylindrical Rack
		2.2	 Configuration of Operating Room
			2.2.1	 Surgeon Console Positioning
			2.2.2	 Positioning of Patient Surgical Platform
				2.2.2.1	 Drive Motor Operation
				2.2.2.2	 Gear Switch
			2.2.3	 Positioning of Image Processing Platform
		2.3	 System Connection
			2.3.1	 Power Connection
			2.3.2	 System Cable Connection
				2.3.2.1	 System Cable Layout
				2.3.2.2	 How to Connect the System Cables
			2.3.3	 Connecting the Camera Cables
				2.3.3.1	 Connecting Camera Cables
				2.3.3.2	 Connecting the Optical Cables
				2.3.3.3	 Maintaining Camera Cables
			2.3.4	 Connecting Auxiliary Devices
			2.3.5	 Video and Audio Connection
				2.3.5.1	 Surgeon Console Connection
				2.3.5.2	 Video Out of Core Components
				2.3.5.3	 Audio In and Out of Core Components
				2.3.5.4	 CCU Video Out
		2.4	 Startup and Boot
			2.4.1	 Standalone Mode
			2.4.2	 System Power-On
			2.4.3	 Boot Sequence
			2.4.4	 Preparing the Patient Surgical Platform Before Drape Installation Work
			2.4.5	 Home Position
		2.5	 Installing the Drape
			2.5.1	 Instructions for Installing the Drape
			2.5.2	 Operating Procedures for Installing the Drape on Instrument Arms
			2.5.3	 Operating Procedures for Installing the Drape on Camera Arm
			2.5.4	 Operating Procedures for Installing the Drape on Camera
			2.5.5	 Operating Procedures for Installation of Drape on Touchscreen (Optional)
		2.6	 Application of Image Processing System
			2.6.1	 Overview of Image Processing System
			2.6.2	 Image Processing System Settings
			2.6.3	 Operating the Cold Light Source
			2.6.4	 Operating the Image Observation Controller on the Touchscreen
				2.6.4.1	 Touchscreen Display
				2.6.4.2	 Accessing the Touchscreen Menu
				2.6.4.3	 Telestration
				2.6.4.4	 Video Source Tab
				2.6.4.5	 Video Settings Tab
				2.6.4.6	 Audio Tab
				2.6.4.7	 Utilities Tab
			2.6.5	 Adjusting the Touchscreen Display
			2.6.6	 Processing Image Quality Problems
				2.6.6.1	 Excessively Bright or Dark Images
				2.6.6.2	 Correcting Unfocused or “Soft” Images
				2.6.6.3	 Replacing the Light Module
		2.7	 Patient Preparation, Incision Arrangement, and Connection
			2.7.1	 Instructions for Patient Preparation
			2.7.2	 Puncture Incision Layout and Trocar Insertion
				2.7.2.1	 Instructions on Puncture Incision Layout
				2.7.2.2	 Puncture Incision Layout and Inserting the Puncture Trocar
			2.7.3	 Connection
				2.7.3.1	 Positioning the Patient Surgical Platform Cart
				2.7.3.2	 Connecting the Camera Arms
				2.7.3.3	 Connecting the Instrument Arm (Fig. 2.110)
		2.8	 Application of Patient Surgical Platform
			2.8.1	 Overview of Patient Surgical Platform Cart
			2.8.2	 Moving the Patient Surgical Platform Robot Arm
				2.8.2.1	 Arm Clutch and Notch Clutch Buttons
				2.8.2.2	 Manual Arm Clutch
				2.8.2.3	 Notch Arm Clutch for Manual Movement of Setup Joint
				2.8.2.4	 Accidental Movement of Setup Joint
				2.8.2.5	 Emergency Power Off
			2.8.3	 EndoWrist Operation
			2.8.4	 Instrument Installation, Insertion, Removal, and Intraoperative Care
				2.8.4.1	 Installation
				2.8.4.2	 Plug and Play
				2.8.4.3	 Insertion
				2.8.4.4	 Precautions Against Fluid Leakage
				2.8.4.5	 Removing the Instrument
