Q: What are da Vinci Surgical Systems and who are they made by?

A: Made by Intuitive Surgical Inc. in Sunnyvale, California, da Vinci Xi® Surgical Systems are advanced robotic-assisted surgical platforms designed to expand a surgeon’s operating capabilities and offer a state-of-the-art minimally invasive option for patients. To date, Intuitive Surgical has launched four robotic-assisted surgical system models, including the latest model, the da Vinci Xi® System.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, da Vinci Surgical Systems make it possible for skilled surgeons to perform minimally invasive procedures involving complex dissection or reconstruction.

Q: Why are the systems called da Vinci?

A: The name “da Vinci” pays homage to Leonardo da Vinci, the 15th century inventor, painter, philosopher and Renaissance man. Leonardo da Vinci is widely known for advancing the study of human anatomy. He was also intrigued by mechanics and automation, which eventually led to the design of the first known robot, "Leonardo's Robot," which was likely made around the year 1495.

Q: Does the robot perform surgeries?

A: No, it is the surgeon who performs surgeries through the robotic interface that allows the surgeon to perform minimally invasive surgery. The robot is 100% in control of the surgeon and performs precisely as the surgeon moves his hands.

Q: Is the operating surgeon in the room? Can they operate remotely?

A: The surgeon performing the procedure is located at a console in the operating room in close proximity to the patient and surgical support staff. The da Vinci Surgical Systems could theoretically be used to operate over long distances. However, optimizing the system for remote or telesurgery applications is currently not a part of the product design and development.

Q: What is the risk of having robotic surgery?

A: The da Vinci robotic surgery system is a tool and is totally in the control of the surgeon. The risk in surgery is less or equal to a normal open surgery.

Q: How safe is robotic surgery?

A: The da Vinci robotic surgery system is incorporated with several safety features:
  1. Motion scaling: The instrument moves only 1 cm when the surgeon’s hand moves 5 cm. This ensures that inadvertent movement and tremors of the surgeon hand are filtered and not transmitted at the operation site.
  2. Head sensor: The robotic arms do not move if the surgeon is not viewing the surgical field. This avoids injuries that may result in unintended arm movements when the surgeon is not concentrating his attention to the surgical field.
  3. Motion sensors: Sudden jerky movement at the surgeons end or at the robotic arms lock the arms and movement is only restored after the surgeon follows the fault recovery mode.
  4. Camera clutch: At one time either the surgical arms or the camera can be moved by the surgeon. This avoids any unintended movement.

Q: What type of surgeries can be performed by the da Vinci robotic surgery system?

A: The da Vinci robotic surgery system is very versatile and may be used by surgeons of various specialties to perform minimal invasive surgery with great precision and control, some of the ones mentioned below are:
  1. Head & Neck surgeries: Surgeries for Obstructive sleep apnea; base of tongue; naso-pharynx.
  2. Thyroid surgeries
  3. Thoracic surgeries: Esophagostomies; lobectomies; surgeries for removal of mediastinal tumors
  4. Cardiac surgeries: Totally endoscopic beating heart cardiac arterial bypass graft surgeries; mitral valve repair surgeries.
  5. Upper GI: Hepato-pancreatic-biliary surgeries; gastric surgeries including bariatric surgeries
  6. Lower GI: Colectomies; Abdominoperineal resection; Lower anterior resection
  7. Gynecological: Radical hysterectomies; benign hysterectomies; tubular ligation; fibroid removal
  8. Urology: Radical prostatectomy; partial and total nephrectomy; cystectomy with intra corporeal ileal conduit; donor and recipient nephrectomy (kidney transplant)

Q: What is the difference between robotic and laparoscopic surgeries?

A: Both robotic and laparoscopic surgeries are minimally invasive surgeries performed through small ports of entry made in the patient’s body. However, laparoscopic surgeries are straight stick surgeries which have series limitations in vision, precision and control as compared to robotic surgeries that offers 10 times magnified 3 dimensional high definition vision with instruments that exceed the dexterity of human hands. Moreover, as per extensive clinical studies laparoscopic surgeries are associated with higher rate of complications and conversion to open surgeries as compared to robotic surgeries. Higher port site trauma is associated with laparoscopic surgeries while in robotic surgeries the remote center technology ensure minimal trauma to patients at the port site. Surgeons performing laparoscopic surgeries need a very long learning curve and the outcome of surgery varies greatly depending on surgeon’s skill, however, in case of robotic surgery the outcomes are more predictable and reproducible thereby leaving little to chance.

Q. What is the da Vinci Firefly technology and how does it work?

A. Intuitive Surgical’s Firefly™ Fluorescence Imaging enables surgeons to switch between standard, visible light and near-infrared imaging during minimally invasive procedures. When a surgeon uses Firefly imaging in conjunction with an injectable fluorescent dye, tissue with blood flow is highlighted in a green color and tissue without blood flow appears gray in the surgeon's view, helping to identify target anatomy.

Q: How many robotic surgery systems are installed in the world and in India?

A: More than 3600 da Vinci robotic surgery systems are installed worldwide. And there are currently 34 da Vinci robotic surgery systems installed in India and counting.

Q: How many robotic surgeries have been performed worldwide and in India?

A: More than 3 million robotic surgeries have been performed worldwide till date and more than 13000 robotic surgeries have been performed in India so far.

Q: What does the da Vinci robotic surgery system look like?

A: The da Vinci robotic surgery system has 3 system components all linked through optical fibre:

1. Surgeon’s console:
  • It has a stereo tactic view port giving immersive 3 dimensional, 10 times magnified High Definition vision to the surgeon.
  • It has master controllers that transmit the surgeon’s hands movement precisely to the operating arms.
  • It has additional foot pedals and controls for engaging camera and the third arm

2. Vision cart – central processing and vision equipment:
  • It has a Touchscreen monitor - 24 inches / 61 cm.
  • Surgical image and control system settings
  • 3D High Definition (HD) camera with multiple Views: Wide (16:9), Full (5:4), 2x and 4x
  • CORE: the system’s central connection point where the system and auxiliary equipment connections are routed

3. Patient cart is the Operative component
a. Remote center technology
  • Fixed point in space around which surgical arms move
  • Enables movement of surgical arms while exerting minimal force on patient’s body wall

b. EndoWrist instrumentation
  • 7 degrees of freedom
  • Natural dexterity
  • Greater range of motion than the human hand

Q: What are the benefits of robotic surgery system to the patient?

A: The benefits of robotic surgery system are:
  1. Minimally invasive
  2. Low Blood Loss
  3. Shorter Hospital stay
  4. Faster recover and return to normalcy
  5. Less Pain
  6. Lower risk of complication
  7. Improved negative margins
  8. Organ preservation

Q: What training does the surgeon need to undergo?

A: Surgeons have to undergo a 5 step technological training pathway:
  1. On-line module
  2. Observation of full length procedure videos
  3. Working on the skill simulator and scoring 90% + on the identified 4 parameters
  4. Attending the familiarization workshop (wet lab) at a certified training center
  5. Performing the first few cases under an expert robotic surgery proctor

Q. What is the future of robotic-assisted surgery?

A. As the clinical issues and advancement opportunities evolve, so too will the innovation and how to solve problems. Select areas of emphasis include:
  • Imaging systems, like Firefly Fluorescence Imaging System, to enable and enhance real-time visual assessment of vessels, blood flow and tissue.
  • Developing and improving systems that are even less invasive to the body during entry such as those that use natural orifices in the body and technologies that are more precise and smart in interacting with tissue.
  • Advancing capabilities to give real-time feedback to surgeons and staff in the operating room.