da Vinci® S System Overview
Script
I. System Component Overview and OR Setup
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1. Vision Equipment (eyes of the System)
a. 3-D Camera Head
• (SD) Standard: Panasonic
• Wide-angle: 60 degree FOV
• High mag: 45 degree FOV
• (HD) High Definition: Panasonic or Ikegami
• Wide-angle: 60 degree FOV
• Views: 4:3, 16:9 and 5 levels of digital zoom
b. Endoscope
• 12 mm 3D
• 8.5 mm 3D
• 5 mm 2D
c. Touchscreen for selecting TilePro, activating telestration, and
calibrating the Endoscope, selecting optical channel
2. Cart Location: Outside the sterile field, where it can be easily viewed
by the patient side assistant and accessed by circulating nurse, and
close enough to the Patient Cart that the camera cable can reach
(~13.5 feet)
3. Position the cart and lock the wheels
4. Plug in Illuminator to a dedicated circuit
5. Plug in isolation transformer to a dedicated circuit
6. Considerations: Need to be near 2 outlets on separate circuits (1 for
isolation transformer, 1 for Illuminator)
F
1. Control Center of da Vinci System (brains of the System)
a. View Port with 3-D Vision
b. Master Controllers with Intuitive® Movement
• Tremor filtration and motion scaling
• Endoscope and Instrument Control
c. Ergonomic Design
2. Console Location: Outside the sterile field, in view of the operative
field, in clear line of communication with the patient side assistant,
and in view of the surgical site
3. Position Surgeon Console using the handle on the back of the console
and depress the rear console wheel locks
a. Console weighs ~800 lbs
b. Only use handle to move Surgeon Console- do not push on the
console shell (contains calibrated video equipment) or pull on
the arm rest (contains delicate cabling), also ensure foot
switch panel is on rails before moving console
4. Plug Surgeon Console into a dedicated outlet (24/7)
Vision Cart
Surgeon Console
System Component Overview and OR Setup 1 of 2
da Vinci S System Overview Script
P/N 210069 Rev. A
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Patient Cart
1. Operative component (arms and hands of the System)
a. Remote Center Technology
• Fixed point in space around which surgical arms move
• Enables movements of surgical arms while exerting minimal
force on a patient’s body wall
b. EndoWrist® Instrumentation with 7 degrees of freedom
• Natural dexterity
• Greater range of motion than the human hand
• Allows for rapid and precise suturing, dissection, and tissue
manipulation
2. Cart Location: Place cart in an open space in the operating room to
prepare for the Homing sequence. During surgery, the sterilely
draped cart will be positioned patient-side within the sterile
operating field
3. To operate Motor Drive:
a. Power on Patient Cart
b. Ensure shift switches are in Drive (D) position
c. Hold in the throttle enable switch and rotate the throttle away
from you to move forward, or towards you to move backwards
• The Cart Power LED will flash green whenever the throttle
enable switch is activated
• Control the drive speed of the cart by how far you rotate
the throttle in each direction
d. When cart is in position, place the shift switches in (D) position
to set brakes
e. Brakes are set and Motor Drive is disabled as soon as a cannula
is installed on the System (in D ONLY)
f. Use two people to move the cart:
• One person to drive the cart
• One person to direct movement of the cart using room
landmarks (instead of right and left)
g. Cart weighs ~1200 lbs
4. To Operate Manually: Move by placing the shift switches in (N)
neutral position and physically pushing the cart
5. Plug Patient Cart into a dedicated outlet (24/7)
6. Unplug when moving cart long distances
System Component Overview and OR Setup 2 of 2
da Vinci S System Overview Script
P/N 210069 Rev. A
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II. System Connections, Start-Up, & Homing
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Vision Cart
Patient Cart
1. Confirm that the Vision Cart power (from the isolation transformer)
and the Illuminator are plugged into separate circuits
2. Check all connections on the back of the Vision Cart and confirm that
