Complications of robotic surgical access

Abstract

Port access symbolizes the backbone of minimally invasive surgery; improper placement can result in technical challenges during the surgery including longer operative time, clashing of instruments both intracorporeally and extracorporeally, difficulty with dissection, and sometimes, necessitates trocar repositioning. Initial access for minimally invasive surgery, both laparoscopic and robotic approaches, can be carried out using different techniques which are equally effective, and it is during the first step of the surgery, obtaining pneumoperitoneum and primary trocar placement, where the highest number of complications can occur. Proper training and an adequate learning curve have proven to significantly decrease the rate of adverse and unwanted events at this critical stage of the operation. Surgeon preference for the method used to obtain access is based what they have the most experience with and feel most comfortable performing. It is always important to individualize each case, identify risk factors, and choose the appropriate techniques and instruments for the prevention of complications. Proper planning and training are also essential for early recognition and diagnosis of complications which is critical for their management in a timely and efficient manner, thereby reducing the morbidity and mortality rates of minimally invasive procedures.