				2.8.4.6	 Emergency Clamp Release
				2.8.4.7	 Intraoperative Instrument Maintenance
				2.8.4.8	 Frequency of Instrument Use
			2.8.5	 Patient-Side Operation of Endoscope
			2.8.6	 Endoscope Installation, Insertion, Removal, and Intraoperative Care
				2.8.6.1	 Installation
				2.8.6.2	 Insertion
				2.8.6.3	 Removal
				2.8.6.4	 Intraoperative Maintenance
				2.8.6.5	 Replacing the Endoscope
		2.9	 Application of Surgeon Console
			2.9.1	 Overview of Surgeon Console
				2.9.1.1	 Master
				2.9.1.2	 3D Viewer
				2.9.1.3	 Touchpad
				2.9.1.4	 Left Box—Ergonomic Controller
				2.9.1.5	 Right Box—Power and Emergency Shutdown
				2.9.1.6	 Footswitch Panel
			2.9.2	 Surgeon Console Settings
				2.9.2.1	 Login
				2.9.2.2	 Ergonomic Settings
			2.9.3	 Touchpad Controller
				2.9.3.1	 Overview
				2.9.3.2	 Unlocking the Touchpad
				2.9.3.3	 Video
				2.9.3.4	 Display Preference
				2.9.3.5	 Audio
				2.9.3.6	 Utilities
			2.9.4	 Surgeon Console
				2.9.4.1	 Handle Match
				2.9.4.2	 Finger Clutch
				2.9.4.3	 Footswitch Panel
				2.9.4.4	 Energy Control Pedal
				2.9.4.5	 3D Viewer Display
				2.9.4.6	 Foot Pedal Diagram (3D Viewer)
				2.9.4.7	 Energy Activation Manifestation
				2.9.4.8	 Simultaneous Energy Control: Disabled Combination
				2.9.4.9	 Conversion Energy Control: A Combination Available for Joint Use
			2.9.5	 Dual Console Surgery
				2.9.5.1	 Dual Console Connection and Startup
				2.9.5.2	 Comparison Between Two Consoles
				2.9.5.3	 Instrument Control
				2.9.5.4	 Camera Control
				2.9.5.5	 Video Control
				2.9.5.6	 Virtual Pointer (Dual Console Teaching Aids)
		2.10	 Shutdown and Storage of Robot System
			2.10.1	 System Shutdown Preparation
			2.10.2	 Inventory Management
			2.10.3	 Shutting Down the Da Vinci Si System
			2.10.4	 System Storage
		2.11	 Cleaning and Maintenance of Robot System
			2.11.1	 Robot System Maintenance
			2.11.2	 Robot System Cleaning
			2.11.3	 Replacing the Lamp Module of the Cold Light Source
			2.11.4	 Replacing the CCU Fuse
	3: Cleaning, Disinfection, and Sterilization of Reusable Instruments, Accessories, and Endoscopes in Robotic System
		3.1	 Overview
			3.1.1	 Symbols and Definitions
			3.1.2	 Overview of the Three Cleaning Procedures
			3.1.3	 Notes
			3.1.4	 Preventive and Protective Measures
			3.1.5	 Preparing the Detergent
			3.1.6	 General Information and Tips
			3.1.7	 Flush System for EndoWrist Instruments
		3.2	 Automatic Cleaning of Instruments (Use of Automatic Washer-Disinfector)
			3.2.1	 Detergent
			3.2.2	 Preparation in the Operating Room
			3.2.3	 Transportation for Disinfection
			3.2.4	 Auto Cleaning Preparation
			3.2.5	 Auto Cleaning and Thermal Sterilization with the Washer-Disinfector
			3.2.6	 Inspection, Maintenance, and Testing
			3.2.7	 Packaging
			3.2.8	 Sterilization
			3.2.9	 Storage
		3.3	 Manual Cleaning of Equipment (Use of Ultrasonic Pool)
			3.3.1	 Detergent
			3.3.2	 Preparation in the Operating Room
			3.3.3	 Transporting for Disinfection
			3.3.4	 Ultrasonic Cleaning Preparation
			3.3.5	 Ultrasonic Cleaning
			3.3.6	 After Ultrasonic Cleaning
			3.3.7	 Inspection, Maintenance, and Testing
			3.3.8	 Packaging
			3.3.9	 Sterilization
			3.3.10	 Storage
