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5 Versius Surgical Robot
Fig. 5.9 Instrument and visualization bedside units
Fig. 5.10 The Versius
instrument bedside unit
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Fig. 5.11 Bedside unit in sleep mode
S. Khanna and A. Barua

Arm Modes

Versius arm has seven modes (Fig.5.12). These modes can be shifted from one mode to another with the help of elbow and V-Wrist buttons placed at the instrument bedside units. These are described in the gure below.
To put the surgical arm from locked to surgical mode, the V-Wrist button is used. The sequence of modes that the arm goes though is depicted in the arm mode map below (Fig.5.13).
1. Sleep mode: In this mode, the arm is in compact storage position, and one needs
to awaken the arm by pressing the sleep button to make further use of the same.
2. Locked mode: In this mode, only the distal end of the bedside unit can be
moved. The rest of the arm stays in position to facilitate attaching the instrument to the arm before port training.
3. Unlocked mode: Unlocked mode is used when the bedside team needs to freely
move and position the arm, for example, during positioning for draping and posi­tioning the arm into an arc before port training.
4. Port training mode: This mode trains the surgical robot so that it knows the
location of the pivot around the fulcrum, on which the instruments and endo­scope move. This pivot point is located on air, at that specied three-dimensional axis, so that the abdominal wall does not need to be the pivot point as in laparos­copy. This decreases the pain signicantly since the trauma to the abdominal wall at the port sites is much lesser.
5. Instrument adjust mode: The instrument can be advanced in this mode inside the
patient cavity once the port training is complete. The arm can be manually moved with complete freedom of movement while respecting the fulcrum position.
5 Versius Surgical Robot
Fig. 5.12 Arm mode icons for a pink arm
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Fig. 5.13 Versius arm mode map showing the use of V-Wrist and elbow buttons to put the arm in various modes
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Fig. 5.14 Arm clash icon for a pink arm
S. Khanna and A. Barua
6. Surgical mode: In this mode, the surgeon can manipulate the endoscopic cam-
era and the instruments using the hand controllers on the surgeon console.
7. Instrument change mode: This mode is used to change an instrument or endo-
scope. The arm respects the fulcrum and the arm’s motion is restrained by the system, so that the arm and instrument or endoscope can only be moved in a straight line along the axis of the instrument. In this mode, the system remem­bers the instrument position upon entering instrument change mode and prevents movement deeper into the patient cavity.

