The Intuitive da Vinci 5’s top design changes: ‘This is groundbreaking for robotic surgery’

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Intuitive Surgical’s da Vinci 5 has more than 150 design enhancements and innovations since the surgical robotics developer’s fourth-generation systems, including one feature that an Intuitive leader described as “groundbreaking.”

“Da Vinci 5 looks similar to [multiport predecessor da Vinci] Xi,” Intuitive President Dave Rosa said in a discussion of the upgrades and enhancements. “It built on Xi’s highly functional design, which has been used around the world in more than 7 million procedures.”

Rosa discussed da Vinci 5’s design along with Intuitive CEO Gary Guthart and Chief Medical Officer Dr. Myriam Curet.

“Da Vinci 5 takes surgical precision to a new level,” Rosa said. “The system is designed with next-generation surgeon controllers and patient-side manipulators with additional sensors. This combination translates to super-smooth, low-resistance and highly precise motion at both slow and high speeds. Unwanted tremor and vibration filtration is the best we’ve ever brought to market.”

The da Vinci 5’s 3D surgical imaging system is the “highest quality and most natural” ever developed by Intuitive, he said, and has additional capability for future generations of surgical endoscopes and vision software.

From a computing power standpoint, da Vinci 5 has 10,000 times more than the fourth-generation Xi system for integration with the My Intuitive app, Intuitive Hub video platform, SimNow virtual reality simulator and Case Insights, which lets surgeons review their surgeries with objective performance indicators and video of critical steps.

The extra computing power could support future features and integration such as better integration of preoperative images as Intuitive brings those into the surgical field, Rosa said.

“It sets us up for our innovation teams internally to make a lot of progress over the coming years,” he said.

Intuitive’s ‘groundbreaking’ Force Feedback tech

Curet described Intuitive’s new Force Feedback technology on the da Vinci 5 as “groundbreaking for robotic surgery.” The system measures subtle forces exerted on tissue during surgery and relays that feeling back to surgeons, a feature that the device developer says is unique to the da Vinci 5 system.

“In preclinical testing, surgeons who used the Force Feedback feedback instruments on da Vinci 5 exerted significantly less force on tissue, which could translate into less tissue trauma during surgery when compared to da Vinci Xi,” she said. “With our customers, we intend to study how this could translate to real-world clinical and patient-reported outcomes as surgeons of all experience levels use this technology in a broad range of procedures.”

“We believe that the ability to measure force during robotic surgery adds an important new data stream to surgical data science,” Curet continued. “Our insights engine will incorporate real-time surgical force measurement along with the surgical data Intuitive currently collects to build analytical insights for surgeons and care teams.”

Da Vinci 5 can record interaction forces during a case when surgeons are using force-sensing instruments. The surgeon can choose to have that haptic feedback in their hands or to turn it off.

Overall, the FDA cleared da Vinci 5 for the same indications as the da Vinci Xi, except for cardiac and pediatric procedures. The Force Feedback needle driver is contraindicated for hysterectomy and myomectomy. While surgeons can still use instruments without Force Feedback, Intuitive is going to pursue the removal of those contraindications, Curet said.

“It’s very clear that there’s significant value in using the Force Feedback needle driver, so we believe that will be used in suturing steps of procedures, but there’s also significant use in retraction and getting that Force Feedback information on the force being applied to tissue.” Curet said. “… Some of that will depend on the surgeon and how much the surgeon wants to get that information during the procedure.”

Intuitive plans prospective and retrospective studies to generate clinical evidence on Force Feedback, with database studies to follow as more surgeons use the feature. Guthart expects a healthy debate among surgeons about Force Feedback, and predicts the feature will be more useful in some procedures than others.

“There will be some surgeons —particularly very experienced surgeons — who say, ‘I can see forces, I can use visual haptics’ … but even when we observe those highly experienced surgeons in lab, when Force Feedback is on versus off there’s a different amount of force that gets transmitted to the tissue,” Guthart said.

“Some of the study here will be exactly this issue of what is the difference in clinical outcome and patient experience when you turn Force Feedback on and off,” he later continued. “It won’t be a matter of opinion — this is the thing that I love — you’ll get a chance to actually see what do you feel and what do you do. That data is the data we’re going to go out and collect over time, and I think it will be fascinating and transformative.”