the cables are plugged into the isolation transformer
3. On the front of the Vision Cart, plug in the R and L camera cables to
the R and L CCUs, plug in focus cable, and attach strain relief
attachment
a. Camera Cable Length: ~13.5 feet (for HD)
4. Inspect cable connectors for debris or bent pins
5. Secure Vision Cart cable connections (blue video cable, green audio
cable) to the rear of the Surgeon Console
a. Pull back the sheath and line up the red dot on the cable
connector with the red dot on the cable receptacle and push
cable into position
b. An audible click should be heard when the cable is connected
c. Gently pull on the cable to verify that the cable is seated
d. Cable Length: ~50 feet
e. NOTE: The fiber optic cable (red) is very delicate! Do not step
on cables or run over with the system components
6. Plug in #1 & #2 connections for TilePro on the back of the Vision Cart
1. Confirm that the Patient Cart is plugged in to a dedicated circuit
(cart should be plugged in at all times- unless being moved to a new
location)
2. Inspect red fiber optic cable connector for debris or bent pins
3. Connect the (red) cable to the back of the Patient Cart and Surgeon
Console
4. Note: Turn off power at Surgeon Console and the Patient Cart before
unplugging or plugging in these cables
1. Confirm that the console is plugged into a dedicated outlet (console
should be plugged in at all times- unless being moved to a new
location)
2. Check the Foot-switch Panel cable connection
3. Review cable connections from the back of the Surgeon Console
a. Blue: Passes video signals between the Surgeon Console
and the Vision Cart
b. Green: Passes audio between Surgeon Console and Vision
Cart
F
Surgeon Console
c. Red: Connects Surgeon Console to Patient Cart and passes
video, audio, and data
d. BI (if available): for Bipolar cautery
e. MONO: for Monopolar cautery
4. Connect any ESU Cables needed for monopolar cautery to the back of
the Surgeon Console, and plug each generator (for both monopolar
and bipolar cautery) into separate wall outlets
5. Plug in #3 & #4 connections for TilePro on the back of the Surgeon
Console (If #1 and #2 on the back of the Vision Cart were not used)
System Connections, Start-Up, & Homing 1 of 2
da Vinci S System Overview Script
P/N 210069 Rev. A
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Start-Up of the
da Vinci S
Surgical System
1. Vision Cart
a. Turn on the isolation transformer on the back of the Vision Cart
b. Turn on the Illuminator and Illuminator lamp (Illuminator lamp
can be turned down until system is ready for procedure)
c. Confirm that each vision cart component is powered up by
checking the front of each unit for an illuminated LED
2. Power on Surgeon Console by depressing the green Power button on
the right-side pod of the Surgeon Console
a. The da Vinci System will perform a Self-test
(~45 - 90 seconds)
d. Do not touch the system during this electrical integrity test
e. Self-test is complete when 3 quick beeps are heard and display
reads: Prepare Masters and Patient Cart Arms for homing.
Remove Instruments. Press HOME when done.
f. System will continue to beep until Homing is complete
g. Homing is required for system operation
3. da Vinci continues to do 1300 system checks/sec while powered on
Homing the da
Vinci S Surgical
System
1. Use the Port Clutch buttons to position Surgical Arms, ensuring that
there is adequate space for arms to calibrate to a neutral position
during the Homing process
2. If using Instrument Arm 3, move arm from stow position and place in
appropriate position for procedure (latch on the back of the arm can
be released to position the arm to the right or the left of the cart)
3. Ensure that the Masters on the Surgeon Console are not attached or
tied together and that area under the arm rest is clear (move chair if
needed)
4. To perform the Homing process, press the HOME button on the rightside pod on the Surgeon Console
a. Do not touch the system during this mechanical integrity test
5. Homing is complete when 3 beeps are heard and the display reads:
Ready. Prepare Patient Cart for surgery.
