The Da Vinci robot minimizes side effects , side pain along with scars, bleeding or infection risks usually observed with conventional open surgery. Minimally invasive surgery with Da Vinci results in shortening intervention times and hospital stays. Da Vinci utilization rate is increasing, especially in urology: by the end of 2013, 80 Da Vinci robots were in service in France and 3,000 in the rest of the world. The basic version has been significantly improved through its several generations. We’ll present in this article the Da Vinci S and Si , both versions retain the strengths of the initial version while improving patient safety and facilitating surgery processes. Surgery procedures are shortened, while improving operating field raising precision of the surgeon gestures.
Da Vinci 1st surgical system tri-arms
The use of the Da Vinci robot in its basic version, launched back in 2003 , was the starting point for robotic surgery . This robot is not anymore in service. It already offered the surgeon a good three-dimensional view of the operating field, ease of movement, filtering its tremors and allowing him an improved dexterity.
- It has three articulated arms in three dimensions that offer the surgeon 7 degrees of freedom, compared to 2 degrees via conventional laparoscopy . Each arm control fine instruments , replicating the movements of the surgeon’s wrist and are interchangeable throughout the surgery .
- The 1st arm carries an endoscopic camera providing the surgeon a 3D vision of the operative field VS a 2D vision in classic laparoscopy. The surgeon controls the camera using his console commands and pedals allowing him to zoom in or move his vision field.
- The surgeon controls the camera and instruments sitting comfortably at the console, his head solidly wedged with a front support in a binocular view, the thumb and middle finger of each hand introduced into joysticks rings,forearms supported to limit fatigue and maintain concentration needed for accurate execution of the surgical procedure.
Advantages of Da Vinci S version VS Da Vinci 1st version
The S version, launched in 2006 is Da Vinci’s second-generation robot, it features the advantages of the basic version while enhancing it in many aspects:
- The accuracy of operating gestures is further enhanced by the addition of a fourth hinged arm thereby allowing the surgeon to control -in addition to the camera- 3 instruments instead of 2 only.
The surgeon can better control the surgery scene raising effectiveness of his surgical assistant. In addition, the hinges of the robotic arms can reach a wider amplitude while not needing more space, limiting possible conflict between the arms in comparison to the basic version.
- Thisversion offers the surgeon a better view of the operating field . Image magnification is permitted by a powerful zoom factor 10 upgrading to 3D High Definition initial endoscopic 3D vision (including 720p , anhigh intensity Xenon source and a digital zoom ). The system provides the urologist interactive visualizations included in his field of vision, combined with multi-source video display capabilities.
- The docking is faster and better secured: the Mobile robotic console allows enhanced precision, quicker positioning while the whole system remains very user-friendly.
There is no need to programm it in advance since surgeon has real-time control with greater accuracy.
The connection is based on high speed optical fibers. Exchange of instruments is handled through an intelligent system guaranteeing quick & secured actions.
- Real-time communications with remote teams are made possible thanks to its integrated web interface.
Da Vinci Si Versus Da Vinci S
Da Vinci Si version is a Da Vinci’s second-generation robot, launched in 2009, this version keeps the advantages of the basis & S versions while featuring new significant improvements.
- The Si version brings the observations of intervention areas to the next level with unprecedented visual quality & accuracy.
High-resolution view of anatomical structures in HD with natural colors is made possible thanks to improved 3D Endoscopic vision compatible with fluorescence imaging , switching to 1080p resolution (in comparison to 720p with version S),
as well as integration of an ultra light and HD smart camera equipped with integrated commands granting the operator with fast and precise focusing.
- It provides to the medical team with two complementary sources helping to picture the operating field in 3D (for example , ultrasound or electrocardiogram ) this is achieved thanks to multi-source screens system. The friendliness of the user interface is enhanced by the simplicity of vision and preoperative settings via new touch screen with special controls & symbols.
- The urologist gains a better control over his manipulations settings as well as video and audio transmissions thanks to new touchpad and an integrated control system.
In addition, each surgeon profile can be stored in a program for quick configuration before the next surgery.
- The system also allows to connect a second console, particularly useful for teaching sessions since double command allows a senior surgeon to safely guide the gesture of a surgeon in training course.
- The simplification of medical team tasks reduces preparation and intervention times, optimizating operating room costs.
The only drawbacks of S and Si versions are their acquisition costs.
It is important to keep in mind the critical role played by urologist surgeon experience and competence which are the key elements for successful interventions.
Also important to note that the risks specific to each medical procedure and each patient remain while the use of the robot cannot annihilate them.
Dr. DAVODY speaks in his own name and receives no sponsorship from INTUITIVE SURGICAL company.