		3.4	 Endoscope Cleaning Instructions
			3.4.1	 Detergent
			3.4.2	 Transportation for Disinfection
			3.4.3	 Endoscope Cleaning
			3.4.4	 Chemical Disinfection
			3.4.5	 Inspection, Maintenance, and Testing
			3.4.6	 Packaging
			3.4.7	 Sterilization
			3.4.8	 Storage
		3.5	 Supplementary Cleaning Instructions
			3.5.1	 Da Vinci HARMONIC and Da Vinci HARMONIC ACE Curved 8 and 5 mm Instruments
			3.5.2	 EndoPass Reprocessing
			3.5.3	 Supplementary Cleaning Instructions for 5 Fr.EndoWrist Luer
			3.5.4	 EndoWrist Stabilizer Reprocessing
			3.5.5	 Reprocessing of Accessories
			3.5.6	 Reprocessing of PK Instrument Cables
			3.5.7	 Reprocessing of Da Vinci and Da Vinci S Light Guide Cables
	4: Personnel Management in the Robotic Surgery Room
		4.1	 Management System Related to Robotic Surgery
			4.1.1	 Management Methods for Surgical Robots
			4.1.2	 Surgical Personnel Allocation and Access
		4.2	 Training in Robotic Surgery
	5: Quality Management of Robotic Surgical Nursing
		5.1	 Quality Management in Robotic Surgery Nursing
			5.1.1	 Total Quality Management
			5.1.2	 Total Quality Management in Robotic Surgery
			5.1.3	 Implementing Total Quality Management in Robotic Surgery Nursing
				5.1.3.1	 Establish a Quality Management Organization for Robotic Surgery
				5.1.3.2	 Organize Regular Theoretical and Technical Training on Robots
				5.1.3.3	 Regular Quality Inspection and Assessment
				5.1.3.4	 Establish the Quality Inspection System for Operating Room Nursing
		5.2	 Quality Monitoring and Evaluation of Robotic Surgery Nursing
			5.2.1	 Monitoring Method
				5.2.1.1	 Self-Examination and Self-Control
				5.2.1.2	 Quality Inspection
			5.2.2	 Quality Assessment
		5.3	 Role of Robotic Surgery Room Manager in Total Quality Management
			5.3.1	 Play the Role of a Specialty Nursing Team Leader
			5.3.2	 Build a High-Quality Professional Robotic Surgery Nursing Team
			5.3.3	 Continue to Carry Out Quality Nursing Activities
	6: Management of Robotic Surgical Supplies
		6.1	 Managing the Robotic Endoscope
		6.2	 Managing the Robot Manipulator
		6.3	 Managing the Robotic Surgery Room
	7: Safety Management of Robotic Surgery
		7.1	 Overview of Safety Management in Robotic Surgery
			7.1.1	 Safety Management in Robotic Surgery
			7.1.2	 Implementing Safety Management in Robotic Surgery
				7.1.2.1	 Set Up a Quality Organization and Define Monitoring Targets
				7.1.2.2	 Keep Ringing the Alarm Bell and Strengthen Safety Awareness
				7.1.2.3	 Establish Rules and Regulations and Improve the Management System
				7.1.2.4	 Strengthen Training and Improve the Quality of Nurses
				7.1.2.5	 Conduct Follow-Up Inspection and Strengthen Preventive Measures
				7.1.2.6	 Optimize the Combination and Utilize Human Resources Scientifically
				7.1.2.7	 Analyze Regularly and Improve the Quality of Nursing
		7.2	 Safety Nursing Practice in Robotic Surgery
			7.2.1	 Medical Technology Classification and Hierarchical Management
				7.2.1.1	 Medical Technology Classification
				7.2.1.2	 Surgical Grading
				7.2.1.3	 Nursing Support
			7.2.2	 Surgical Risk Assessment and Surgical Safety Objectives
				7.2.2.1	 Surgical Risk Assessment
				7.2.2.2	 Surgical Safety Verification
