Sterile Processing of Surgical Robotics

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LEARNING OBJECTIVES:
1. Discuss advantages of utilizing a surgical robot.

Instrument 2. Identify three basic components of a surgical robotic system.

3. Describe functional components of robotic instruments.
Continuing 4. Compare processing of traditional laparoscopes with robotic scopes.

Education 5. Relate importance of proper packaging and labeling techniques.

(ICE)
SELF-STUDY Robotic surgery is not a dream of the future for today's hospitals; it is a
reality. Surgical teams, including the surgeon, assistant, scrub person and
circulating nurse are provided extensive specialty training before using the
robotic system. Because the patient and surgical team require the support of
dedicated sterile processing technicians to assure positive patient outcomes,
they too must be provided specialty training. This training must take place
prior to scheduling the first robotic procedure. While the sterile processing
team may be the last to receive the training required to properly process
robotic devices, they are vital to the overall success of the program.

Carla McDermott, RN, CRCST, ACE

Education Specialist,
Morton Plant Mease Healthcare
Dunedin, FL
mailbox@iahcsmm.org
Instrument Continuing Education lessons
provide members with ongoing education
in the complex and ever-changing area
of surgical instrument care and
handling. These lessons are designed
for CIS technicians, but can be of value
to any CRCST technician who works
with surgical instrumentation.
The Instrument Continuing Education
(ICE) lessons are easy to use. Just read
and study the article, take the quiz at the
end of the article (see page 18), and
log on to www.iahcsmm.org to grade
and print your quiz results (click the
Instrument CE banner or navigate to
www.iahcsmm.org/ICE_home.htm).
Successfully completed ICE lessons can
help you gain recertification points.
Training to process robotic devices should
include a brief introduction of the robotic
concepts. Information outlining
advantages and limitations that relate to
procedures performed using this
technique will be helpful. Explicit
instructions are required regarding specific
handling, packaging and sterilization
techniques of the devices to be utilized.
The manufacturer will be your resource
for education materials. Insisting on
written policies, procedures and
competency evaluations will help to
ensure the facilities 1.5 million-dollar
investment is handled and processed
appropriately.
Our collective imaginations have 'grown'
incredibly versatile robots over the years,
resulting in 'generations' of the fictitious
man-made creations. Real life is
following the lead. Two types of surgical
robots are currently available for use in
the United States. The Food and Drug
Administration (FDA) must approve the
robotic systems, as well as each specific
type of surgical procedure to be
attempted. Several additional systems are
currently pending FDA approval.
Surgical robots are not designed to
replace the surgeon, or any team
member; they function as an extension of
the team members. Advantages of
utilizing surgical robots include the ability
to work through even smaller port
incisions. Smaller ports mean less tissue
damage, and less tissue damage means
less healing time is required for the
patient to return to normal activities.
Less physical trauma also means less pain
for the patient and less potential for
blood loss requiring blood replacement.
Reduced hospitalization time reduces the
potential for a hospital acquired infection.
Using a robotic camera provides a
superior view of the surgical site.
Traditional laparoscopes provide the
surgical team with a two dimensional
picture. Robotic scopes provide the

