Robot setup

Introduction

The focus of this chapter is how to set up the da Vinci Xi robot for surgery. Da Vinci robots are the most widely used surgical robots in the world, with over 5500 machines installed globally, and have been a monopoly system for the past 20 years. The configurations of new and emerging surgical robotics are varied. A brief overview of the setup for some of these emerging robotic systems will be covered at the end of this chapter.

The da Vinci surgical system has three main components: the surgeon console, the robot cart with arms, and the vision tower ( Fig. 3.1 ). The da Vinci robot is an operator-robot system, where the surgeon sits at a console away from the patient. The surgeon sees a 10 times magnified stereoscopic three-dimensional (3D) vision of the operative field. Hand movements are digitalized and transmitted to surgical instruments attached to robot arms operating on the patient. Video is also transmitted to a vision tower to guide the bedside assistants.

Overview of components

Surgeon console

The surgeon console ( Fig. 3.2 ) contains four main components.

The vision system or stereo viewer

Dual lenses in the surgical camera ( Fig. 3.3 ) provide depth perception by delivering a stereoscopic 3D view of the operative field. The operative field is 10 times magnified and displayed in high definition. A safety beam in the headrest must be broken to activate movement of the hand controls. If the surgeon moves their head out of the viewer, the instruments will not move. A microphone and speakers within the headrest enhance communication between the console surgeon and bedside surgical team.

Hand controls

Two identical hand controls ( Fig. 3.4 ) enable telerobotic intuitive hand movements of endowristed instruments inside the operative field. Movements are adjusted to remove tremor. The hand controls have finger grips for the thumb and middle finger and finger clutches that can be triggered by the index finger.

Arm board

The arm board contains ergonomic controls, a touch screen, and power buttons to turn the robot on and off. Ergonomic controls can be used to adjust the positions of the stereo viewer, the arm board, and the footplate to achieve a comfortable position for the surgeon. Ideally, the surgeon should achieve a configuration that enables them to sit upright with a straight back and the arm bar beneath mid-forearm with relaxed hands. The touchscreen displays lens controls (30 degrees up, 30 degrees down), instruments in use, scaling motion (quick 1:1, normal 2:1, fine 3:1). Once configured, individual surgeon preferences can be saved and activated for easy setup for the next case.

Foot plate

The foot plate contains a number of pedals as shown in Fig. 3.5 . The instrument clutch, camera control, and arm swap pedals are activated using the left foot. The primary and secondary energy pedals are activated using the right foot. Pressing the left and right energy pedals activates the corresponding instruments in the surgeon’s hands.