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Introduction ofRobot-assisted
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Surgical Technology: theda Vinci
Xi System
KunZheng andZhongkuanLin
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2.1 The Main Components
andCharacteristics ofthe da
Vinci Xi System
Surgical robots are an example of one of the most
cutting-edge technologies that combines medicine, mechanics, electronics, and computer science [1]. The application of robotic technology to
minimally invasive surgery is a major innovation
in this eld [2]. It not only expands the surgical
capabilities of doctors, improves the accuracy and
consistency of surgery, and shortens surgical procedure duration but also broadens the scope of
application of minimally invasive surgery [3–5].
Robot systems have the advantages of extremely
high operation accuracy, strong exibility, and
excellent repeatability and are much less affected
by operator physiological factors, such as fatigue
and emotion [6]. It has been shown to improve
surgical outcomes in the medical literature [7, 8].
The da Vinci surgical robot system is currently the
most widely used advanced surgical platform system in the world. Its tremor ltering and motion
reduction system can guarantee surgical accuracy
up to the submillimeter level [9]. Another important feature is the alleviation of anxiety about
K. Zheng (*) · Z. Lin
Department of Clinical Engineering, Children’s
Hospital of Zhejiang University School of Medicine,
Hangzhou, China
e-mail: zhengkun@zju.edu.cn; lzk@zju.edu.cn
potential damage to adjacent tissues [10]. Its supporting equipment has seven degrees of freedom,
breaking through the limit of the human hand
traits and the rotatable wrist range of motion, and
can realize exible operation in narrow anatomical areas as well [11]. The da Vinci Xi series is the
agship device of the fourth- generation surgical
robot developed by Intuitive Surgical Inc [12]. It
was cleared through the FDA510 (K) review back
in April 2014 [13]. This surgical system can be
used on both adult and pediatric patients. Da Vinci
surgical robots are widely used in general surgery,
urology surgery, thoracic surgery, gynecology
surgery, cardiovascular surgery, and head and
neck surgery [14]. The operating platform of the
robot allows the operator to grasp, cut, dissect,
approximate, ligate, cauterize, suture, transport,
and place microwave and cryogenic ablation
probes endoscopically with precise control of the
da Vinci Xi EndoWrist instruments and accessories [6].
The safe use of such a system requires additional training for the surgical team and engineering service providers. The system is considered a
major capital investment and requires facility
planning both for its installation and support in
the surgical area. The main components of the
robot system include a surgeon console, a patient
operation platform and an image processing platform, which are used together with endoscopes
[14, 15], da Vinci Xi EndoWrist instruments, and
accessories, as shown in Fig.2.1.
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
Q. Shu (ed.), Pediatric Robotic Surgery, https://doi.org/10.1007/978-981-19-9693-1_2
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K. Zheng and Z. Lin
a
b
c
d
Fig. 2.1 System composition (a) surgeon console, (b) patient surgery platform, (c) image processing platform, (d)
typical system and surgeon positions
2.1.1 Surgeon Console
to human factors engineering principles, and the
surgeon’s position can be adjusted accordingly to
The surgeon console is the workstation that
allows the surgeon to operate and control the
robot system. The surgeon can fully control the
operation, video, audio and system settings
through a sitting operation. The surgeon console
is usually positioned outside the sterile area of
the operating room. The product design conforms
promote comfort and minimize fatigue and wearand- tear on the body during the operation [13,
16]. The surgeon sits by the console, with his or
her hands and feet operating the two main controllers and foot pedals, respectively, that enable
control of all the needed actions of the instrument
and the endoscope. The observation window of
2 Introduction ofRobot-assisted Surgical Technology: theda Vinci Xi System
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the console provides clear views of the patient’s
anatomy and the operating instruments, as well
as icons and other user interface functions. The
surgeon can view the three-dimensional picture
with the naked eye in the observation window.