				7.2.2.3	 Nursing Support
			7.2.3	 Observing the Patient Condition
				7.2.3.1	 Definition of Intraoperative Condition Observation
				7.2.3.2	 Specific Content of Condition Observation Guidelines
				7.2.3.3	 Implementation Method
				7.2.3.4	 Quality Supervision and Management of Links
			7.2.4	 Establish Communication Records of Medical Work
			7.2.5	 Establishing an Execution List of Verbal Orders for Intraoperative Medication
				7.2.5.1	 Current Methods and Problems in the Implementation of Surgical Drug Instructions
				7.2.5.2	 Contents and Execution Requirements of the Intraoperative Execution List of Verbal Orders
		7.3	 Common Rules and Regulations of Robotic Surgery
			7.3.1	 Rules and Regulations Governing the Use of Surgical Robots (Da Vinci System)
			7.3.2	 Operating Procedures for Surgical Robots (Da Vinci System)
			7.3.3	 Cleaning and Maintenance System for Robot (Da Vinci System) Instruments
			7.3.4	 Operating Room Management System for Surgical Robots (Da Vinci System)
			7.3.5	 Regulations on Management of Trainees and Interns
		7.4	 Nursing Management of Adverse Events in Robotic Surgery
			7.4.1	 Types of Adverse Surgical Events
				7.4.1.1	 Major Adverse Events
				7.4.1.2	 Serious Adverse Events
				7.4.1.3	 Nursing Errors
				7.4.1.4	 Nursing Problems (Almost Errors)
			7.4.2	 Treatment of Adverse Events During Robotic Surgery
			7.4.3	 Basic Requirements for Risk Management in Robotic Surgery Rooms
		7.5	 Treatment of Emergencies in Robotic Surgery Room
			7.5.1	 Emergency Plan for Fire in Operating Room (Fig. 7.2)
			7.5.2	 Emergency Plan for Planned and Sudden Power Failure in Operating Room (Fig. 7.3)
			7.5.3	 Emergency Plan for Planned and Sudden Water Shutdown in Operating Room
			7.5.4	 Emergency Plan for Sudden Cessation of Central Oxygen Supply in Operating Room
			7.5.5	 Emergency Plan for Sudden Cessation of Central Attraction in Operating Room
			7.5.6	 Emergency Plan for Wrong Count of Surgical Items
			7.5.7	 Preventive Measures for Patient Falling from Bed, Tumbling, or Collision in Operating Room and Emergency Plan for Patient Falling from Bed, Tumbling, or Collision
			7.5.8	 Preventive Measures for Pressure Sores in Operating Room and Emergency Plan in Case of Occurrence of Pressure Sores
			7.5.9	 Prevention of Burns or Scalding in Operating Room and Emergency Plan for Burns or Scalding
			7.5.10	 Emergency Plan for Surgical Robot Failure
	8: Infection Management in Robotic Surgery Room
		8.1	 Regulations and Infection Control
		8.2	 Disinfection, Sterilization, and Storage of Robot Equipment
		8.3	 Self-Protection Against Surgery Room Risk Factors
	9: Overall Operating Mode of Nursing in Robotic Surgery Room
		9.1	 Preoperative Nursing
		9.2	 Intraoperative Nursing
			9.2.1	 Safety Verification
			9.2.2	 Preoperative Preparation
			9.2.3	 Equipment and Instruments in the Operating Room Should Be Properly Distributed
			9.2.4	 Posture Care
			9.2.5	 Records of Intraoperative Nursing
		9.3	 Postoperative Nursing
	10: Treatment of Nursing and Emergency Situation of Patients Receiving Robotic Surgery in the Recovery Period
		10.1	 Nursing of Patients Recovering from Robotic Surgery
			10.1.1	 Postoperative Resuscitation Nursing
