The focus of this chapter is how to set up the da Vinci Xi robot for surgery. Da Vinci robots are the most widely used surgical robots in the world, with over 5500 machines installed globally, and have been a monopoly system for the past 20 years. The configurations of new and emerging surgical robotics are varied. A brief overview of the setup for some of these emerging robotic systems will be covered at the end of this chapter.
The da Vinci surgical system has three main components: the surgeon console, the robot cart with arms, and the vision tower ( Fig. 3.1 ). The da Vinci robot is an operator-robot system, where the surgeon sits at a console away from the patient. The surgeon sees a 10 times magnified stereoscopic three-dimensional (3D) vision of the operative field. Hand movements are digitalized and transmitted to surgical instruments attached to robot arms operating on the patient. Video is also transmitted to a vision tower to guide the bedside assistants.
Overview of components
The surgeon console ( Fig. 3.2 ) contains four main components.
The vision system or stereo viewer
Dual lenses in the surgical camera ( Fig. 3.3 ) provide depth perception by delivering a stereoscopic 3D view of the operative field. The operative field is 10 times magnified and displayed in high definition. A safety beam in the headrest must be broken to activate movement of the hand controls. If the surgeon moves their head out of the viewer, the instruments will not move. A microphone and speakers within the headrest enhance communication between the console surgeon and bedside surgical team.
Two identical hand controls ( Fig. 3.4 ) enable telerobotic intuitive hand movements of endowristed instruments inside the operative field. Movements are adjusted to remove tremor. The hand controls have finger grips for the thumb and middle finger and finger clutches that can be triggered by the index finger.
The arm board contains ergonomic controls, a touch screen, and power buttons to turn the robot on and off. Ergonomic controls can be used to adjust the positions of the stereo viewer, the arm board, and the footplate to achieve a comfortable position for the surgeon. Ideally, the surgeon should achieve a configuration that enables them to sit upright with a straight back and the arm bar beneath mid-forearm with relaxed hands. The touchscreen displays lens controls (30 degrees up, 30 degrees down), instruments in use, scaling motion (quick 1:1, normal 2:1, fine 3:1). Once configured, individual surgeon preferences can be saved and activated for easy setup for the next case.
The foot plate contains a number of pedals as shown in Fig. 3.5 . The instrument clutch, camera control, and arm swap pedals are activated using the left foot. The primary and secondary energy pedals are activated using the right foot. Pressing the left and right energy pedals activates the corresponding instruments in the surgeon’s hands.
Two surgeon consoles can be linked to enable a pilot–co-pilot arrangement. Control of the robot can then be handed back and forth between surgeons in tandem. The surgeons are not directly visible to each other and rely on communication via microphones and speakers, as well as the ability to draw animation onto the visual field.
Clutching disconnects the hand controls from the instruments. This allows safe repositioning of hand controls without moving the instruments inside the operative field. Hand controls can be repositioned individually by using the finger clutches, or both hands can be repositioned simultaneously by stepping on the clutch pedal.
A virtual reality “backpack” simulator can be added to the surgeon’s console ( Fig. 3.6 ). Compared to stand-alone simulators, backpack simulators are expensive, and access can be limited if they are placed on a console that is used for surgery in a live operating room.
Some surgeons do not use the Velcro straps on the finger controls and instead just “palm” the hand controls. The controls are spring loaded and immediately return to a neutral position when operating. For some surgeons, removing the straps allows better instrument manipulation when suturing and dissecting.
Robot cart with arms
The robot (patient) cart has four arms hanging from a gantry that attach to instruments for surgery at the bedside ( Fig. 3.7 ). The cart is motor driven to enable easy maneuverability, which can be guided by a laser aiming beam for optimal arm placement.