# Da Vinci Surgical System

The da Vinci Surgical System is a robotic surgical system that uses a minimally invasive surgical approach. The system is manufactured by the company Intuitive Surgical. The system is used for prostatectomies, increasingly for cardiac valve repair and for renal and gynecologic surgical procedures.
It was used in an estimated 200,000 surgeries in 2012, most commonly for hysterectomies and prostate removals. The system is called "da Vinci" in part because Leonardo da Vinci's study of human anatomy eventually led to the design of the first known robot in history.

## Medical uses

The system has been used in the following procedures:
* Radical prostatectomy, pyeloplasty, cystectomy, nephrectomy and ureteral reimplantation;
* Hysterectomy, myomectomy and sacrocolpopexy;
* Hiatal hernia and inguinal hernia repair;
* GI surgeries including resections and cholecystectomy;
* Transoral robotic surgery (TORS) for head and neck cancer;
* Lung transplantation, the da Vinci System has been used in the world's first fully robotic surgery of this kind thanks to a pioneering technique.

## Device

The da Vinci System consists of a surgeon's console that is typically in the same room as the patient, and a patient-side cart with three to four interactive robotic arms (depending on the model) controlled from the console. The arms hold objects, and can act as scalpels, scissors, bovies, or graspers. The final arm controls the 3D cameras. The surgeon uses the controls of the console to manoeuvre the patient-side cart's robotic arms. The system always requires a human operator.

## FDA clearance

The Food and Drug Administration (FDA) cleared the da Vinci Surgical System in 2000 for adult and pediatric use in urologic surgical procedures, general laparoscopic surgical procedures, gynecologic laparoscopic surgical procedures, general non-cardiovascular thoracoscopic surgical procedures, and thoracoscopically assisted cardiotomy procedures.

## Notable procedures

* 2000: First robot-assisted prostatectomy worldwide performed by Professor Clément-Claude Abbou in France using a Da Vinci surgical system."Un robot réalise une opération de la prostate Créteil (Val-de-Marne)".
* 2003: First prostatectomy performed using Da Vinci in the United States by Mani Menon."La réalisation de la prostatectomie radicale par coelioscopie".
* November 2008: A Da Vinci robot used to operate on tongue cancer.
* December 2008: First cardiac resynchronization surgeries in France using Da Vinci at the Limoges University Hospital (CHU de Limoges).Première resynchronisation cardiaque avec le robot Da Vinci on reseau-chu.org
* September 25, 2009: First total robotic-assisted thyroidectomy at the Nîmes University Hospital (CHU de Nîmes).« CHU de Nîmes : ablation de la thyroïde avec assistance robotique : une première à Nîmes », read online on robotchirurgie-news.blogspot.comChirurgie de la thyroïde on orl-nimes.fr
* Early 2010: Da Vinci used at Nancy University Hospital (CHU de Nancy) to remove a thoracic tumor in a 5-year-old child.Robotique et chirurgie pédiatrique : première au CHU de Nancy on continentalnews.fr, published 05/05/10
* July 19, 2010: First total transoral laryngectomy in France (and the fourth worldwide) performed at Georges-Pompidou European Hospital.Da Vinci : le robot qui facilite la laryngectomie on Journal international de médecine, published 5 August 2010
* May 2011: First robot-assisted vaginal hysterectomy performed at Lille University Hospital (CHRU de Lille).« Ablation de l'utérus par robot : une première mondiale au CHRU », read online on lavoixdunord.fr
* October 2011: First neonatal robotic surgery in Europe by Dr. Fourcade and team at CHU Limoges.AFP Source Limoges : un nourrisson opéré à l'aide d'un robot on LePoint.fr
* July 9, 2015: First worldwide "Nephrectomy – Kidney Transplantation" sequence from a living donor via pure robotic-assisted approach, performed at Toulouse University Hospital by Dr. Federico Sallusto and Dr. Nicolas Doumerc."Toulouse. Un robot a greffé un rein par voie vaginale, une première".
* December 1, 2015: World-first robotic mastectomy performed at Gustave Roussy Hospital in Villejuif by Dr. Benjamin Sarfati."L'ablation du sein effectuée par un robot". www.high-tech-info.fr.
* February 21, 2018: Surgeons from Gustave Roussy Institute successfully removed a tumor located in the rhinopharynx of a 28-year-old man.Thibert, Cécile (22 February 2018). "Cancer: une tumeur inatteignable retirée grâce à un robot chirurgical". Le Figaro (in French).
* July 2020: Dr. Annabel Paye-Jaouen performed France’s first outpatient robotic-assisted reconstruction of the pyeloureteral junction on a 14-year-old at Robert-Debré Hospital.« Première française en ambulatoire de chirurgie de reconstruction de la jonction pyélo-urétérale avec le robot chirurgical da Vinci », read online on Hôpital Robert-Debré AP-HP.

## Criticism

While the use of robotic surgery has become an item in the advertisement of medical services, there is a lack of studies that indicate long-term results are superior to results following laparoscopic surgery. Critics of robotic surgery assert that it is difficult for users to learn. The da Vinci system uses proprietary software, which cannot be modified by physicians, thereby limiting the freedom to modify the operating system. The system has a cost of $2 million which places it beyond the reach of many institutions.
The manufacturer of the system, Intuitive Surgical, has been criticized for short-cutting FDA approval by a process known as 510(k) premarket notification instead of entering the market through a more stringent premarket approval process. The company has also been accused of providing inadequate training and encouraging healthcare providers to reduce the number of supervised procedures required before a doctor is allowed to use the system without supervision.
There have also been claims of patient injuries caused by stray electrical currents released from inappropriate parts of the surgical tips used by the system. Intuitive Surgical counter this argument by saying the same type of stray currents can occur in non-robotic laparoscopic procedures. A study published in the Journal of the American Medical Association found that side effects and blood loss in robotically-performed hysterectomies are no better than those performed by traditional surgery, despite the significantly greater cost of the system. As of 2013, the FDA was investigating problems with the da Vinci robot, including deaths during surgeries that used the device; a number of related lawsuits were also underway.

## Use in popular media

Doctors in Japan were considering promoting the procedure for cardiac surgery. A way to show this, both its good and bad sides is through visual media. 2018 Japanese drama Black Pean takes on this challenge, showing both sides' point of view. Two University Hospitals are competing to be the best in the Cardiac Surgery Department. One, Tojo, has the best traditional surgeons, while the other, Teika, is all about researching and implementing the most recent technology. With this, Teika sends its technical specialist to Tojo to try to convince them to update their techniques, including the use of the Da Vinci robot (named in the drama as Darwin). Newhart Watanabe International Hospital, a pioneer in Da Vinci surgery for the heart in Japan, was used as background for the drama, with Dr. Gou Watanabe providing technical support.
In Grey's Anatomy season 5 episode 23, Chief of Surgery Dr. Richard Webber (played by James Pickens Jr.) reveals to Chief Resident Dr. Miranda Bailey (played by Chandra Wilson) that he has purchased a Da Vinci surgical robot to entice her to choose general surgery over the paediatrics fellowship she is considering under the supervision of Dr. Arizona Robbins (played by Jessica Capshaw).