Optimizing first trocar access for robot‐assisted radical prostatectomy: Optical trocar access through the upper abdominal quadrant using the Kii Fios First Entry trocar

• Published in: Asian journal of endoscopic surgery Vol. 14; no. 3; pp. 443 - 450
• Main Authors: Shimbo, Masaki, Endo, Fumiyasu, Tominaga, Koki, Sano, Masayuki, Nishino, Takato, Kyono, Yoko, Komatsu, Kenji, Ohyama, Takehiro, Sakurai, Masato, Narimoto, Kazutaka, Matsushita, Kazuhito, Hattori, Kazunori
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01-07-2021; Wiley Subscription Services, Inc
• Subjects: Abdomen; Endoscopy; Kii Fios; optical trocar access; Prostate; Robotic surgery; robot‐assisted radical prostatectomy; Surgical outcomes; Urological surgery
• ISSN: 1758-5902; 1758-5910
• DOI: 10.1111/ases.12889

Objectives
A pre‐equipped metal trocar is required to use as a camera trocar due to a specification change in the da Vinci X/Xi system (Intuitive Surgical). We observed slight slippage of a trocar placed by the open method. With optical trocar access (OTA), the initial trocar is viewed directly with a laparoscope during placement. Reports regarding OTA for robotic surgery are limited, particularly for robot‐assisted radical prostatectomy (RARP). We modified the OTA procedure such that it was appropriate for RARP.
Patients and Methods
A total of 158 patients were enrolled in this study. The first trocar placement time (FTPT) was compared between the open and OTA groups. In the OTA group, the trocar was mainly placed through the upper abdominal quadrant. We also analyzed the differences between the conventional and modified OTA procedures using the Kii Fios First Entry trocar (Applied Medical). We examined the factors affecting the FTPT using linear regression models. A P value <.05 was considered significant.
Results
The FTPT was significantly shorter in the OTA group than the open group (P < .0001). The modified method was associated with a shorter FTPT (P = .0001). None of the patient characteristics affected the FTPT in either group. No major complications were observed.
Conclusions
OTA was applied successfully during RARP. Use of the Kii Fios First Entry trocar with upper abdominal quadrant placement was suitable for RARP.