Fig. 2.1
The da Vinci® Surgical System with its main components (courtesy of Intuitive Surgical, Inc.)
The shared core technology of all systems offers the following distinguished features:
Physical separation of the surgeon from the patient by operating at a console rather than at the patient’s side
A three-dimensional stereoscopic image (HD for the S and Si model) with up to ten times magnification
Wrist action of the robotic instruments providing seven degrees of freedom (compared with five degrees of freedom for standard laparoscopic instruments), a range of motion greater than the human hand and with intuitive control (Fig. 2.2)
Software features such as tremor elimination and optional motion scaling up to 3:1
The following description of the main da Vinci® components are based on the da Vinci® Si Surgical System.
Fig. 2.2
Range of motion of robotic instruments (courtesy of Intuitive Surgical, Inc.)
The da Vinci® Surgical System: The Surgical Console
The surgical console is the workplace of the robotic surgeon and contains the following core elements: master controllers, stereo viewer, touchpad for preference and feature selection, left-side pod for ergonomic controls, right-side pod for power and emergency stop, and a footswitch panel for operative mode selection and energy actuation.
The master controllers (Fig. 2.3) or masters are the joysticks of the robotic surgeon. Two fingers of each hand are placed inside the Velcro straps to control the movements of the patient cart instruments.
Fig. 2.3
Master controllers (courtesy of Intuitive Surgical, Inc.)
The masters are built essentially like a human arm, with a wrist portion (orienting platform) and the elbow/shoulder joints for positioning. The wrist portion orients the instrument tip in the surgical environment. The elbow and shoulder joints move the instrument to the appropriate location in the surgical field and can be scaled to a 3:1 (fine), 2:1 (normal), or 1.5:1 (quick) ratio. The master controllers also possess finger clutches, which decouple the master from control of its instrument to allow for ergonomic repositioning of the master controllers during surgery. Research on learning curves has indicated that appropriately frequent use of master clutching appears to be a crucial part of mastering the da Vinci Surgical System as it results in workspace and ergonomic optimization.
The stereo viewer provides the video image to the surgeon including the image of the surgical site and extended system information. With the head in the viewer, the surgeon can view the 3D image in full-screen mode or can choose to swap to TilePro™ mode, which displays the 3D image along with up to two auxiliary images. Icons and text messages are overlaid on the video to provide extended information to the surgeon. The system provides 2-way audio communications with the patient cart operator by a microphone located under the viewport and a pair of speakers located in the headrest.
The touchpad is the main control interface at the Surgeon Console for system functions. The touchpad home screen provides system status, including instrument arm selection, and control selections. In dual-console mode, the surgeon can use the touchpad to assign robotic arm control between the two consoles. The center of the touchpad provides three quick setting buttons indicating settings for scope angle, zoom level, and motion scaling.
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