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Flow Chart

for Improving Operating Room Efficiency during

Pre-Surgery Inspection Checklist


ALL INSPECTIONS SHOULD BE CONDUCTED PRIOR TO PATIENT ANESTHETIZATION

Inspection Step

Completed

Inspect system connections

Conducted While Setting Up Back Table

Connect system, power on


Home system (without sterile adapters)
Unpack instruments & accessories
Inspect vision components

Inspect camera head glass for damage/debris


Check camera cable connections at the camera head and CCUs
Inspect all endoscopes for damage/debris
Set illuminator output to 100% or appropriate level for the procedure

Drape system
Vision set-up

Inspect light guide & insert completely in illuminator


Perform black/white balance
Confirm that there are no warning lights on CCUs
Perform scope calibration
Activate focus from surgeon console
Check for correct image brightness & simultaneous focus in surgeon console

Inspect instruments & accessories

Check for compatible instruments (da Vinci S vs. standard da Vinci)


Inspect instrument housing, shaft and tip
Inspect cannulae

Tools to help you succeed: Ask your representative about accessories that can promote OR efficiency:

da Vinci S drape kits

Instrument sterilization trays

SonicPro Cleaning System

For complete information on pre-surgery inspection of the da Vinci System, please refer to Pre-Surgery Inspection Quick Reference Card, 550780-01. Read all da Vinci System documentation and instructions carefully. Failure
to properly follow instructions, notes, cautions, warnings and danger messages associated with this equipment may lead to serious injury or complications for the patient.

Pre-Surgery Inspection

Setting up
Back Table

Surgeon

Circulator

Scrub

Assist

Anesthesia

Gets Patient

Sets-up Back Table

Sets-up Back Table

Gets Patient

The Key: Create Task Overlap


Circulator - Gets patient from pre-op while back table is set up.
Anesthesia - Gets patient from pre-op while back table is set up.
TASK OVERLAP: NO NEED TO WAIT TO GET PATIENT UNTIL AFTER BACK TABLE SET UP.
Scrub and Assist - Set up back table:
Minimize the amount of instruments on the back table. Limit it to da Vinci
instruments only.
Open surgical tray can remain unopened and placed to the side of back table.
PRE-SURGERY INSPECTION SHOULD BE CONDUCTED PRIOR TO THE ANESTHETIZATION OF PATIENT

Setting Up Back Table

Patient Enters
OR

Surgeon

Circulator

Scrub

Assist

Anesthesia

Position Patient

Position & Prep


Patient

Draping da Vinci
Patient Cart*

Pre-Surgery
Inspection Patient
Prep

Intubation

The Key: Create Task Overlap


Surgeon - Positions patient and performs surgical site assessment
Circulator Positions patient, preps patient
Scrub - Continues to drape da Vinci patient cart while patient is positioned and prepped
NO NEED TO WAIT FOR PATIENT CART TO BE DRAPED BEFORE PATIENT ENTERS ROOM
Assist - Conducts pre-surgery inspection and assists in patient preparation
PRE-SURGERY INSPECTION SHOULD BE CONDUCTED PRIOR TO THE ANESTHETIZATION OF PATIENT.
*Drape kits designed to reduce OR turnover time are now available for the da Vinci S model. Ask your representative for more information.

Patient Enters OR

Patient Draped

Surgeon

Circulator

Scrub

Assist

Makes Incisions,
Places Ports

Connect Bovie &


CO2

Assists
Surgeons

Cleans, Preps
Scope

Anesthesia

The Key: Create Task Overlap


Surgeon - Insufflates, makes incisions, places camera and instrument ports
Scrub - Assists surgeon with incision, port placement, instrumentation
Circulator - Prepares auxiliary equipment (ESU, gas, etc.)
Assist - Cleans and prepares scope for port placement visualization
TEAM MEMBERS SHOULD ANTICIPATE THE SURGEONS NEED FOR INSTRUMENTS AND EQUIPMENT.
Connect Bovie
Gas tubing connected

Patient Draped

Ports
Placed

Surgeon

Circulator

Scrub

Docks Robotic Arms


to Patient

Moves Patient Cart


into Position/ Begins
Paperwork

Docks Robotic Arms


to Patient

Assist

Anesthesia

Instrument
Inspection/ Insertion

The Key: Create Task Overlap


Circulator Moves da Vinci patient cart into position. Once locked in place and surgery begins,
paperwork can be started.
Surgeon - Docks robotic arms to ports
Scrub - Assists surgeon in docking of robotic arms to ports
Assist - Gathers and inspects robotic instrumentation and auxiliary instrumentation and
prepares for insertion
DOCKING AND DRIVING THE DA VINCI SYSTEM IS A TEAM EVENT THAT SHOULD BE PRACTICED
CONTINUALLY. HAVING CONSISTENT TEAM MEMBERS FOR ALL CASES WILL ALSO INCREASE EFFICIENCY.

