At the outset, Intuitive had hopes of marketing the da Vinci for cardiovascular surgeries [2]. Instead, the wristed instruments were found to enhance urologists’ ability to work deep in the pelvis for prostatectomy, and robotic prostatectomy showed improved clinical outcomes compared to both open and laparoscopic approaches [6]. These benets lead to most prostatectomies being done robotically [7]. Gary Guthart, Intuitive CEO, recalls this episode saying, “We aimed at the heart

As the clinical value story began to unfold, new indications were developed across multiple surgical specialties, and the process of continuous innovation adapted the robotic technology to the new procedures. In 2006, Intuitive’s second­generation da Vinci “S” platform simplied the robotic arms on the bedside patient cart, allowing easier setup and instrument exchange. Continued advancements were introduced with the third-generation “Si” da Vinci platform in 2009 with rene­ments to the surgeon console and advanced instrumentation, including a stapler and vessel sealer, along with instruments for single-site surgery. In 2014, the fourth­generation “Xi” daVinci platform redesigned the robotic arms, freeing them from the column of the beside patient cart, attaching them to a moveable gantry sus­pended over the patient, which provided greater access to surgical work sites. And longer and more advanced instruments allowed a wider array of surgical procedures to be performed. The latest, fth generation, “da Vinci 5”, was launched in 2024 with improved surgeon ergonomics, enhanced 3D imaging with heads-up display menus so surgeons can manage functions like light intensity, electrocautery and suction, and others with greater efciency. It introduced rst-of-its-kind force sens­ing technology which enables the system to measure, and surgeons to feel, subtle forces exerted on tissue during surgery. The system also has over 10,000 times the computing power of Xi giving it advanced data capabilities to provide objective performance insights, leverage machine learning, and power AI opportunities into the future.

Continuous innovation has progressed beyond the multiarmed dV5 robotic plat­forms. In 2018, Intuitive introduced the da Vinci Single-Port “SP” platform, which has three operating arms and a camera that are introduced through one incision that can be as small as 2.7cm. The 6-mm-diameter instruments have wrists like their multi-armed predecessors, but they also have elbows that provide separation and triangulation of the instruments to reduce clashing. The camera is exible, articulat­ing much like an endoscope, to rise above or below the instruments to give an unob­structed view of the operative eld. While previous laparoscopic single-incision surgical techniques have attempted to do the same operations while reducing the number of laparoscopic port sites from four or ve down to one, the SP platform is exploring new ways to access operative sites to preserve healthy tissue and improve outcomes by accessing narrow spaces as in trans-anal, trans-oral, or trans-vaginal

Robotic-assisted surgery introduces signicant computing power into the operat­ing room. Intuitive’s Digital platform capitalizes on this by gathering objective data and utilizing it to help support preoperative planning, intraoperative guidance, and postoperative analytics. My Intuitive App allows surgeons to track their robotic practices from their smart device. SimNow provides simulation training for new trainees or surgeons learning new techniques. Integrated Telepresence makes it pos­sible for surgeons to obtain guidance from outside experts while in the operating room or provide educational experiences for surgeons remotely. Instrument move­ments can be analyzed as Objective Performance Indicators, to understand ef­ciency, learning curves and improve surgeon performance. The Customer Portal supplies important information about instrument and platform utilization to guide health system time and cost efciencies.

It appears certain that robotic innovation will continue to ourish as more sur­geons and companies explore ways to improve patient care using robotic technol­ogy. A review of surgical companies with exciting new surgical robots included a nonexhaustive list of 24 companies offering new robotic solutions for a wide array of surgical specialties ranging from classic intra-abdominal or intrathoracic proce­dures to orthopedic surgery and dental procedures, tumor ablation, and spine and brain surgery [9]. New imaging devices may overlap the endoscopic visualization with 3D reconstruction of CT and MRI scans to let surgeons see through solid organs to nd hidden disease [10]. Injectable molecules may identify cancer or nerves or other critical anatomic structures, allowing them to be seen within the surgical workspace [3]. And throughout it all, the computer-driven robotic devices will provide a wealth of data to be analyzed with machine learning and articial intelligence to evaluate surgical procedures, allowing surgeons and health systems to improve surgical performance and provide surgical efciency.