The da Vinci Si Model, from Intuitive Surgical, was launched in April 2009 as an advancement from the prior S Model. Three key features of da Vinci surgical systems (3D HD vision, EndoWrist instrumentation, and surgeon console ergonomics) were maintained, but improved upon for this model. Several features where added to this model over the prior. The Si Model allows dual-console capability, enhanced high-definition 3D vision, updated user interface, and OR integration capabilities.

The dual-console option (Fig. 15.2) with the Si Model has allowed improved robotic training and collaboration. Each surgeon sits at a separate console and visualizes the same operative view though the endoscope. Two modes can be used. The teaching mode allows the student surgeon to visualize the movements of the mentoring surgeon and then can be given control of the same instruments at any time. This allows real-time feedback for the trainee, improved safety for the patient, and improves operative times over teaching on a single console [2, 3]. The collaborative mode allows two surgeons to operate at the same time. One surgeon will perform the primary operation, while the assistant surgeon performs retraction or countertraction. This mode allows all working arms to be used in concert.

The enhancement of the optics and console display of the Si Model is another improvement from the prior model. The 3D image now has enhanced HD, giving the surgeon the ability to see anatomic structures with more natural colors, up to 10× magnification, and with more clarity than before. 3D visualization has been shown to improve surgeon skill and efficiency at performing certain tasks when compared to traditional 2D visualization from a standard laparoscope [4]. This 3D view and image enhancement provide a superior advantage over standard laparoscopy in terms of anatomic visualization of the operative field.

Intuitive Surgical made improvements to the surgeon interface with the robotic system with the Si Model as well. In addition to the enhancement of the visual resolution provided to the surgeon, a few more modifications were made. Improved ergonomic settings of the surgeon console allow adjustment of the display, wrist board, and footswitch panel. The display position can be modified in four different parameters to allow the surgeon to find the most ergonomic position for his or her neck and upper back. An integrated surgeon control interface on the wrist board gives control of the video, audio, and system settings to the surgeon. The settings are then stored with a unique user profile so that the individualized settings can be recalled for future cases.

Control of the robotic arms and EndoWrist instruments has been enhanced with the Si Model. The master controllers allow precise, dexterous control using scaling algorithms that enable adjustments of hand to instrument movement ratios. These adjustments and scaling provide precise, fluid motion while eliminating the natural twitch of the human hand. The foot pedal platform enables full control of the camera, instrument swapping, and energy. Different types of energy can be utilized depending on the instrument types used and the pedals that are pushed. The foot pedal platform is also scalable to support future advancements in robotic instrumentation.

As with any new technology, adoption into the OR setting can be difficult, inefficient, and time consuming. This leads to longer OR times, higher cost, and less efficient use of resources. To address these concerns, the Si Model has enhancements that focus on OR efficiency, ease of use, and simple time saving setup. First, the 3D HD camera head is more lightweight, with integrated controls for focus, illumination, and scope setup. This allows one person to fully prepare the camera once it is connected. The patient-side cart is motor driven to help facilitate a quicker and more controlled dock (Fig. 15.3). The robotic arm drapes are a one-piece system with built-in instrument adapter to allow more efficient draping of the patient cart. The communication lines for the three components (vision cart, patient cart, and surgeon console) have been designed to allow one-step cable connections, which again will save time and allow quick and efficient setup in the OR. The Si Model is a robust option for robotic surgery and is currently the most used model by da Vinci.

The fourth generation of the da Vinci surgical system was FDA approved on April 1, 2014, and unveiled at the annual SAGES meeting in Salt Lake City, UT. This model was met with much anticipation due to the expected advancements in technology that would lead to a more efficient setup, greater adaptability to multi-quadrant operations, and simplified use. Moving from the Si to the Xi Model, Intuitive made improvements to all core technologies of the surgical system resulting in a system that is more advanced but also scalable to future innovations.

First, the view at the surgeon console was upgraded with new heads-up displays that can orient the surgeon to instruments out of the field of vision, decreasing unwanted contact of the instruments with surrounding structures (Fig. 15.4). The same 3D HD magnified image remains as the hallmark of the improved visualization gained with robotic surgery . The same ergonomic adjustments to the display, wrist board, and foot pedal platform are maintained. The control screen on the wrist board now allows further functionality in regard to controlling the more advanced laparoscope, such as the ability to flip from a 30° downward view to a 30° upward view with the touch of a button. The majority of the changes for the Xi model come in the patient-side cart and vision cart.