				10.1.1.1	 Nursing Assessment and Observation Points
				10.1.1.2	 Nursing Intervention
		10.2	 Nursing Management of Emergency Situation in Robotic Surgery
			10.2.1	 Nursing Capability Management
				10.2.1.1	 Standardize Nursing Work Behavior
				10.2.1.2	 Strengthen Theory and Skill Training
				10.2.1.3	 Improve the Patients’ Acceptance of Surgical Anesthesia
			10.2.2	 Handling Emergency Situations
				10.2.2.1	 Surgical Shock
				10.2.2.2	 Key Nursing Points
	11: Economic Analysis and Performance Management of Robotic Surgery
		11.1	 Economic Analysis of Robotic Surgery
		11.2	 Performance Management of Robotic Surgery
	12: Nursing Cooperation for Anesthesia in Robotic Surgery
		12.1	 Influence of Artificial Pneumoperitoneum on Physiological Function
			12.1.1	 Effect of Artificial Pneumoperitoneum on Respiration
			12.1.2	 Effects of Laparoscopic Surgery on Circulatory Function
			12.1.3	 Effect of Patient’s Special Posture
			12.1.4	 Common Complications of Laparoscopic Surgery
		12.2	 General Anesthesia
			12.2.1	 Pre-anesthesia Evaluation
			12.2.2	 General Anesthesia
			12.2.3	 Intraoperative Monitoring
			12.2.4	 Postoperative Treatment
		12.3	 Application of Controlled Hypotension in Anesthesia
			12.3.1	 Theoretical Basis of Controlled Hypotension
			12.3.2	 Effects of Controlled Hypotension on the Body
			12.3.3	 Indications and Contraindications of Controlled Hypotension
			12.3.4	 Complications
			12.3.5	 Commonly Used Controlled Hypotensive Methods
			12.3.6	 Monitoring and Management of Controlled Hypotension
		12.4	 Hypothermic Anesthesia
			12.4.1	 Common Methods of Anesthesia
			12.4.2	 Posterior Parallel Circulation and Cessation of Extracorporeal Circulation
			12.4.3	 Monitoring of Hypothermia Extracorporeal Circulation Anesthesia
			12.4.4	 Common Complications of Hypothermia Extracorporeal Circulation Anesthesia
		12.5	 Resuscitation Management After Anesthesia
			12.5.1	 Admission Criteria for Resuscitation Room
			12.5.2	 Discharge Criteria for Resuscitation Room
			12.5.3	 Extubating Conditions
			12.5.4	 Work of PACU
			12.5.5	 Common Complications and Treatment During Recovery Period
				12.5.5.1	 Common Complications
				12.5.5.2	 Watch Closely to Prevent Accidents
			12.5.6	 Relevant Systems of PACU
				12.5.6.1	 Responsibilities of Head Nurse in PACU
				12.5.6.2	 Responsibilities of Nurses in PACU
				12.5.6.3	 PACU Nursing System
				12.5.6.4	 PACU Safety Management System
				12.5.6.5	 PACU Instrument Management System
				12.5.6.6	 Emergency Drill for Unexpected Power Failure of the Respirator
Part II
	13: Nursing Cooperation for Robotic Surgery in Urology Surgery
		13.1	 Robotic Surgery Position in Urology Surgery
			13.1.1	 Supine and Trendelenburg Position
			13.1.2	 Lateral Position (90°)
			13.1.3	 Improved Lateral Position (60°)
		13.2	 Robotic Adrenalectomy (Via Retroperitoneum)
		13.3	 Robotic Kidney Surgery
			13.3.1	 Robotic Radical Nephrectomy
			13.3.2	 Robotic Partial Nephrectomy
		13.4	 Nursing Support in Robot-Assisted Laparoscopic Extraction of Inferior Vena Cava Thrombosis
		13.5	 Robotic Radical Resection of Renal Pelvic Carcinoma (Ureteral Carcinoma)
		13.6	 Robotic Ureterovesical Replantation