When the surgeon carries out the operation under
the observation window, he or she may grasp the
manual controller with both hands and control
the tip of the instrument in the eld of view to
operate. During this process, the controller can
precisely and exibly control the da Vinci
EndoWrist instruments. The action ratio setting
allows the surgeon to adjust the hand-to-instrument motion ratio seamlessly, which translates
the surgeon’s hand, wrist, and nger motions
with precision, achieving real-time synchronization between the tip of the surgical instrument
and the surgeon’s hands [11]. In addition, the
multiterminal input display function of the console’s TileProTM provides the whole surgical
team with clear presentation of 3D images and
other image information of the surgical eld,
plus the patient’s ECG images and ultrasound
images as needed. In addition, according to various clinical needs, the dual-console system can
be upgraded, which can not only meet the needs
of two surgeons in joint operations but also facilitate the required training and guidance.
that the system accommodates can be attached to
other instrument arms as well. Furthermore, the
platform has a built-in voice communication system to facilitate communication among members
of the surgical team.
2.1.3 Image Processing Platform
The image processing platform is also one of the
core components of the robot system, which processes the data and image information. It mainly
consists of the electronic system module, the
endoscope control module, the video processing
module, the VIO dV module, and the vision system module. It generates high-quality video
images through advanced processing and control
algorithms. The platform is equipped with a high
luminance light source and a touchscreen monitor, plus image function capacity for up to four
times digital zoom, to achieve surgical visual
effects similar to open surgery. If equipped with
high-denition uorescence imaging capability,
it can show and evaluate the real-time perfusion
of blood vessels, bile ducts, and tissues, which is
very helpful for the surgeon to make timely clinical judgment.
2.1.2 Patient Surgery Platform
The patient surgery platform is a major operational component of the da Vinci Xi system. It
includes four instrument arms and a laser positioning-assisted system. By being positioned
next to the patient operating table with its easy
placement at any location around the patient, it
facilitates exible surgical layout and increases
the movement angle of surgical instruments.
The instrument arm can be moved appropriately to a desired position with a greater range of
motion to access a signicant intraoperative surgical workspace by the rotating adjustable overhead boom and the laser positioning-assisted
system. The endoscope and surgical instrument
2.1.4 Endoscope andEndoWrist
Instrument
The function of the da Vinci Xi electronic endoscope is to acquire high-denition (HD) threedimensional (3D) videos from the surgical eld.
The endoscope has a diameter of 8mm and has
two angle options of 0° and 30°. The EndoWrist
instrument is a multipurpose swivel wrist surgical instrument used with the system, with a diameter of 8mm and a total length of 53 cm.
EndoWrist instruments can be used for endoscopic operations during surgery, providing surgeons with natural exibility and range of motion.
It can achieve grasping, cutting, blunt and sharp
peeling, approaching, ligation, electrocautery,
suturing and other operations, which can acquire
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K. Zheng and Z. Lin
high-precision surgical results. During the operation, it is the patient-side assistant who performs
the attachment and detachment of the endoscope
and the surgical instrument in the sterile area.
Meanwhile, the surgeon at the console controls
the four arms to manipulate the surgical instruments and the endoscope.
2.2 Introduction totheBasic
Operation oftheRobot
System
2.2.1 System Start-Up
Assure that the electric power outlet intended to
be used for the robot system has been tested and
conrmed appropriately. All system components,
namely, the image processing platform, patient
operation platform, and surgeon console are connected to AC power accordingly, and each component is connected through cables as well. Press
any single power button to power the entire system. The power switch positions are shown in
Fig. 2.2. Once powered up, the robotic system
will run a self-test rst. During that period, all the
components will conduct relative activities
accordingly, and a ready sound is emitted afterwards once the system self-test has successfully
run. Make sure that there is no error code displayed on the monitor of the image processing
platform.
2.2.2 Connecting theEndoscope
totheImage Processing
Platform
The integrated cable of the endoscope is connected to the endoscope controller. If the LED
next to the connector lights up, the endoscope
detected by the system is properly connected, as
shown in Fig.2.3.