Instrument Continuing Education (ICE) Self-Study
surgeon with a three dimensional view.
Other team members continue to see two
dimensional views on monitor screens.
The robots do not get tired or hungry and
have to be relieved during a procedure.
Their movements are consistent in speed,
force, and form. One of the more simple
models consists of a single 'arm' that
mounts to the operating table. It may be
controlled by the surgeon utilizing a foot
pedal or voice activation with the surgeon
remaining in the sterile field at the
patient's side. The single arm typically
manipulates a traditional laparoscopic
camera or holds a retracting instrument.
The more complex model currently
available may utilize up to five 'arms'
attached to a mobile base. The surgeon
scrubbed and at the sterile field, makes
incisions for placement of the ports.
Next, the base station that has been
covered with sterile drapes is moved into
very close proximity to the patient.
Instrument arms are placed into the ports
then 'docked' to the base station arms.
As this is being completed, the surgeon
drops out of the sterile field and takes his
place at the control console. Both the
base and control console are quite large,
each being larger than a refrigerator.
These components communicate by
computer link-up so distance is irrelevant.
They can be located across the room or
across the state from each other.
Microphones and speakers allow the
surgeon and the surgical team members
who remain in the sterile surgical field to
communicate verbally. Working from the
control console, the surgeon can perform
a variety of procedures. Currently the
FDA has approved robotics for use in
open heart, urology, gynecology and
neurology procedures. Voice, hand and
foot controls are used simultaneously to
manipulate the robotic instruments.
Movements generated from the control
console can mimic every movement of
the human hand. Even better, the device
can compensate for fine muscle motor
tremors the surgeon may experience. It is
truly amazing to watch just how delicate
and precise the movements are to
IAHCSMM
accomplish each task.
The instrument list will sound familiar to
the Sterile Processing and Certified
Instrument Specialist. There will be one
or more flexible endoscopes, light guide
cable, light guide cable adaptors, camera
arm sterile adaptor, camera sterile
adaptor, instrument sterile adaptor,
graspers, scissors, large and small needle
drivers, blades, instrument arm cannula
(sheath), cannula adaptors, obturators
and reducers. Education for processing
these instrument components is vital.
There is one critical difference from
common laparoscopic instrumentation;
both the instruments and scopes have
electronic and microprocessors built into
them. The adaptors are the computer
links that connect the control console to
the operating end of the instrument.
Robotic instrumentation is even more
fragile than general laparoscopic
instruments. Currently, not all the
components can be cleaned or sterilized
by the same method. As with general
laparoscopes, current robotic endoscopes
can not be cleaned in an ultrasonic bath.
The remaining components vary in the
recommendation for ultrasonic cleaning.
All of the current robotic endoscopes may
be sterilized with gas plasma or ethylene
oxide. All components (other than the
actual endoscope) are to be steam
sterilized, and not presently approved for
processing by any other sterilization
method. Flash sterilization is specifically
NOT recommended for any of the
components. All these variances add to
the importance of thorough training and
written guidelines.
Instructions for proper cleaning begin
with the surgical team who should not
allow debris to dry in or on the
instruments. Soaking them in water or
enzymatic cleanser between operative use
and instrument processing is strongly
recommended by the manufacturer.
Flush ports and intricate movable parts
require a combination of manual and
ultrasonic cleaning. This process may
need to be repeated until the instrument
rinses clear. All instruments should be
protected from mechanical shock (being
dropped, striking other instruments, etc.)
and stress (bending, placed under heavier
instruments, etc.). As with other surgical
instruments, avoid use of hydrogen
peroxide, bleach, or alkaline-based
cleaning agents.
Packaging and sterilization of robotic
components requires a keen adherence to
processing guidelines. Improper
packaging or labeling of package
contents will contribute to utilization of
incompatible sterilization processes.
Severe instrument damage can result.
Labeling is also key to avoiding
misplacement of individually packaged
components. And as noted earlier in this
lesson, the names are similar to other
more common laparoscopic instruments.
A great deal of stress is avoided when the
proper instrumentation, in proper
working order is available to the surgical
team as requested. Attention to detail is
crucial in selecting the appropriate
packaging system and applying complete
and correct labeling of the devices.
Limited availability of these exquisitely
expensive instruments means each piece
can impact the success of every robotic
surgical procedure. The Certified
Instrument Specialist will play a vital role
in providing sterile processing support to
their facility's robotic program.
References:
Lind, Natalie; Instrumentation Resource
Course: Identification, Handling and
Processing of Surgical Instruments.
Intuitive Surgical, 2006; Instrument
Cleaning and Sterilization Instruction
Manual
Pott PP, Scharf H-P, Schwarz MLR, Today's
State of the Art of surgical Robotics,
Journal of Computer Aided Surgery, 10,2
101-132, 2005
Prosurgics - Precision Robotics for
Surgeons; http://www.prosurgics.com/
 IAHCSMM
Instrument Continuing Education (ICE)
Powered Surgical Instruments
Questions (circle correct answer):

1. Surgical robotic instruments require additional education for the 9. Surgical procedures that include the use of a robotic system
Sterile Processing team who will be responsible for reprocessing must first be approved by the FDA.
these items. True
True False
False
10. Poor labeling guidelines could result in misplacement of packaged
2. Robotic programs are relatively inexpensive to initiate in the robotic devices.
hospital. True
True False
False
11. A surgical robotic system consists of a base station, docking
3. The primary goal of surgical robotics is to reduce the number of station and arms.
people required in the operating room. True
True False
False
12. Cleaning instructions are very similar to more common laparoscopic
4. The Food and Drug Administration regulates use of surgical instrumentation.
robotic devices. True
True False
False
13. Robotic endoscopes can be sterilized using peracetic acid.
5. One advantage of using surgical robotics is reduced tissue damage True
and pain. False
True
False 14. Computer link ups allow the control console to be positioned
any distance from the patient.
6. Larger ports are required for use of robotic instrumentation. True
True False
False
15. Certified Instrument Specialists are great additions to a facilities
7. The control console provides the surgeon with a superior three robotic program.
dimensional view of the operative site. True
True False
False
8. Robotic devices are sturdy by design and require minimal Sponsored by:
protection
during processing.
True
False

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Lesson 200
May 2012
Lesson expires May 2015 Name

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