How Do Clutches Work in the da Vinci Surgical System?
In our Dissection Manual: An Introduction to Robotics in Head & Neck Surgery, there is a chapter entitled “Driving the da Vinci.” Why drive? Is it really like driving … a car?
Let’s dive into a bit of electro-mechanics.
I often joke during our training courses:
“If an American surgeon can operate a system with five clutches, any of you can!”
(Of course, I only say this when no American surgeon is around—especially one who struggles with a European manual transmission.)
But humor aside, the concept is quite similar.
What is a Clutch?
A clutch is a mechanism that temporarily “disconnects” motion from the engine to the output system. In a car, pressing the clutch pedal disengages the transmission, preventing movement even though the engine is running.
Clutches in Robotic Surgery
Now, let’s return to the concept of telemanipulation in robotic surgery—one of the core principles of robotic surgical systems.
We use two master manipulators, where our hand movements are translated into the motion of the robotic arms (a master-slave configuration).
But the space in which our hands move is different than that where the arms of the robot do. It is easier to understand this concept if we consider virtual training. We move our hands, and the virtual arms of the robot do move in a virtual environment. But, either real-virtual or real-real, they continue to be different physical/virtual spaces.
Additionally, human surgeons have two hands, but the system controls four robotic arms.
So, we need a way to adjust and reposition as we operate, and a system to change control.
This is exactly what clutches are for.
The Five Clutches in the da Vinci Xi System
In the da Vinci Xi multi-arm there are 5 clutches: three pedals and two hand-clutches (and remember, foot clutches are activated with the left foot… as any driver knows…).
- Master Clutch (Foot Pedal). Pressing this pedal disconnects both master manipulators from the robotic arms. This allows you to freely reposition your hands without affecting the robotic instruments. You use this to adjust your hands position at the Surgeon’s Console.
- Camera Clutch (Foot Pedal). While holding this pedal, the master manipulators control the endoscope instead of the instrument arms. You can move the endoscope in any direction, closer-further, and rotate (like turning a wheel). If you try to move only one manipulator, the other will try to follow – just let go, gently.
- 4th arm Clutch (Left Foot Kick). A quick kick to the left activates this clutch. It temporarily disconnects either the right or left master manipulator and assigns it to control the fourth robotic arm (used for tasks like retraction). To return to normal control, just kick again—the clutch reverses the action.
- Hand Clutches (Levers on Each Master Manipulator). Since the da Vinci Si (3rd generation), each manipulator has its own hand clutch. Sliding it disconnects only that specific hand, while sliding both acts like the main foot clutch. Most surgeons prefer using the hand clutches over the foot clutch (it is more intuitive).
SP System Clutch (Camera Control Update)
In earlier da Vinci SP models, repositioning the common cannula required an extra fourth foot clutch.
In the current version, pressing the camera clutch opens a menu (at the display) with three camera movement options. These are selected using the master manipulator, and once the movement is performed, upon releasing the camera clutch, control returns to the instrument arms.
Although I have described the clutches of the da Vinci, every soft-tissue robotic surgery system has the same functions. Actually, for those that are “versions” of the da Vinci, they look exactly the same. Also in Hugo. In the Versius there are no pedals, and all clutches are hand-held, but do the same.
Too Complex?
Not at all—it’s just like driving!
At first, it requires practice to automate movements, but once you master it, your focus will shift entirely to the surgery itself.
J Granell. March 13, 2025
PD. Next more on clutches, brakes and the pivot point.