The da Vinci Surgical System

Integrating robotic technology into clinical medicine has been a sought-after goal for decades. This desire has manifested itself in a wide range of human-robot interfaces. On one end, fully automated surgical robots have been envisioned to perform techniques in the absence of human intervention. On the other, remote-controlled robotic technology offers a true master–slave relationship between human and robot. Although there have been many implementations of robotic-assisted surgical systems along this spectrum, the most successful and penetrant system has been the da Vinci Surgical System, which enables remotely controlled laparoscopic surgery.

Predecessors of the da Vinci Surgical System

The first publicized use of robotics within surgery was ARTHROBOT in 1983. This instrument, used at the University of British Columbia in Vancouver, was developed by Dr. James McEwan and used by orthopedic surgeon Dr. Brian Day for arthroscopic procedures. In 1985, the PUMA 650, developed by Unimation, was used for computed tomography (CT)–guided stereotactic brain biopsies. PROBOT, developed in 1988 at Imperial College London, allowed for fully automated resection of prostatic tissue, after input from the urologic surgeon.

From these technologic developments arose the concept that remotely operated robots could be used to perform telesurgery. Backed by funding from the Defense Advanced Research Projects Agency (DARPA) and National Aeronautics and Space Administration (NASA), SRI International (founded as Stanford Research Institute) championed the initial efforts to develop surgical technologies that could be used in hazardous situations, such as the battlefield. Computer Motion, Inc. joined these research efforts and introduced the ZEUS system, a three-armed robot with AESOP (Automated Endoscopic System for Optimal Positioning), a voice-activated endoscopic arm ( Figs. 5-1 and 5-2 ). The powerful capabilities of this technology were demonstrated on September 7, 2001, when a 68-year-old woman in Strasbourg, France, underwent a successful cholecystectomy performed remotely in New York by Dr. Jacques Marescaux, later coined the “Lindbergh operation.” Concurrently, Intuitive Surgical developed the da Vinci Surgical System, based on SRI research efforts, and obtained U.S. Food and Drug Administration (FDA) approval in 2000. Intuitive Surgical merged with Computer Motion, Inc. in 2003 to develop the earliest versions of the current da Vinci system.

Figure 5-1

AESOP (Automated Endoscopic System for Optimal Positioning) system, a predecessor to the da Vinci Surgical System.

(From Regan JJ: Robotics and computers in minimally invasive spine surgery. Spine Universe. Montclair, NJ. .)

Figure 5-2

ZEUS robotic surgical system.

(Right, from Sung GT, Gill IS. Robotic laparoscopic surgery: a comparison of da Vinci and Zeus systems. Urology. 2001; 58:893-898. Left, from .)

Evolution of the da Vinci system

Since its introduction into the surgical realm, the da Vinci system has undergone multiple iterations of improvement and optimization ( Box 5-1 ; Figs. 5-3 to 5-7 ). Each system continues to have three general components: a surgeon’s console, an endoscopic equipment and image processing tower, and the patient-side cart. The laparoscopic camera projects a three-dimensional image with up to 10× magnification to the surgeon’s console and requires a specialized arm to control it. The additional robotic arms are capable of using a spectrum of laparoscopic tools, providing seven degrees of freedom for surgical tasks.

BOX 5-1

da Vinci Standard Surgical System

  • Introduced 1999

  • FDA approval 2000

  • Introduction of fourth arm 2003

da Vinci S system

  • Introduced 2006

  • Tile Pro multi-input display for integrated viewing of information

  • Monitor built into patient-side cart

  • Rapid instrument exchange

da Vinci Si system

  • Introduced 2009

  • Simplified user interface

  • Dual console system

  • Ergonomic upgrades

  • High-definition camera

  • Single-site instrumentation introduced 2011 (see Fig. 5-5 )

  • Firefly fluorescence imaging capabilities 2011 (see Fig. 5-6 )

  • EndoWrist One vessel sealer and stapler introduced 2012 (see Fig. 5-7 )

  • Surgical simulator

da Vinci Xi system (see Fig. 5-8 )

  • Introduced 2014

  • Redesigned instrument architecture to allow for multiquadrant surgery and camera placement in any robotic arm

  • Longer, thinner instrument arms to improve reach

FDA, U.S. Food and Drug Administration.

Iterations of the da Vinci System

Figure 5-3

Evolution of da Vinci Surgical System: standard model ( top, 1999), S ( middle, 2006), and Si ( bottom, 2009) systems.

(Copyright © Intuitive Surgical, Inc., Sunnyvale, CA.)

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Sep 11, 2018 | Posted by in ABDOMINAL MEDICINE | Comments Off on The da Vinci Surgical System

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