2.2.3 Positioning andDocking
ofthePatient’s Surgical
Platform
First, the boom and instrument arm were
adjusted to place the patient’s surgical platform
next to the patient operating table. Subsequently,
there are two methods for positioning and docking the patient’s surgical platform. The rst
choice is to use a Guided Setup. The system
will be set up to the preset docking position
according to the anatomical part intended to be
worked on and the position of the surgical plat-
a
Fig. 2.2 The power switch positions of the surgeon console (a), patient operation platform (b), and image processing
platform (c)
b
c
ab
2 Introduction ofRobot-assisted Surgical Technology: theda Vinci Xi System
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Fig. 2.3 Endoscope connection. (a) the integrated cable of the endoscope to the endoscope controller; (b) the LED
light indicates that the system is connected
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a
Fig. 2.4 Equipment installation before (a) and after (b). (a) the instrument housing into the sterile adapter; (b) if you
hear the completion prompt sound means the device has been installed
form selected from the patient’s surgical plat-
b
2.2.4 Equipment Installation
form touch pad. Guided setup is the easiest way
to precisely place the patient’s surgical platform. However, if the Guided Setup cannot
reach the desired position, by using manual
controls, the height of the boom and the extension of the instrument arm can be adjusted to
reach the appropriate positioning and surgical
movement range.
First, make sure that the wrist of the instrument is
straightened and the jaws are closed, insert the
end of the instrument into the sleeve, and press
the instrument housing into the sterile adapter. If
you hear the completion prompt sound, it means
that the device has been installed, as shown in
Fig.2.4.
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Fig. 2.5 Adjust the
position of the surgeon
console
K. Zheng and Z. Lin
2.2.5 Adjustment of thePosition
oftheSurgeon Console
It is important to match the system’s console
position with the dimensions of the surgeon’s
body. The seat height, armrest height, height, and
slope of the 3D observation window were
adjusted, and the depth of the foot switch panel
was adjusted by operating the ergonomic control
switch, as shown in Fig. 2.5. First, adjust the
height of the seat to ensure that the surgeon’s legs
can move exibly; second, adjust the position of
the armrest so that the surgeon can rest comfortably on it while relaxing the shoulders; nally,
adjust according to the surgeon’s personal preference. The height and slope of the 3D observation
window and the depth of the foot switch panel
can also be adjusted accordingly.
2.2.6 System Shutdown
Ensure that instruments and endoscopes are
removed from the patient’s surgical platform. Use
the channel clutch button to move the instrument
arm far away from the patient. Move the patient’s
operating platform away from the patient operating table. The Stow button on the touch screen of
the patient’s surgical platform was used to retract
the patient’s surgical platform. Press any power
button on the equipment to switch off the system.
2.3 Troubleshooting Common
Problems
As described in the previous section, the robot
system is a complex integration of many electronical mechanical and software components
that have been developed and updated over the
past 20 years. The development of this complex
system was not without challenges. For example,
between 2012 and 2018, the developer issued 25
product recalls of defects. It is important to fully
understand the safe use and maintenance of such
a system and be able to determine how to respond
when a problem arises. Users should have in
place a program to follow recall and system performance announcements issued by the vendor or
regulatory authority.
2.3.1 System Power Problems
When any components of the system cannot start
properly or cannot enter an automatic and controlled shutdown procedure, the system may
exhibit abnormal behavior.
Troubleshooting procedures:
1. Conrm that all the power cords of the sur-
geon console, patient operation platform, and
image processing platform are connected correctly to the dedicated AC power outlets.
2 Introduction ofRobot-assisted Surgical Technology: theda Vinci Xi System
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instrument arm LED indicator will light up in
amber, and a related prompt message will be displayed on the screen. In such cases, pressing the
port clutch button of the arm can release the additional force that may be applied to the patient.
2.3.3 The System Does Not Respond
If the system does not respond or work properly,
the problem must be investigated immediately
according to the protocol with troubleshooting of
the fault’s reason by the following methods:
(1) Check the information displayed on the
screen to determine whether the system is
performing a task.
(2) Press the emergency stop button on the con-
Fig. 2.6 EPO switch
2. Conrm that the power switches on the surgeon console, patient operation platform, and
image processing platform are set to the on
position.
3. Check if the Emergency Power Off (EPO)
button on the patient’s surgical platform has
been pressed. Once it is pressed, it needs to be
pressed again to reset the EPO button. The
EPO switch is shown in Fig.2.6.
