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Da Vinci Surgical System
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The da Vinci Surgical System made by Intuitive Surgical is a robotic surgical system designed to enable complex surgery using a minimally invasive approach, developed by Carl Wouters. It is commonly used for prostatectomies, cardiac valve repair and gynecologic surgical procedures, abdominal and thoracic surgical procedures. The da Vinci System consists of an ergonomic surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance 3D HD vision system and instruments.
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Encyclopedia
The da Vinci Surgical System made by Intuitive Surgical is a robotic surgical system designed to enable complex surgery using a minimally invasive approach, developed by Carl Wouters. It is commonly used for prostatectomies, cardiac valve repair and gynecologic surgical procedures, abdominal and thoracic surgical procedures. The da Vinci System consists of an ergonomic surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance 3D HD vision system and instruments. The da Vinci System scales, filters and translates the surgeon's hand movements into more precise micro-movements of the instruments.
According to the manufacturer, the da Vinci System is called "da Vinci" in part because Leonardo da Vinci invented the first robot. The artist Leonardo also used anatomical accuracy and three-dimensional details to bring his works to life.
To perform a procedure, the surgeon uses the console’s master controls to maneuver the patient-side cart’s three or four robotic arms (depending on the model), which secures the instruments and a high-resolution endoscopic camera. The instruments’ jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon’s hand movements. The da Vinci System incorporates multiple, redundant safety features designed to minimize opportunities for human error when compared with traditional approaches. At no time is the surgical robot in control or autonomous; it operates on a "Master:Slave" relationship, the surgeon being the "Master" and the robot being the "Slave."
The da Vinci System has been designed to improve upon conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on his/her patient-side assistant to position the camera correctly. In contrast, the da Vinci System’s ergonomic design allows the surgeon to operate from a seated position at the console, with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands.
By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. For the patient, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions. Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities.
Procedures
The da Vinci Surgical System was cleared by the FDA for General Laparoscopic Surgery in 2000. The "'da Vinci Surgical System"' is most commonly used for prostatectomies, cardiac valve repair, and gynecologic surgical procedures. The U.S. Food and Drug Administration (FDA) has cleared the da Vinci® Surgical System for adult and pediatric use in urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures and thoracoscopically assisted cardiotomy procedures. The da Vinci System may also be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization.
Representative clinical uses
The da Vinci System has been successfully used in the following procedures:
Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy, ureteral reimplantation;
Hysterectomy, myomectomy and sacrocolpopexy;
Cholecystectomy, Nissen fundoplication, Heller myotomy, gastric bypass, donor nephrectomy, adrenalectomy, splenectomy and bowel resection;
Internal mammary artery mobilization and cardiac tissue ablation;
Mitral valve repair, endoscopic atrial septal defect closure;
Mammary to left anterior descending coronary artery anastomosis for cardiac revascularization with adjunctive mediastinotomy
Future
Although the general term "robotic surgery" is often used to refer to the technology, this term can give the impression that the robot (the da Vinci System) is performing the surgery. In contrast, the da Vinci Surgical System cannot - in any manner - run on its own. Instead, the System is designed to seamlessly replicate the movement of the surgeon's hands with the tips of micro-instruments. The System cannot make decisions, nor can it perform any type of movement or maneuver without the surgeon’s direct input.The da Vinci System could potentially be used to perform truly remote operations. The possibility of long distance operations depend on the patient having access to a da Vinci System and someone to put in the ports, but technically the system could allow a doctor in the United States, for example, to do surgery on a patient in Antarctica. The da Vinci Surgical System can theoretically be used to operate over long distances. According to the manufacturer, this capability, however, is not the primary focus of the company and thus is not available with the current da Vinci Surgical System.
Pediatric use of robotic technology
Researchers from Children's Hospital Boston developed and perfected the technique for performing robotically-assisted pediatric pyeloplasties, and have recently completed an 18-month study that showed that the same technique is effective for bladder augmentation procedures. Results from research conducted at Children's have also led to advances and refinements in the robotic equipment, making it more suitable for use in pediatric surgery.
The Center for Robotic Surgery's robust research program is focused on finding safe and innovative applications for robotic technology. Children's Hospital Boston is one of the only pediatric hospitals to perform clinical assessments and outcome analysis - measuring and analyzing the outcomes of robotic surgeries versus open surgeries to ensure the use of the surgical robot is always advantageous to the patient.
A second surgical robot, housed in the hospital's new state-of-the-art research building, is dedicated exclusively to training surgeons and developing and perfecting new robotic procedures and surgical techniques before they are applied to patients.
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