The Da Vinci Surgical System is a robotic surgical system made by the
American company Intuitive Surgical. Approved by the Food and Drug
Administration in 2000, it is designed to facilitate complex surgery using a
minimally invasive approach, and is controlled by a surgeon from a console.
The system is commonly used for prostatectomies, and increasingly for
cardiac valve repair and gynecologic surgical procedures. According to the
manufacturer, the da Vinci System is called "da Vinci" in part because
Leonardo da Vinci's "study of human anatomy eventually led to the design of
the first known robot in history." Da Vinci robots operate in hospitals
worldwide, with an estimated 200,000 surgeries conducted in 2012, most
commonly for hysterectomies and prostate removals. As of June 30, 2014, there was
an installed base of 3,102 units worldwide, up from 2,000 units at the
same time the previous year. The location of these units are as follows:
2,153 in the United States, 499 in Europe, 183 in Japan, and 267 in the
rest of the world. The "Si" version of the system costs on average slightly
under US$2 million, in addition to several hundred thousand dollars of
annual maintenance fees. The da Vinci system has been criticised for its cost
and for a number of issues with its surgical performance.
Overview The da Vinci System consists of a
surgeon’s console that is typically in the same room as the patient, and a
patient-side cart with four interactive robotic arms controlled from the
console. Three of the arms are for tools that hold objects, and can also act as
scalpels, scissors, bovies, or unipolar or hi. The surgeon uses the console’s
master controls to maneuver the patient-side cart’s three or four
robotic arms. 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 always requires a human operator, and incorporates multiple redundant
safety features designed to minimize opportunities for human error when
compared with traditional approaches. 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 a patient-side assistant to position the
camera correctly. In contrast, the da Vinci System’s design allows the surgeon
to operate from a seated position at the console, with eyes and hands positioned
in line with the instruments and using controls at the console to move the
instruments and camera. 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. FDA clearance
The Food and Drug Administration cleared the da Vinci Surgical System in 2000 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 FDA also cleared the da
Vinci System to 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 and ureteral
reimplantation; Hysterectomy, myomectomy and
sacrocolpopexy; Hiatal hernia repair;
Spleen-sparing distal pancreatectomy, 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 and endoscopic
atrial septal defect closure; Mammary to left anterior descending
coronary artery anastomosis for cardiac revascularization with adjunctive
mediastinotomy; Transoral resection of tumors of the
upper aerodigestive tract and transaxillary thyroidectomy
Resection of spindle cell tumors originating in the lung
Future applications Although the general term "robotic
surgery" is often used to refer to the technology, this term can give the
impression that the da Vinci System is performing the surgery autonomously. In
contrast, the current da Vinci Surgical System cannot – in any manner – function
on its own, as it was not designed as an autonomous system and lacks decision
making software. Instead, it relies on a human operator for all input; however,
all operations – including vision and motor functions— are performed through
remote human-computer interaction, and thus with the appropriate weak AI
software, the system could in principle perform partially or completely
autonomously. The difficulty with creating an autonomous system of this
kind is not trivial; a major obstacle is that surgery per se is not an engineered
process – a requirement for weak AI. The current system is designed merely to
replicate seamlessly the movement of the surgeon's hands with the tips of
micro-instruments, not to make decisions or move without the surgeon’s direct
input. The possibility of long-distance
operations depends on the patient having access to a da Vinci System, but
technically the system could allow a doctor to perform telesurgery on a
patient in another country. In 2001, Dr. Marescaux and a team from IRCAD used a
combination of high-speed fiber-optic connection with an average delay of 155
ms with advanced asynchronous transfer mode and a Zeus telemanipulator to
successfully perform the first transatlantic surgical procedure,
covering the distance between New York and Strasbourg. The event was considered
a milestone of global telesurgery, and was dubbed “Operation Lindbergh”.
Criticism Critics of robotic surgery assert that
it is difficult for users to learn and that it has not been shown to be more
effective than traditional laparoscopic surgery. The da Vinci system uses
proprietary software, which cannot be modified by physicians, thereby limiting
the freedom to modify the operation system. Furthermore, its $2 million cost
places it beyond the reach of many institutions.
The manufacturer of the system, Intuitive Surgical, has been criticized
for short-cutting FDA approval by a process known as "premarket
notification," which claims the product is similar to already-approved products.
Intuitive has also been accused of providing inadequate training, and
encouraging health care providers to reduce the number of supervised
procedures required before a doctor is allowed to use the system without
supervision. There have also been claims of patient injuries caused by stray
electrical currents released from inappropriate parts of the surgical tips
used by the system. Intuitive counters that the same type of stray currents can
occur in non-robotic laparoscopic procedures. A study published in the
Journal of the American Medical Association found that side effects and
blood loss in robotically-performed hysterectomies are no better than those
performed by traditional surgery, despite the significantly greater cost
of the system. As of 2013, the FDA is investigating problems with the da Vinci
robot, including deaths during surgeries that used the device; a number of
related lawsuits are also underway. From a social analysis, a disadvantage
is the potential for this technology to dissolve the creative freedoms of the
surgeon, once hailed by scholar Timothy Lenoir as one of the most professional
individual autonomous occupations to exist. Lenoir claims that in the "heroic
age of medicine," the surgeon was hailed as a hero for his intuitive knowledge of
human anatomy and his well-crafted techniques in repairing vital body
systems. Lenoir argues that the da Vinci's 3D console and robotic arms
create a mediating form of action called medialization, in which internal
knowledge of images and routes within the body become external knowledge
mapped into simplistic computer coding. See also
ZEUS robotic surgical system, a rival system discontinued in 2003
References Da Vinci Live Surgery Videos
"Live robotic da Vinci radical prostatectomy during EAU congress" on
YouTube by European Urological Association.
"India's 1st Da vinci Robotic Live Surgery" on YouTube by Muljibhai Patel
Urological Hospital. "da Vinci Robotic Hysterectomies /
Uterine Fibroids" on YouTube. External links
Intuitive Surgical website