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Standardized Approach for Port Placement for Robotic-Assisted Lobectomies with the Robotic Stapler
Nguyen M. Le, MD, Richard S. Lazzaro, MD, Laurence N. Spier, MD.
Northwell Health - Long Island Jewish Medical Center, New York, NY, USA.

OBJECTIVE: With the recently introduced robotic stapler, there is much variability in terms of port placement for robotic-assisted lobectomies. We suggest a standardized technique that allows for stapling from both anterior and posterior directions.
METHODS: Using the Da Vinci Xi, we use five standard ports for robotic-assisted lobectomy - two 8mm cannulas, two 12mm cannulas, and a 15mm trocar. Port placement is arranged like the “5” on a dice, with the camera port serving as the center dot and the four remaining ports being placed 10cm from the center. One hand width is used to approximate 10cm. The patient is positioned in full lateral decubitus. We mark the inferior tip of the scapula. From the tip of the scapula about 10 cm inferior, our 8mm camera port is positioned on the mid-axillary line. Going anterior-superior from the camera port by 10cm, we place a 15mm accessory port. Going anterior-inferior 10cm from the camera port, we place a 12mm cannula with an 8mm reducer. Again from our mid-axillary camera port, going in a posterior-superior direction by 10cm, we place an 8mm cannula. And finally posterior-inferior 10cm from the camera port, we place the second 12mm cannula with an 8mm reducer. We demonstrate this technique in this video of a patient undergoing robotic-assisted right upper lobectomy.
RESULTS: With our standardized port placement, the robotic stapler can be used through either the anterior or posterior 12mm port. In addition, these two ports are placed very low in the chest, allowing for the 45mm robotic stapler loads to be utilized with minimal space issues. Ultimately, our standardized port placement provides an optimal angle for safe stapling, which can be applied to any lobe on either side of the patient.
CONCLUSIONS: We propose a standardized approach to port placement for robotic-assisted lobectomies using the robotic stapler, as it allows for excellent stapling angles bilaterally.

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