4. Check if the blue system cable between the
patient’s operating platform, the surgeon
console and other core equipment is connected appropriately.
trol panel of the patient’s operating platform
or the surgeon console.
(3) Press the fault recovery button on the touch
pad or touch screen to conrm proper system
functioning.
(4) Press any power button on the device to
restart the system.
(5) If the system cannot be restarted, you need to
mandatory shut down and then press any
power button to start again .
(6) If the problem persists, contact the vendor
for further assistance.
2.4 Preventive Maintenance
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2.3.2 Accidental Movement
When the instrument arm is overloaded, it may
cause accidental movement. Various factors can
contribute to this problem, including applying
excessive force to the patient and interfering with
the patient’s surgical platform components. If the
system detects any movement, the corresponding
Preventive maintenance (PM) is an important
measure to ensure that the robot system is in a
safe and optimal working condition. Clinical
engineers and manufacturers regularly maintain
the system. The specic maintenance tasks are
shown in Table2.1. PM should be carried out at
least once every half year during normal system
operation and also required after troubleshooting,
component or part replacement.
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K. Zheng and Z. Lin
Table 2.1 Preventive maintenance items and contents
Maintenance
item Content
Preliminary
inspection
Equipment
function check
Service mode
function test
Electrical
safety test
Other tests Check system software
(a) Appearance inspection of the
equipment
(b) Inspection of the connection
and condition of each power
cord
(c) Inspection of the connection
between the components
(d) Inspection of the data
transmission ber
(e) Calibration of time
(a) Drive check
(b) Battery status check
(c) Touch screen function check
(d) Robot arm movement range check
(e) Surgeon side console zero
motion check
(f) Surgeon side console movement
and brake function check
(g) Vision cart display support arm
check
(h) Trolley lter cleaning check
(i) HRSV video check
(j) SSC touch screen function check
(k) PSC touch screen function check
(l) VSC touch screen function
check
(m) VSC video system function
check
(n) Check system log
(a) SUJ-Z count
(b) USM sensor range detection
(c) USM braking performance
detection
(d) USM motion detection of each
node
(e) USM motion resistance
detection
(f) Carriage Strength detection
(g) USM level detection
(h) USM motion range detection
(i) SSC control arm function
detection
(j) Voice communication function
detection
(k) System log processing
(l) Maintenance count reset
(a) Ground resistance test
(b) Leakage current test
compatibility
References
1. Wang W, Wang WD, Yan ZY, et al. Development
review of laparoscopic surgical robotic. CN Med
Devices. 2014;29:5–10. (In Chinese).
2. Ghani RK, Trinh Q, Sammon J, et al. Robot-assisted
urological surgery: Current status and future perspectives. Arab J Urol. 2012;10:17–22.
3. Norasi H, Tetteh E, Law KE, et al. Intraoperative
workload during robotic radical prostatectomy:
Comparison between multi-port da Vinci Xi
and single port da Vinci SP robots. Appl Ergon.
2022;104:103826.
4. Moschovas MC, Bhat S, Sandri M, Rogers
T, Onol F, Mazzone E, Roof S, Mottrie A,
Patel V. Comparing the Approach to Radical
Prostatectomy Using the Multiport da Vinci Xi
and da Vinci SP Robots: A Propensity Score
Analysis of Perioperative Outcomes. Eur Urol.
2021;79:393–404.
5. Wang RS, Ambani SN. Robotic Surgery Training:
Current Trends and Future Directions. Urol Clin
North Am. 2021;48:137–46.
6. Kallingal GJ, Parekh DJ. Rise of robotics in urologic
surgery: current status and future directions. Expert
Rev Med Devices. 2013;10:287–9.
7. Dy GW, Jun MS, Blasdel G, Bluebond-Langner
R, Zhao LC. Outcomes of Gender Afrming
Peritoneal Flap Vaginoplasty Using the Da Vinci
Single Port Versus Xi Robotic Systems. Eur Urol.
2021;79:676–83.
8. Panteleimonitis S, Pickering O, Ahmad M, et al.
Robotic rectal cancer surgery: Results from a
European multicentre case series of 240 resections and comparative analysis between cases
performed with the da Vinci Si and Xi systems.
