Transperitoneal Approach

For the transperitoneal approach, the patient is placed in a modified flank position at an angle of 45° with the operating table, with the side of the kidney of interest facing upward. A sand bag is placed posterior to the ipsilateral flank for support. The arms are crossed over the chest and padded with egg crate padding or pillows (Fig. 7). This is to ensure that the patient's hands and arms do not rest upon the AESOP robotic arm. Alternatively if the AESOP robotic arm is not utilized, the arms can be kept outstretched on an arm board with sufficient padding placed between the arms. Neither an axillary roll nor flexion of the table is required.

The dependent leg is gently flexed at the knee, and pillows are placed between the legs. The patient is secured to the operating table with heavy cloth tape at the level of the shoulders and thighs. Additional egg crate sponge padding is placed over the shoulder and thighs to prevent abrasion and compression injuries as a result of the cloth tape. The operating room table is rotated to the extreme lateral limits to ensure that the patient is adequately secured to the table.

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