Da Vinci Surgical System

The da Vinci Surgical System is the most successful and most widely used surgeon-driven robot to date.

Since its introduction in Europe in 2000 by cardiovascular surgeons, its applications have been expanding to include a number of surgical procedures, such as Nissen fundoplication, cholecystectomy, hernia repair, gastroplasty, appendectomy, and hysterectomy. The use of the da Vinci Surgical System in urologic surgery, including radical prostatectomy, radical cystectomy, adrenalectomy, pyeloplasty, donor nephrectomy, partial nephrectomy, and vasovasostomy is also rapidly evolving (32-37).

The da Vinci system consists of three major components—the surgeon's console, the patient side cart, and the vision cart.

■ Surgeon's Console: The surgeon's tool handles are serial link manipulators designated the masters. The masters act as (i) high-resolution input devices reading the position, orientation, and grip commands from the surgeon, and (ii) as haptic displays transmitting forces and torques to the surgeon in response to various measured and synthetic force cues. The console also consists of two medical grade cathode ray tube monitors that receive the image of the surgical site to display one image to each of the surgeon's eyes. The user interface at the surgeon's console consists of foot pedals and buttons, which allow the surgeon to control the system. This interface allows the surgeon to control the endoscope from the console itself, position the masters in the work space, focus the endoscope, control the cautery, and so on.

The surgeon's console also consists of an electronic controller. It is a custom-designed control computer, with a peak computational power of 384 Mflops and a sustained processing power of 128 and 256 Mflops. Redundant sensors, hardware watchdogs, and real-time error detection ensure fail-safe operation of the controller in all its states.

■ Patient Side Cart: The patient side cart consists of two instrument arms and a centrally located camera arm holding the endoscope. An optional fourth instrument arm has been recently added in an attempt to reduce one patient side assistant.

The instrument arms are designed to accurately deliver instruments with seven degrees of freedom into the body. Each instrument arm is fixed to the patient with the help of a cannula, which attaches to a cannula mount on the instrument arm with the help of cannula mount pins. To permit precise instrument tip movements, move the instrument arms position under the direction of the surgeon at the console. The surgeon's hand movements at the masters are precisely replicated at the instrument tips. A wide range of custom-made instruments (Endowrist) are available. These Endowrist instruments are fully sterilizable and are attached interchangeably to the two-tool manipulators.

Advanced Robotics and Telemanipulator System for Minimally Invasive Surgery was the first system that provided instrument mobility with six degrees of freedom.

The da Vinci Surgical System is the most successful and most widely used surgeon-driven robot to date.

The instruments used in the Zeus system closely resemble conventional surgical instruments.

The camera arm is also fixed to the patient through a cannula, which attaches to the cannula mount on the camera arm with the help of a cannula mount camera clamp. The camera arm controls the position and movement of the three-dimensional endoscope from outside the patient's body.

The set up joints hold the instrument arms and the camera arm, and are used to position the surgical cart arms to achieve optimal approach to patient's anatomy.

■ Vision System: Vision is provided by a high-resolution stereoendoscope that uses two independent optical channels, sampled by two independent three-chip charge-coupled device cameras. The image is relayed to the vision cart through a camera head attached to the endoscope. Left and right images are processed independently by the two camera control units, one each for the left and right optical paths. The vision cart also consists of two synchronizers, a focus controller, and a light source. The synchronizers process the operative image to maximize clarity and edge definition. The focus controller is operated via the foot switch on the surgeon console or two push buttons on the front panel of the focus controller. The light source provides the desired illumination during the operation and also heats the tip of the endoscope to minimize lens fogging during the operation. The distal tip of the endoscope may exceed 41°C when used, thus contact with skin and tissue may cause tissue damage.

The da Vinci system is designed to create an "immersive operating environment" for the surgeon by providing both high-quality stereovisualization and a man-machine interface, which directly connect the surgeon's hands to the motion of his surgical instrument tips inside the patient's body (38,39). The registration, or alignment, of the surgeon's hand motions to the motion of the surgical instrument tip is both visual and spatial. To restore hand-eye coordination and to provide a natural correspondence in motions, the system projects the image of the surgical site atop the surgeon's hands with the help of mirrored overlay optics. Moreover, the controller transforms the spatial motion of the tools into the camera frame of reference, so that the surgeon feels as if his hands were inside the patient's body. Lastly, the system restores the degrees of freedom lost in conventional laparoscopy by employing three degrees of freedom wrist, bringing a total of seven degrees of freedom to the movement of the instrument tip. The control system of the robot eliminates surgeon tremor, makes the instrument tip steadier than the unassisted hand, and allows for variable motion scaling from the masters to the slaves. Together with image magnification of 10X, motion scaling enables delicate motions easier to perform (40).

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