Quick Start Guide

Robot-Assisted Surgery (RAS) At Sunnybrook

Dr. Alia Busuttil is the Anesthesiology clinical lead for the RAS program, debuted in October 2024.
The da Vinci Xi robotic surgical platform is located in OR 2.
Surgical services include urology, gynecology and general surgery.

Benefits Of Robot-Assisted Surgery

Magnified three-dimensional vision.
Digitally controlled hand movement with algorithm to filter out natural hands tremor.
More degrees of maneuverability / superior dexterity of robotic instruments.
Reduction in blood loss, length of stay, 30-day overall complication rate and post op pain compared to open procedures. When compared with MIS, there is still some evidence to suggest reduced length of stay, conversion rate and EBL.

Disadvantages Of Robot-Assisted Surgery

Capital cost
Steep learning curve
Longer procedure time
Potential complications related to extreme position (e.g. steep Trendelenburg) and pneumoperitoneum for prolonged period of time (see anesthesia considerations below)

Brief Overview Of da Vinci Xi

Intuitive Surgical Inc.'s 4th generation robotic platform.
The platform has been in production since 2014.
The system comprises of Three main components:

1. Surgeon Console

The operating surgeon seated at the Surgeon Console with three-dimensional endoscopic view of the surgical field and hand controls for instruments and endoscope.

2. Patient Cart

Patient Cart Helm

The draped patient cart is positioned by the OR table in the sterile field, exact cart orientation depends on each specific surgery, target anatomy and patient's position. Endoscope and instruments are attached / detached to each of the 4 arms by patient-side surgical assistant.

Close-up view of 1 of the 4 arms

3. Vision Cart

The Vision Cart includes the supporting electronic equipment such as the light source and video image processing equipment for the endoscope and the main electronic and software processing units. The Vision Cart also has a touchscreen to view the endoscopic image and adjust system settings.

OR Configuration & Carts Placement

Surgeon Console is located outside the sterile field, positioned in such a way that the surgeon has an unobstructed view of the operative field, vision cart and be able to communicate directly with the rest of the OR team e.g. anesthesiologist, assistant surgeon and scrub nurse.
Patient Cart is properly draped and located within the sterile field. Its position is surgery-specific and dependant on surgeon's preference.
Vision Cart is positioned adjacent to the Patient Cart just outside the sterile field allowing assistant surgeon & scrub nurse to see the endoscopic surgical view.

Surgeries of pelvic organs (e.g. prostatectomy), the Patient Cart can also be positioned between patient's legs

Patient Cart position with respect to location of target anatomy.

Quick Start Guide

Robot-Assisted Surgery (RAS) At Sunnybrook

Dr. Alia Busuttil is the Anesthesiology clinical lead for the RAS program, debuted in October 2024.

The da Vinci Xi robotic surgical platform is located in OR 2.

Surgical services include urology, gynecology and general surgery.

Benefits Of Robot-Assisted Surgery

Magnified three-dimensional vision.

Digitally controlled hand movement with algorithm to filter out natural hands tremor.

More degrees of maneuverability / superior dexterity of robotic instruments.

Reduction in blood loss, length of stay, 30-day overall complication rate and post op pain compared to open procedures. When compared with MIS, there is still some evidence to suggest reduced length of stay, conversion rate and EBL.

Disadvantages Of Robot-Assisted Surgery

Capital cost

Steep learning curve

Longer procedure time

Potential complications related to extreme position (e.g. steep Trendelenburg) and pneumoperitoneum for prolonged period of time (see anesthesia considerations below)

Brief Overview Of da Vinci Xi

Intuitive Surgical Inc.'s 4th generation robotic platform.

The platform has been in production since 2014.

The system comprises of Three main components:

1. Surgeon Console

The operating surgeon seated at the Surgeon Console with three-dimensional endoscopic view of the surgical field and hand controls for instruments and endoscope.

2. Patient Cart

The draped patient cart is positioned by the OR table in the sterile field, exact cart orientation depends on each specific surgery, target anatomy and patient's position. Endoscope and instruments are attached / detached to each of the 4 arms by patient-side surgical assistant.

3. Vision Cart

The Vision Cart includes the supporting electronic equipment such as the light source and video image processing equipment for the endoscope and the main electronic and software processing units. The Vision Cart also has a touchscreen to view the endoscopic image and adjust system settings.

OR Configuration & Carts Placement

Surgeon Console is located outside the sterile field, positioned in such a way that the surgeon has an unobstructed view of the operative field, vision cart and be able to communicate directly with the rest of the OR team e.g. anesthesiologist, assistant surgeon and scrub nurse.

Patient Cart is properly draped and located within the sterile field. Its position is surgery-specific and dependant on surgeon's preference.

Vision Cart is positioned adjacent to the Patient Cart just outside the sterile field allowing assistant surgeon & scrub nurse to see the endoscopic surgical view.

Surgeries of pelvic organs (e.g. prostatectomy), the Patient Cart can also be positioned between patient's legs

Patient Cart position with respect to location of target anatomy.