The Da Vinci Surgical System is a robotic surgical system that uses a minimally invasive surgical approach. The system is manufactured by the company Intuitive Surgical. The system is used for prostatectomies, and increasingly for cardiac valve repair, and for

renal The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; bloo ...

and

gynecologic Gynaecology or gynecology (see spelling differences) is the area of medicine that involves the treatment of women's diseases, especially those of the reproductive organs. It is often paired with the field of obstetrics, forming the combined area ...

surgical procedures."Robots as surgical enablers"
''MarketWatch''. 3 February 2005. Retrieved 17 March 2013.
. ''

The New York Times ''The New York Times'' (''the Times'', ''NYT'', or the Gray Lady) is a daily newspaper based in New York City with a worldwide readership reported in 2020 to comprise a declining 840,000 paid print subscribers, and a growing 6 million paid ...

''. 4 May 2008. Retrieved 17 March 2013. It was used in an estimated 200,000 surgeries in 2012, most commonly for hysterectomies and prostate removals. The system is called "Da Vinci" in part because

Leonardo da Vinci Leonardo di ser Piero da Vinci (15 April 14522 May 1519) was an Italian polymath of the High Renaissance who was active as a painter, draughtsman, engineer, scientist, theorist, sculptor, and architect. While his fame initially rested on ...

's study of

human anatomy The human body is the structure of a human being. It is composed of many different types of cells that together create tissues and subsequently organ systems. They ensure homeostasis and the viability of the human body. It comprises a hea ...

eventually led to the design of the first known

robot A robot is a machine—especially one programmable by a computer—capable of carrying out a complex series of actions automatically. A robot can be guided by an external control device, or the control may be embedded within. Robots may be ...

in history.

Medical uses

The system has been used in the following procedures: * Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy and ureteral reimplantation; *

Hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries ( oophorectomy), Fallopian tubes ( salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may b ...

, myomectomy and sacrocolpopexy; *

Hiatal hernia A hiatal hernia or hiatus hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngop ...

and

inguinal hernia An inguinal hernia is a hernia (protrusion) of abdominal-cavity contents through the inguinal canal. Symptoms, which may include pain or discomfort especially with or following coughing, exercise, or bowel movements, are absent in about a thir ...

repair; * GI surgeries including resections and

cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed i ...

; * Transoral robotic surgery (TORS) for head and neck cancer

Device

cmglee Cambridge Science Festival 2015 da Vinci

cmglee Cambridge Science Festival 2015 da Vinci console

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 three to four interactive robotic arms (depending on the model) controlled from the console. The arms hold objects, and can act as scalpels,

scissors Scissors are hand-operated shearing tools. A pair of scissors consists of a pair of metal blades pivoted so that the sharpened edges slide against each other when the handles (bows) opposite to the pivot are closed. Scissors are used for cutt ...

, bovies, or graspers. The final arm controls the 3D cameras. The surgeon uses the controls of the console to manoeuvre the patient-side cart's robotic arms. The system always requires a human operator.

FDA clearance

The

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

(FDA) 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.

Criticism

While the use of robotic surgery has become an item in the advertisement of medical services, there is a lack of studies that indicate long-term results are superior to results following laparoscopic surgery. Critics of robotic surgery assert that it is difficult for users to learn. The Da Vinci system uses

proprietary software Proprietary software is software that is deemed within the free and open-source software to be non-free because its creator, publisher, or other rightsholder or rightsholder partner exercises a legal monopoly afforded by modern copyright and i ...

, which cannot be modified by physicians, thereby limiting the freedom to modify the operating system. The system has a cost of $2 million which places it beyond the reach of many institutions."The Slow Rise of the Robot Surgeon"
'' MIT Technology Review''. 24 March 2010. Retrieved 23 March 2013. The manufacturer of the system, Intuitive Surgical, has been criticized for short-cutting FDA approval by a process known as premarket notification, and instead of entering the market through the

510(k) The United States Federal Food, Drug, and Cosmetic Act (abbreviated as FFDCA, FDCA, or FD&C) is a set of laws passed by the United States Congress in 1938 giving authority to the U.S. Food and Drug Administration (FDA) to oversee the safety of f ...

process. The company has also been accused of providing inadequate training and encouraging healthcare 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 Surgical counter this argument by saying the same type of stray currents can occur in non-robotic laparoscopic procedures. A study published in the ''

Journal of the American Medical Association ''The Journal of the American Medical Association'' (''JAMA'') is a peer-reviewed medical journal published 48 times a year by the American Medical Association. It publishes original research, reviews, and editorials covering all aspects of b ...

'' 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 was investigating problems with the Da Vinci robot, including deaths during surgeries that used the device; a number of related lawsuits were also underway.

References

External links