Laparoscopic, Endoscopic and Robotic Surgery.
2020;3:6–11.
9. Yang LS, Hou ZS, Tang W, et al. Development of
Surgical Robots in Recent Years. Zhongguo Yiliao
Qixie Zazhi. 2023;47:1–12. (In Chinese)
10. Hong W, Jin L. Overview of the Development of
Spatial Positioning Accuracy Testing Technology for
Surgical Robots. Zhongguo Yi Liao Qi Xie Za Zhi.
2023;47:32–7. (In Chinese)
11. Ahmad A, Ahmad ZF, Carleton JD, et al. Robotic surgery: current perceptions and the clinical evidence.
Surg Endosc. 2017; 31:255–63.
12. Liu H, Xu M, Liu R, et al. The art of robotic colonic
resection: a review of progress in the past 5 years.
Updates Surg. 2021;73:1037–48.
13. Robotics Business Review. Intuitive Surgical
Receives FDA Approval for New da Vinci Xi. 2014.
https://www.roboticsbusinessreview.com/health-
2 Introduction ofRobot-assisted Surgical Technology: theda Vinci Xi System
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medical/intuitive_surgical_receives_fda_approval_
for_new_da_vinci_xi/. Accessed 1 Aug 2023.
14. Wang G, Zeng Y, Sheng X. Robotic Surgery and
Nursing. 1st ed. Springer Singapore; 2021.
15. Intuitive Surgical Inc. da Vinci Xi Surgical
System. https://www.intuitive.com/en-us/prod-
ucts-and-services/da-vinci. Accessed 1 Aug
2023.
16. Catchpole K, Bisantz A, Hallbeck SM, et al.
Human factors in robotic assisted surgery:
Lessons from studies ‘in the Wild’. Appl Ergon.
2019;78:270–6.
Robotic Operating Room
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Conguration
HangYanZhao andChunyanZhan
3
3.1 Robotic Operating Room
Conguration
The area of the da Vinci Robotic Operating
Room is recommended to be approximately
60m2 to easily move the equipment exibly. In
the overall layout, fully consider the use of
doors, power sockets and overhead structures.
The doctor’s console is xed on the wall outside
the central area of the operating room, ensuring
that the surgeon can look directly at the operating area and communicate with the assistant.
The patient’s surgical platform is placed on the
principle of ensuring the largest patient-side
contact area [1]. The da Vinci Xi system supports 2700 patient contact areas, which can be
placed anywhere around the patient. According
to our experience, placing the patient’s surgical
platform on the right side of the patient can meet
most operations [2]. For surgery where the target
anatomical site is not in the midline, such as kidney surgery, the patient’s operating platform
should be placed on the side of the target anatomical site. The image processing platform is
placed on the side of the end of the operating bed
to ensure that the operator of the patient operat-
H. Y. Zhao (*) · C. Zhan
Department of Pediatric Surgery Room, Children’s
Hospital of Zhejiang University School of Medicine,
Hangzhou, China
e-mail: 6200021@zju.edu.cn
ing platform can see the image processing platform components and touch screen and x the
equipment compatible insufator, energy platform, electric knife, and other equipment in the
image processing platform host, which not only
saves space but also reduces repeated movement
and connection of equipment. Display equipment is installed on the mobile arm or wall to
facilitate the operator of the patient’s surgical
platform to obtain image information from multiple angles. In the limited operating room space,
reasonably adjust the spatial layout of the power
supply, air source, various information interfaces
and medical equipment to reduce the interference of equipment layout on laminar ow, ensure
the safety of the operating environment and
improve the work efciency of relevant personnel and patient satisfaction [1].
3.2 System Cable Management
1. The system cable is 20m long, and the cable
core is optical ber. Take care to avoid trampling and bending the cable. The minimum
safe bending radius is 2.54cm, which can be
wiped with a soft cloth [1].
2. During the operation, the cable was placed
between the shaft of the endoscope and the
arm of the instrument, and the cable of the
endoscope was handled carefully during the
operation to avoid severe bending or kinking
[3].
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023
Q. Shu (ed.), Pediatric Robotic Surgery, https://doi.org/10.1007/978-981-19-9693-1_3
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