		13.7	 Robot-Assisted Radical Prostatectomy
		13.8	 Robotic Lymph Node Dissection
			13.8.1	 Robotic Pelvic Lymph Node Dissection
			13.8.2	 Robotic Retroperitoneal Lymph Node Dissection
	14: Nursing Cooperation for Robotic Surgery in General Surgery
		14.1	 Common Surgical Approaches for Robotic Surgery in General Surgery
			14.1.1 Body Position for Patients Undergoing General Robotic Surgery
			14.1.2 Establishment and Closure of Robotic Puncture Trocar for General Surgery
			14.1.3 Common Surgical Approaches for General Surgical Robots
				14.1.3.1	 Abdominal Approach (Anterior)
				14.1.3.2	 Extraperitoneal Approach (Anterior)
				14.1.3.3	 Removal Method of Surgical Specimens
		14.2	 Hepatopancreatobiliary Surgery
			14.2.1 Robotic Roux-en-Y Choledochostomy (A Case Study of Type I Choledochocyst)
			14.2.2 Robotic Partial Hepatectomy (A Case Study of Left Hepatocellular Carcinoma)
			14.2.3 Robotic Partial Hepatectomy (A Case Study of Right Hepatocellular Carcinoma)
			14.2.4 Robot-Assisted Pancreaticoduodenectomy
			14.2.5 Total Robotic Pancreaticoduodenectomy
			14.2.6 Robot-Assisted Spleen-Preserving Distal Pancreatectomy
			14.2.7 Robotic Splenectomy
		14.3	 Gastrointestinal Surgery
			14.3.1 Robot-Assisted Radical Total Gastrectomy
			14.3.2 Total Robotic Radical Gastrectomy
			14.3.3 Robot-Assisted Radical Distal Gastrectomy (Billroth I Procedure)
			14.3.4 Robot-Assisted Radical Distal Gastrectomy (Billroth II Procedure)
			14.3.5 Total Robotic Radical Distal Gastrectomy (Billroth I Procedure)
			14.3.6 Total Robotic Radical Distal Gastrectomy (Billroth II Procedure)
			14.3.7 Total Robotic Radical Distal Gastrectomy
			14.3.8 Robot-Assisted Radical Proximal Gastrectomy
			14.3.9 Robot-Assisted Radical Resection of Right Colon Cancer
			14.3.10 Robot-Assisted Radical Resection of Left Colon Cancer
			14.3.11 Robot-Assisted Radical Resection of Rectal Carcinoma
			14.3.12 Robot-Assisted Radical Resection of Rectal Carcinoma
			14.3.13 Total Robotic Radical Resection of Rectal Cancer
		14.4	 Robot-Assisted Herniorrhaphy
			14.4.1 Robotic Indirect Inguinal Hernia Repair by Extraperitoneal Approach (Right)
			14.4.2 Robot-Assisted Hiatal Hernia Repair and Fundoplication
	15: Nursing Cooperation for Robotic Surgery in Obstetrics and Gynecology
		15.1	 Overview of Robotic Surgery in Obstetrics and Gynecology
		15.2	 Establishment of Robotic Surgical Approaches in Gynecology
		15.3	 Related Surgery in Obstetrics and Gynecology
			15.3.1	 Robotic Hysterectomy
			15.3.2	 Robotic Pelvic Lymphadenectomy
			15.3.3	 Robotic Omentectomy
			15.3.4	 Robotic Uterine or Vaginal Sacral Fixation
			15.3.5	 Robotic Fallopian Tube Recanalization
	16: Nursing Cooperation for Robotic Surgery in Thoracic Surgery
		16.1	 Overview of Robotic Surgery in Thoracic Surgery
			16.1.1	 History of Robot-Assisted Thoracoscopic Lobectomy
			16.1.2	 Training Certification for Robotic Surgery
			16.1.3	 Patient Position (Common Position in Thoracic Surgery)
		16.2	 Robotic Lobectomy
		16.3	 Robotic Esophageal Hernia Repair
		16.4	 Robotic Radical Resection of Esophageal Cancer
		16.5	 Robotic Mediastinal Tumor Resection
		16.6	 Robotic Esophageal Reflux Surgery