Arm Clash

This robot, having multiple independent arms, has a possibility of frequent clashes if not placed optimally. A Versius arm detects an arm clash if it is pushed too hard by a user pushing or by the arm colliding with an object. If an arm clash occurs, an arm clash icon appears in the icon group of the affected bedside unit (Fig.5.14).
To resolve thearm clash
• If the clash was from manual pushing, let go of the arm.
• If the clash was from a collision, manually move the arm away from the object
in instrument adjust mode.
Instrument Compatibility, User Interface, andErgonomics
It has all the standard instruments like monopolar hook, monopolar curved scissor, bipolar Maryland grasper, cold scissor, fenestrated graspers, and nee­dle holder, all with a wristed tip. The instruments are attached to the distal end
5 Versius Surgical Robot
55
of an instrument arm after the arm drape has been fitted. Each instrument type has the same attachment head and a shaft of 6.8mm diameter. The attachment head has latches for attaching the instrument to the arm, and fins, which mechanically drive the instrument during surgery. The distal joint can rotate 720° on its own axis for greater maneuverability. The endoscopes have a 10mm diameter shaft and a 300 mm working length. It comes with 0-degree and 30-degree scopes, which can be attached 30° up or 30° down. It can be moved up–down and left–right. It provides an 81.1° of view. The magnification is 15x with 3D high-definition vision (3DHD). The surgeon needs to put on polarizing 3D glasses for 3D visualization. The head-up display has the option of visual­izing in 2D vision also if the surgeon desires so. The visualization unit needs an 11mm port, while all the instrument ports are 5mm. Applied Medical bal­loon ports are one among the validated ports for use with the 10mm robotic endoscope and 5mm wristed instruments. Inappropriate port size could lead to an incorrect fulcrum being detected during port training. One of the biggest advantages of this system is that the laparoscopic port placement can be repli­cated for any surgery and a distance of min 5–6cm from each port is enough to avoid arm clash. Post training of the arm, the instrument tip has to be a min of 2cm intracorporeally to start functioning. Apart from the robotic ports, stan­dard laparoscopic ports can be used by the assistant surgeon for additional retraction, suction, mopping with gauze, use of staplers, use of choledocho­scope, etc. The assistant surgeon can shift the elbow of the robotic arm without disturbing the intracorporeal position of the instrument and fit in at any posi­tion for putting up a port and assistance, with minimal risk of injury to the assistant surgeon due to extracorporeal movement of the instrument arms. In contrast to laparoscopic surgeries, where the standard laparoscopic endoscope needs to be repeatedly cleaned and dipped in hot water to avoid fogging, the problem of fogging of the robotic camera lens is virtually nonexistent due to constant smoke evacuation and achieving the desired electrocautery effect at very low-level settings. Although the Versius Surgical System was validated using a Wolf Endo light system, the light sources of various other companies are compatible. The instruments can be used multiple times, and the life of each instrument varies. All instruments are supplied nonsterile and must be cleaned and steam sterilized before each use. The Versius robotic system requires an Internet connection with an average upload bandwidth of up to 2Mbps for use in analyzing and improving Versius, and analyzing and improv­ing minimal access surgical techniques. This data is uploaded using a wired Ethernet connection to the Internet. Versius will function normally if there is no connection to the Internet, but data will not be uploaded. This system is indicated for adult use only. The Versius Surgical System requires no routine adjustments to maintain operation and must be serviced only by CMR Surgical or by an appointed agent (Figs.5.15, 5.16, and 5.17).
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Fig. 5.15 Versius instruments
S. Khanna and A. Barua
Fig. 5.16 Endoscopic camera
Fig. 5.17 Endoscope
angled (30°) and straight (0°)
Bedside Unit Positioning Around theOperating Table
The position of the bedside units (BSUs) varies according to the surgical procedure being planned, which again depends on what anatomical region the arms need to reach. They should always be placed parallel to the operating table, with the brake
5 Versius Surgical Robot
Fig. 5.18 Position of the BSU parallel to the operating table
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button away from the table. A maximum of three instrument bedside units can be used along with a visualization bedside unit with the Versius system. The BSUs can be placed close to each other, taking care that the V-Wrists are adequately separated, so that they do not clash on movement during the surgery (Figs.5.18 and 5.19). The BSUs should be placed so that
• The V-Wrist is not too close to other arms.
• The V-Wrist will not clash with the base.
• The arm does not need to extend any joints fully.
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S. Khanna and A. Barua
Fig. 5.19 Example of Versius system with four bedside units layout

System Connections

Surgeon console connection panel Located on the base of the surgeon console at the rear, the connection panel is where all the cables are connected to the surgeon console (Fig.5.20).
5 Versius Surgical Robot
Fig. 5.20 Surgeon console connection panel
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Fig. 5.21 Cart connection panels
The cables connected to the surgeon console are
• Surgeon console power cable (nonsterile)
• Network cable (nonsterile)
• Auxiliary screen cable (nonsterile)
• Video feed cable (nonsterile)
• Bedside unit cable(s) (nonsterile)
Connecting aBedside Unit totheSystem
The power-in and power-out sockets available on a cart connection panel are used to connect a bedside unit to either the surgeon console or another bedside unit, based on the system conguration (cabling scheme) chosen: “spider,” “daisy chain,” or “hybrid” (Figs.5.21 and 5.22).
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S. Khanna and A. Barua
Fig. 5.22 The system cabling congurations
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