The da Vinci platform

The three pieces

Every da Vinci system, regardless of generation, has the same three physical components:

• Surgeon console - where the operating surgeon sits. Contains the 3D stereoscopic viewer and the hand-and-foot controllers. Has no direct line of sight to the patient; the surgeon operates entirely through the video feed.
• Patient-side cart - the movable tower with the robotic arms. Docks to ports that have been placed through the abdominal wall. The instrument tips sit inside the patient; the arms themselves stay outside.
• Vision cart - a separate tower that houses the light source, image processor and external monitors so the bedside team can see what the console surgeon sees.

da Vinci Xi - the current four-arm workhorse

The Xi is the current multi-arm platform and does the majority of urological robotic work in Sydney. Four slim articulating arms attach to a boom that can rotate over the patient, which makes it suitable for operations that need access in more than one quadrant of the abdomen (for example, right-sided kidney work plus lymph node dissection). Xi is the platform used for:

• robotic prostatectomy;
• robotic partial nephrectomy;
• robotic radical nephrectomy;
• robotic pyeloplasty;
• robotic adrenalectomy;
• robotic cystectomy.

da Vinci SP - the single-port platform

The SP is a newer platform designed around a single 2.5 cm access port through which three wristed instruments and a fully articulated camera deploy in a triangulated fashion. The purpose is to minimise the number and size of incisions. SP is used in selected prostate, kidney and upper-tract operations and is still relatively uncommon in Australia; Dr Kooner runs a dedicated SP program at St Vincent's.

The SP platform has its own standalone patient information site at singleportrobot.com.au; a short overview is also on this site.

Generations and naming

The Sydney program started with an earlier-generation da Vinci S/Si (four arms; fixed boom) and upgraded to Xi as the platform evolved. Functionally, day-to-day urological operations are very similar across generations: the principles - wristed instruments, magnified 3D vision, tremor filtering, motion scaling, pneumoperitoneum - are the same. Where a specific procedure page refers to "the robot" it is generally the Xi unless otherwise stated.

Layout of a robotic theatre

Typical setup for a robotic case:

• Patient under general anaesthetic, positioned for the specific operation (steep head-down for pelvic work, flank position for kidney work).
• Ports placed through the abdominal wall; CO2 insufflation establishes the working space.
• The patient-side cart is wheeled in and docked to the ports. Instruments are introduced through the ports and attached to the arms.
• The operating surgeon moves to the console; the bedside team and scrub nurse remain at the patient.
• Instruments are swapped at the bedside as the operation progresses; the console surgeon drives the dissection and reconstruction.