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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, increasingly for cardiac valve repair and for
renal In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and right in the retrop ...
and gynecologic surgical procedures."Robots as surgical enablers"
''MarketWatch''. 3 February 2005. Retrieved 17 March 2013.

. ''
The New York Times ''The New York Times'' (''NYT'') is an American daily newspaper based in New York City. ''The New York Times'' covers domestic, national, and international news, and publishes opinion pieces, investigative reports, and reviews. As one of ...
''. 4 May 2008. Retrieved 17 March 2013.
It was used in an estimated 200,000 surgeries in 2012, most commonly for hysterectomies and
prostate The prostate is an male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemica ...
removals. The system is called "da Vinci" in part because
Leonardo da Vinci Leonardo di ser Piero da Vinci (15 April 1452 - 2 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 o ...
's study of
human anatomy Human anatomy (gr. ἀνατομία, "dissection", from ἀνά, "up", and τέμνειν, "cut") is primarily the scientific study of the morphology of the human body. Anatomy is subdivided into gross anatomy and microscopic anatomy. Gross ...
eventually led to the design of the first known
robot A robot is a machine—especially one Computer program, programmable by a computer—capable of carrying out a complex series of actions Automation, automatically. A robot can be guided by an external control device, or the robot control, co ...
in history.


Medical uses

The system has been used in the following procedures: *
Radical prostatectomy Prostatectomy (from the Greek , "prostate" and , "excision") is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other ...
, pyeloplasty, cystectomy,
nephrectomy A nephrectomy is the surgical removal of a kidney, performed to treat a number of kidney diseases including kidney cancer. It is also done to remove a normal healthy kidney from a living or deceased donor, which is part of a kidney transplant pro ...
and
ureter The ureters are tubes composed of smooth muscle that transport urine from the kidneys to the urinary bladder. In an adult human, the ureters typically measure 20 to 30 centimeters in length and about 3 to 4 millimeters in diameter. They are lin ...
al reimplantation; *
Hysterectomy Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes ( salpi ...
, 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 laryng ...
and
inguinal hernia An inguinal hernia or groin 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 absen ...
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 Head and neck cancer is a general term encompassing multiple cancers that can develop in the head and neck region. These include cancers of the mouth, tongue, gums and lips (oral cancer), voice box ( laryngeal), throat ( nasopharyngeal, orophary ...
; *
Lung transplantation Lung transplantation, or pulmonary transplantation, is a surgical procedure in which one or both lungs are replaced by lungs from a donor. Donor lungs can be retrieved from a living or deceased donor. A living donor can only donate one lung lobe ...
, the da Vinci System has been used in the world's first fully robotic surgery of this kind thanks to a pioneering technique.


Device

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
scalpel A scalpel or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various handicrafts. A lancet is a double-edged scalpel. Scalpel blades are usually made of hardened and tempered ...
s,
scissors Scissors are hand-operated shearing tools. A pair of scissors consists of a pair of 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 cutting var ...
, 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 List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...
(FDA) cleared the da Vinci Surgical System in 2000 for adult and pediatric use in urologic surgical procedures, general
laparoscopic Laparoscopy () is an operation performed in the abdomen or human pelvis, pelvis using small Surgical incision, incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few ...
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 Laparoscopy () is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.Medli ...
. Critics of robotic surgery assert that it is difficult for users to learn. The da Vinci system uses
proprietary software Proprietary software is computer software, software that grants its creator, publisher, or other rightsholder or rightsholder partner a legal monopoly by modern copyright and intellectual property law to exclude the recipient from freely sharing t ...
, 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 ''MIT Technology Review'' is a bimonthly magazine wholly owned by the Massachusetts Institute of Technology. It was founded in 1899 as ''The Technology Review'', and was re-launched without "''The''" in its name on April 23, 1998, under then pu ...
''. 24 March 2010. Retrieved 23 March 2013.
The manufacturer of the system, Intuitive Surgical, has been criticized"Identification of predicate creep under the 510 (k) process: A case study of a robotic surgical device"
'' PLoS One''. 28 March 2023. Retrieved 8 October 2024.
for short-cutting FDA approval by a process known as 510(k) premarket notification instead of entering the market through a more stringent premarket approval 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 ''JAMA'' (''The Journal of the American Medical Association'') 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 ...
'' 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. , 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.


Use in popular media

Doctors in Japan were considering promoting the procedure for cardiac surgery. A way to show this, both its good and bad sides is through visual media. 2018 Japanese drama Black Pean takes on this challenge, showing both sides' point of view. Two University Hospitals are competing to be the best in the Cardiac Surgery Department. One, Tojo, has the best traditional surgeons, while the other, Teika, is all about researching and implementing the most recent technology. With this, Teika sends its technical specialist to Tojo to try to convince them to update their techniques, including the use of the Da Vinci robot (named in the drama as Darwin). Newhart Watanabe International Hospital, a pioneer in Da Vinci surgery for the heart in Japan, was used as background for the drama, with Dr. Gou Watanabe providing technical support. In ''
Grey's Anatomy ''Grey's Anatomy'' is an American medical drama television series focusing on the personal and professional lives of surgical internship (medicine), interns, residency (medicine), residents, and attending physician, attendings at the fictional ...
'' season 5 episode 23, Chief of Surgery Dr. Richard Webber (played by James Pickens Jr.) reveals to Chief Resident Dr. Miranda Bailey (played by Chandra Wilson) that he has purchased a Da Vinci surgical robot to entice her to choose general surgery over the paediatrics fellowship she is considering under the supervision of Dr. Arizona Robbins (played by Jessica Capshaw).


See also

* ZEUS robotic surgical system — A robotic surgical system discontinued in 2003 * Sina Surgical System — Iranian surgical system


References


External links

* * {{YouTube, id=6At3zIwwk7Q, title="Live robotic da Vinci radical prostatectomy during EAU congress" by European Urological Association. Surgery Surgical robots