da Vinci Surgical Systems (Intuitive Surgical, Inc.) for Performing Robotic-assisted Surgery

This Special Report examines the clinical literature on the various surgical procedures for which da Vinci® Surgical Systems (Intuitive Surgical, Inc., Sunnyvale, CA, USA) are used. Because we identified many relevant publications in PubMed using the search dates January 1, 2010, through November 10, 2015, for this report, we reviewed only abstracts of the systematic reviews (of which there were 58) published in 2015.

Da Vinci systems for robotic-assisted surgery have been used mainly in the fields of urology (primarily prostatectomy), gynecology (primarily hysterectomy), general surgery, and cardiothoracic surgery. Use of da Vinci Surgical Systems is an alternative to use of laparoscopic devices for performing minimally invasive surgery.

Intuitive Surgical has three da Vinci systems: da Vinci Xi®, da Vinci Si®, and da Vinci Si-e®. Each system has three main components: a patient-side chart, a surgeon console, and a vision system cart. The patient-side cart is the actual robot and contains the multi-arm surgical robotic assistant with detachable instruments. The surgeon console is a workstation with a surgical field viewer and hand and foot controls to operate the robotic arms, endoscope, and surgical instruments. The vision system cart has the central processing unit and includes a surgical video system for the high-definition three-dimensional (3-D) endoscope, an audio system, and a viewing monitor for the operating room team (see the ECRI Institute Health Devices report: Choosing a Surgical Robot: The da Vinci Xi, Si, and Si-e Compared).

In 2014, with the introduction of the da Vinci Xi, Intuitive's newest system with several new features and capabilities, the company announced its intent to promote the system for additional uses, including colorectal surgery (under general surgery), mitral valve repair and replacement, and hernia repair (see Investor Presentation Q4 2014). Intuitive Surgical's Annual Report for 2014assesses current applications for its devices and estimates future use (see Intuitive Surgical 2014 Annual Report).

The da Vinci Xi surgical robotic system (see ECRI Institute Health Devices report: Choosing a Surgical Robot: The da Vinci Xi, Si, and Si-e Compared) has four robotic arms and is designed for procedures that require a substantial range of motion and involve large surgical fields, such as colorectal procedures and procedures that would otherwise be performed as open surgery. One arm operates the endoscope, one arm for each of the surgeon's hands, and the fourth arm can be used by the surgeon to alternate with one of the other two "surgical" arms, or by an assistant surgeon if a dual console is being used. The Xi system is not compatible with the da Vinci Single-Site instruments developed by Intuitive for single-incision procedures. The robot arms are mounted above the patient and may be useful for procedures that cover large areas of the body and require shifting the arms from one surgical field to another. These arms are thinner and have a wider range of motion than those of the Si and Si-e. The da Vinci Xi's instruments are also longer. According to Intuitive, these features assist with procedures in which surgical access is difficult, especially colorectal and gynecologic oncology procedures.

The Xi uses a high-definition 3-D endoscope for real-time color images of the surgical site, as do the other two models. The Xi can use Intuitive's Firefly Fluorescence Imaging system (see ECRI Institute Firefly Product Brief). The Firefly system is designed to provide real-time fluorescence image-guided surgery in which contrast agents (near-infrared fluorescent dyes) are used to identify vessels, bile ducts, and tissue perfusion. The da Vinci Xi's endoscope has a 33% larger field of view than the other two systems and can be attached to any of the arms.

The da Vinci Si has four robotic arms but fewer of the da Vinci Xi's advanced features. The Si can be used to perform procedures through a single incision (endoscope and surgical instruments are inserted into the same incision), which is enabled by the da Vinci five-lumen single-site port, curved cannulae, and single-site instruments.

The Si-e is identical to the Si, but has one less robotic arm. Of its three arms, one supports the endoscope and one is for each of the surgeon's hands. The Si-e can also be used to perform procedures through a single incision, using the single-site instruments. In these models, the robot...