Fig. 1 –

Patient positioning and port placement. Veress needle pneumoperitoneum is achieved, and the 12-mm camera port is placed at the level of the 12th rib in a somewhat more medial location than regular renal robotic surgery, where this port is closer to the right lateral rectus border. The rest of the bariatric robotic ports are inserted, the most caudal located cephalad to the pubic symphysis and slightly lateral to the medial umbilical ligament. One robotic port is placed three fingerbreadths cephalad and medial to the anterosuperior iliac spine; of note, an equilateral triangle configuration is the goal of these three ports (including the camera port). The uppermost bariatric robotic port is placed one fingerbreadth from the costal margin, 8–10 cm cephalad to the camera port. A 5-mm port is placed below the xiphisternum for liver retraction; a 12-mm assistant port is placed medially between the camera and uppermost robotic port; and a 15-mm assistant port is placed distal to the umbilicus, closer to the midline. The robot is docked over the patient’s shoulder. (a) Schematic demonstrating port placement for vena caval control (laterality nonspecific) and right-sided caval thrombectomy; (b) operative photograph demonstrating port placement for vena caval control (laterality nonspecific) and right-sided caval thrombectomy; (c) schematic demonstrating port placement for left radical nephrectomy following caval thrombectomy; (d) operative photograph demonstrating port placement for left radical nephrectomy following vena caval thrombectomy.

As = assistant port; Cam = camera; Liv = liver.