Presented by:

May 28, 2019      
Dr. Roger Smith

Robotic surgery and its da Vinci system have almost become synonymous terms. Even with multiple surgical robotic systems available, the Intuitive Surgical machine remains the workhorse and most widely used robotic device. Interestingly, new designs that allow for single-port access could lead to the creation of a bread-and-butter system that could be used for multiple procedures across specialties – dare we say standard?

For almost 20 years, Intuitive has progressively improved the da Vinci device through five models – the Standard, S, Si, Xi, and the recent hybrid X models. All of these have followed the usual pattern of multi-port access to the abdominal and thoracic cavities, allowing surgeons to triangulate on the tissue of interest.

Intuitive Surgical SP system

Intuitive Surgical Da Vinci SP

But the company has also developed and tested a single-port version of the robot since at least 2010. The da Vinci SP introduced a camera and three flexible instruments through a single, 2.5-cm port. The rigid shaft of the instrument allows it to retain its strength while penetrating deep into a body cavity. The instruments that emerge use a combination of rigid and flexible sections to create a relatively large operating area, with tools approaching from multiple angles. The rigid sections retain the strength of the instrument, while the flexible sections allow for maneuverability in many directions.

Changes to procedures

While previous generations of the da Vinci introduced technology improvements, the SP is the first to bring significant changes to how procedures can be performed. For example, hospitals that already use either the Xi or X models can couple those systems with the SP patient cart and instruments. This could begin the practice of building a family of compatible robots that can be configured for different procedures and approaches. Surgeons who develop a proficiency with the Xi model will find control and use of the SP to be almost identical.

This is the closest that surgical robots have ever come to a standardization of user interface and control, similar to that of automobiles and families of aircraft – so that a driver or pilot can transfer their skills directly to one vehicle to another without needing extensive specialized training.

Initially, the SP was cleared by the FDA for use in urologic procedures such as prostatectomies and nephrectomies. This is where the earliest trials were conducted in 2010 by a combined surgical team from Cleveland Clinic and the University of Lille France, as reported in a 2014 paper in European Urology. More recently, trials have explored the use of the device for both transoral and transanal procedures, with the company announcing in March 2019 it received clearance for the use in certain transoral otolayngology procedures in adults.

Single-port access to all these areas is advantageous for all the reasons that have been widely cited for other forms of minimally invasive surgery – smaller incisions, less blood loss, less trauma to the body, reduced opportunity for infection, and more rapid recovery by the patient.

If the SP demonstrates its effectiveness in multiple specialty areas, the machine that at first glance appears to be highly specialized could suddenly become the new bread-and-butter machine for many procedures across multiple specialties. This means a trained surgeon could choose to use either a multi-port Xi or a single-port SP machine, depending on which is the most appropriate based on the procedure, rather than due to a surgeon’s familiarity with a specific model.

Roger Smith Nicholson Center surgeon articleAbout the author: Dr. Roger Smith is the CTO at AdventHealth Nicholson Center. He was previously the CTO for U.S. Army Simulation, Training and Instrumentation and a Research Scientist at Texas A&M University. He is also Graduate Faculty at University of Central Florida and President of Simulation First where he provides keynote event presentations and scientific lectures.