Ports Placed

Surgeon off
Console

Surgeon

Circulator

Scrub

Assist

Scrubs In
& Closes

Rolls out, Undrapes


Patient Cart

Undocks Patient
Cart/ Assists Surgeon

Undocks Patient
Cart/ Clears Back
Table

Anesthesia

The Key: Create Task Overlap


Surgeon - Scrubs in to close ports
Scrub - Undocks da Vinci Patient Cart and assists surgeon in preparation of suture and port-site
closure
Assist - Helps in undocking da Vinci Patient Cart and begins clearing back table of all da Vinci
instruments
INSTRUMENTS AND SCOPES SHOULD BE IMMEDIATELY SENT TO CENTRAL PROCESSING FOR CLEANING,
STERILIZATION.*
Circulator Rolls da Vinci patient cart out and begins undraping and cleaning the system
ONCE THE SURGEON STANDS UP FROM THE CONSOLE, DA VINCI EQUIPMENT IS NO LONGER NEEDED.
PATIENT CART SHOULD BE UNDRAPED; ASSISTANT CAN BEGIN TO CLEAR AND CLEAN BACK TABLE.
*The da Vinci Sonic Pro Cleaning System and instrument sterilization trays are designed to help minimize processing time for both the da
Vinci S and the standard da Vinci models. Ask your representative for more information.

Surgeon off Console

Patient Exits
OR

Surgeon

Circulator

Scrub

Assist

Anesthesia

Speaks to Family/
Sees Next Patient

Patient to Recovery/
Sees Next Patient

Turnover
Room

Turnover
Room

Patient to Recovery/
Sees Next Patient

The Key: Create Task Overlap


Surgeon - Speaks to family post-operatively and sees next patient pre-operatively
Scrub - Cleans room and begins room turnover for next patient
HOUSEKEEPING MAY HELP SCRUB WITH TURNOVER
Circulator Takes patient to recovery with Anesthesia and sees next patient pre-operatively
Anesthesia - Takes patient to recovery with circulator and sees next patient pre-operatively
IDENTIFY THE ACTIVITIES CURRENTLY BEING PERFORMED WHILE THE PATIENT IS OUT OF THE ROOM
THAT CAN BE DONE WITH THE PATIENT IN THE ROOM.

Incision Closed

Intuitive Surgical wishes to thank Dr. Randy Fagin, Chief Administrative Officer, Texas Institute for Robotic Surgery
Intuitive
Surgical
wishes
to thank
Dr. Randy
Fagin,
Director,
Robotic Surgery,
The Hospital at Westlake - Austin, TX,
and Senior
Medical
Advisor
Training,
Intuitive
Surgical,
for providing
this material.
for providing this material.
This guide is provided for general information only and is not provided as formal medical training or certification. Intuitive Surgical trains
only on the use of the da Vinci Surgical System. Intuitive Surgical does not provide clinical training nor does it provide or evaluate surgical credentialing or train in surgical procedures or techniques. Before performing any clinical procedure utilizing the System, physicians are
responsible for receiving sufficient training and proctoring to ensure that they have the requisite training, skill and experience necessary to
protect the health and safety of the patient.
For technical information, including full cautions and warnings on using the da Vinci System, please refer to the System User Manual. Read
all instructions carefully. Failure to properly follow instructions, notes, cautions, warnings and danger messages associated with this equipment may lead to serious injury or complications for the patient.
While clinical studies support the use of the da Vinci Surgical System as an effective tool for minimally invasive surgery, outcomes cannot be
guaranteed, as surgery is patient and procedure specific.
2009 Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S, InSite, TilePro and EndoWrist are
trademarks or registered trademarks of Intuitive Surgical. All other product names are trademarks or registered trademarks of their respective
holders. PN 871881 Rev. C 2/09