The da Vinci robotic surgery system has been for more than twenty years the leading device for soft tissue robotic surgery. For people entering the world of robotic surgery it might be confusing the reference to the da Vinci “generations”, But it is important to know how changes did evolve to foresee the possible future.
1st generation: da Vinci Standard
The first generation, the da Vinci Standard, came to the market in December 1999. The basic concept and even the design of some of the components have remained without substantial modifications through the next generations.
It was a system for the remote manipulation of an endoscope and surgical instruments, with three basic components: the surgeon´s console, the patient-side cart and the vision cart. Adding to telemanipulation, the system introduced relevant improvements like 3D visualization and a wrist articulation in the surgical instruments.
The matching of telemanipulation with minimally invasive approach surgery was the nudge that robotic surgery required to start a revolution.
2nd generation: da Vinci S
In 2006 Intuitive launched the da Vinci S. Improvements were introduced in the hardware and in the software. The patient-side cart adopted a more light appearance, but with the same basic design with four arms mounted in the four sides of a central column. The arm facing the surgical table was the camera arm. The surgeon´s console, including the pedal-board, remained quite similar.
However, notice that technology has been evolving quite fast. The original pedal-board did have a long central pedal for camera focus which is no longer required with autofocus systems. Also the camera arm did have a strong counter-weight as the original double optic endoscopes with camera heads were quite heavy. High definition image was introduced through the S generation (da Vinci S HD).
3rd generation: da Vinci Si
The third generation, the da Vinci Si (year 2009) introduced relevant changes. Most important, the brain of the system was transferred from the surgeon´s console to the vision cart. Apart from allowing the surgeon console to adopt a more stylish appearance this was a relevant move for improvements in generations to come. For example it allowed for the use of a double console, with priceless possibilities for surgical learning. The communication between the elements of the system was simplified to two optic cables.
The patient side cart remained similar.
A touch-screen was added in the arm rest to allow for system configuration. This can be done also by an assistant at the touch-screen in the vision cart.
4th generation: da Vinci Xi
The currently available is the fourth generation, the da Vinci Xi. It was launched in 2014. Notice that the surgeons´s console is quite similar to that of the da Vinci Si. But a radical was change was this time introduced in the patient-side cart.
The most obvious modification is that the four arms are no longer at the sides of a column, but inserted at a platform that is suspended above the surgical field. The freedom for different set-up configurations and the change from one to another is radically improved. Moreover, the is no longer a fixed camera-arm. Every insertable tool, including the camera, is 8mm, and can be inserted in any arm, numbered 1 through 4.
The da Vinci X is an hybrid between the 3rd and the 4th generations. The patient-side cart preserves the platform of the Si, modified to support the Xi endowrist instruments.
It was designed to reduce costs.
The da Vinci SP (Single Port) was originally designed on the Si platform, but it never reached the market in this form. The available device is the da Vinci Xi SP.
The four arms (camera and three instruments) use the same cannula, so at the surgical field they have to first diverge and then merge again.
The Single Port access might have advantages is some clinical situations.
The surgical simulator of the da Vinci has also evolved through time. The hardware of the original Skills Simulator was designed as a backpack attached to the surgeon´s console.
The current SimNow is designed to be used with a strong on-line support . It is personalized for every surgeon and has and great learning and teaching potential.
So, the current concept of the da Vinci (Xi) surgical system is that it can be used in a variety of configurations, depending of every particular use or clinical situation.
“A future of care that is less invasive and profoundly better” is the claimed vision of the company. For more information visit Intuitive Surgical web.
J Granell, May 2023.
Head and Neck Robotic Surgery 