User experience design and surgeon training

Curet also highlighted design improvements and innovations for increased surgeon autonomy and workflow efficiency to streamline operating room workflow and potentially save valuable time during certain procedures.

“During our clinical work and clinical trials, we saw preliminary evidence that procedures done with da Vinci 5 may take less time to complete compared to cases done with da Vinci Xi,” she said.

That’s based on what Intuitive said is aggregate, qualitative analysis of data from 53 first-in-human-use cases on da Vinci 5, including 23 surgeons at novice, intermediate, and expert experience levels.

“Faster cases that don’t compromise patient safety allow for more efficient human use of precious human and capital resources at the hospital and should be well appreciated by our customers,” Curet continued.

Intuitive is starting to see growth in emergency and short-scheduled surgery volumes with da Vinci X and Xi, Guthart said. Da Vinci 5 could accelerate that trend if it proves easy to learn and delivers higher throughput over time.

The ability for the surgeon to be more autonomous means he or she is less dependent on the expertise of the care team,” Curet said in a folllow-up. “The after-hours care teams have to do a larger breadth of procedures, so they may not know as much in-depth. I think that’s where da Vinci 5 can really bring value.”

Da Vinci 5 training for surgeons who are experienced with da Vinci Xi “is pretty rapid and actually can be done at the hospital” said Curet, citing Intuitive’s IDE studies and experience from the preclinical study lab. ” For surgeons who are new to robotics who are going to learn on DV5, they will follow our typical pathway that they would have followed for Xi, which is multilearning modality, multiday, multihour training pathway until they reach the ability to use the system independently.”

Intuitive’s da Vinci 5 ergonomics design

Intuitive also designed the Da Vinci 5 system with ergonomic features to help surgeons make the most of every day.

Rosa said Intuitive’s design team “prioritized the often undervalued area of ergonomics” for surgeon comfort and stamina in the surgeon’s console, which “allows for a broad range of surgeon postures [and] less physical strain to the surgeon during the operation.”

To help surgeons be more productive on a daily basis and to lengthen their professional lifespans, Intuitive designed the surgeon’s console with musculoskeletal problems, repetitive motion issues and fatigue in mind. Intuitive also designed the latest system with easy-to-reach controls for the rest of the care team.

“We are all aware of the increasing need for surgeons around the world,” Curet said. “Intuitive continues our commitment to improving ergonomics with da Vinci 5 enhancements that could improve care team satisfaction and enable higher productivity during a single operative case and over a career.”

The latest surgeon console can fit different body types, including surgeons who are pregnant.

Previously: Intuitive’s Kathryn Rieger on human factors design in surgical robotics

More tools in da Vinci 5’s toolbox

Intuitive included equipment on da Vinci 5 that had previously been purchased by hospitals as third-party add-ons, such as cameras, insufflators and electrosurgical generators.

The insufflator, for example, features integrated smoke evacuation with automatic sensing and actuation. However, even though the insufflator comes with da Vinci 5, customers can still use third-party tools with the new system.

Intuitive integrated those capabilities with da Vinci 5 for two reasons, Rosa said. The first is to add to the overall care team experience with better workflows and efficiencies. The second, he said, is because that equipment can generate or capture data that might be important to Intuitive’s efforts to deliver actionable insights and analytics to customers.

A big step forward

“Sophisticated technology tools well integrated into the operating room should be ubiquitous, and we think this is a step on that on that journey,” Guthart said. “I don’t think most surgeons care about the word robots, and I don’t think patients care about robots, nor should they. I think this is about how do you make really high quality surgery ubiquitous, how do you make it easier for care teams to become proficient quickly and in a data-driven way?”

“There’s an opportunity here, and one of the big steps forward in da Vinci 5 is really setting up surgical data science, the ability to have integrated, high quality, synchronized data that allows computation plus sharp care teams to make really good decisions about what they’re doing and how to improve,” he continued. “And I think if we do that in a way that lowers the total cost to treat per patient episode so that it’s self-financing for the healthcare systems … that is the ethos behind da Vinci 5. I think it’s another step. It’s not the last step. It’s just the next step. And I think it’s going to get us there.”

Editor’s Note: This article was syndicated from The Robot Report’s sister site Medical Design & Outsourcing.