Figure 1: Port placement for RARC with RICIC. The port for the fourth arm is “piggy backed” through a 12 mm instrument port on the patient’s left side (partially obscured by the third arm port). The fourth arm and it is port can be undocked to allow access for a stapling device for the bowel anastomosis. The camera port needs to be at least 5 cm above the umbilicus to allow room for bowel and ureteric anastomoses. Ideally, the port for the right robotic arm is placed at the site for the intended stoma; however, this was too medial to be of use in this patient.