Docking the robotic platform onto the trocars and insertion of the robotic instruments into the surgical cavity is a significant step in robotic surgery, and when done correctly can facilitate the flow of surgery. This is emphasized when contemplating if to undock and redock during surgery, either partially (one arm) or completely.

There are four steps during the docking process:

1.

Trocar insertion and positioning the operating room table in the necessary tilt and roll position;

2.

Driving the arm cart/s to proximity of the patient;

3.

Connecting the arms to the trocars;

4.

Insertion of the instruments into the operating field.

While steps 1–3 improve significantly with experience, insertion of the instruments is still a time-consuming step since it involves the safety of patients, demanding special attention and maneuvers. The definition of docking time varies greatly between studies resulting in a wide range of time from an average of 4 to 29 min (1–10). Some define docking time as the time from moving the arm cart until all instruments are inserted and some from skin incision to all instruments inserted. In studies reporting docking time less than 5 min, the docking time is usually defined from moving the arm cart until all arms are connected to the trocars, not including instrument insertion, although this step sometimes takes longer than all steps together.

As opposed to standard laparoscopic surgery, insertion of robotic instruments cannot be performed blindly, since there is no sense of touch or resistance when the instruments are driven into the surgical field using large mechanical arms, which reduce forces by dedicated springs and motors. In addition, there is a tendency to begin insertion of the instruments perpendicular to the skin, and then change the direction of insertion into an acute angle, pointing the instrument to the target zone. Inserting a robotic instrument perpendicular may result in organ injury without necessarily being aware of the injury. This is why the robotic companies insist on inserting the instruments only under direct visualization. Once the camera arm is docked, it is manipulated to visualize the trocar, and only then under direct visualization the instrument should be inserted and advanced to the target zone. This is not always easy since the camera arm needs to be moved significantly to show the abdominal wall and can potentially collide with an adjacent arm already in place. Also visualizing a trocar in close proximity or one that is behind the falciform ligament is particularly challenging. Since locating the trocars for instrument insertion is not trivial, some robotic platforms, like the daVinci Xi, aid the surgeon by presenting their approximate location on the periphery of the screen, thereby moving the camera toward the specific trocar indicator should eventually bring the trocar into view.

Herein, we present a simple technique for safe insertion of robotic instruments, which avoids the necessity of camera manipulation and significantly reduces the overall docking time.