6. Homing sets the Surgical Arms in position to maximize range of
motion
7. Note: If the System detects a mounted Instrument Arm Sterile
Adapter, EndoWrist instrument, or cannula prior to Homing, the
Patient Cart arms will not move during Homing. This is a feature that
is designed to allow the System to Home during a procedure while
connected to a patient (For example, if it is necessary to restart the
system following a fault)
8. Note: The Patient Cart can be moved using the Motor Drive until a
cannula is installed on the system
System Connections, Start-Up, & Homing 2 of 2
da Vinci S System Overview Script
P/N 210069 Rev. A
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III. Vision Cart Overview
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Components
1. 3-D Camera
a. (SD) Standard: Panasonic
• Wide-angle: 60 degree FOV
• High mag: 45 degree FOV
b. (HD) High Definition: Panasonic or Ikegami
• Wide-angle: 60 degree FOV
• Views: 4:3, 16:9 and 5 levels of digital zoom
2. Endoscope
a. 12 mm 3D: 0°, 30° Up, 30° Down
b. 8.5 mm 3D: 0°, 30° Up, 30° Down
c. 5 mm 2D: 0°, 30° Up, 30° Down
3. 1 Bifurcated Light Guide Cable
4. Touchscreen Monitor: Used for selecting TilePro View, activating
telestration, and calibrating Endoscope
5. Illuminator
a. ~500 hours of service on each bulb
b. Confirm that lamp is set to 100% (this helps the endoscope
reduce fogging)
c. WARNING: The temperature of the distal tip of the endoscope
may exceed 41°C during use. Avoid contact with skin, tissue
and clothing when the illuminators are turned on and the
endoscope is outside the camera cannula, as damage may occur
to skin, clothing and equipment. Do not attempt to clean the
tip of the endoscope by dipping it in tissue. The tissue can be
damaged because of the heat, and the tip of the endoscope
may develop baked-on deposits which can decrease light
throughput.
d. If the light is too bright during the procedure turn down the
Level (Panasonic SD and Ikegami HD) or Brightness (Panasonic
HD), (on the CCUs), DO NOT DECREASE THE LAMP SETTING on
the Illuminator
e. DO NOT switch off the Illuminator if operation is required
within 30 minutes. Use the Close button when system is
temporarily out of use.
6. Camera Control Units (CCUs)
a. Standard CCU (Panasonic Standard Camera Head): Switches
should be in the “pinch, center, up, up” position, and all dials
should be set to the 12 o’clock position
b. Panasonic High Definition CCU: default settings (no dials to set)
c. Ikegami High Definition CCU: default settings and all dials
should be set to the 12 o’clock position
7. Focus Controller
a. Press and hold or tap the Focus In/Focus Out buttons on the
controller to focus camera
b. Also controlled by the Focus (+/-) Foot Switch Pedal on the
Surgeon Console
8. Video Digitizer: DO NOT adjust any settings
9. Isolation Transformer
10. Audio Settings
Vision Cart Overview 1 of 2
da Vinci S System Overview Script
P/N 210069 Rev. A
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(continued)
Customer Supplied
Components
11.
12.
13.
14.
Recording device (customer supplied)
Insufflator and CO2 tank (customer supplied)
Electrocautery Device (customer supplied)
DVI and S-video Source Input for Tile Pro (customer supplied)
a. Only 2 video inputs can be integrated at any one time
Options for inputs: 1 DVI, #1 and #2 on back of Vision Cart, #3 and #4 on
back of Surgeon Console
System Status Text
2
Instrument
Arm
(Opt.) 3
Instrument
Arm
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Icons:
Assistant Monitor
and Surgeon
Console Display
LFT
Master
Draping the
TouchScreen
Monitor
1
Instrument
Arm
(Opt.) 3
Instrument
Arm
RT
Master
Zoom Level
Tab Menu
TilePro Image #1
F
Camera
Camera
Horizon
TilePro Image #2
1. Remove the monitor drape from the sterile packaging
2. The scrub nurse places the drape on a sterile table with the label
facing up. Remove and discard the paper insert
3. Place one hand in the bottom opening of the drape and hold the top
of the drape with the other hand
4. Lower the drape over the monitor with the label facing towards you
5. Use the cuff of the drape to move the drape all the way down to the
base of the monitor arm
6. Tighten the drawstring around the base of the monitor arm, using the
fastener to keep it secure. Either cut and remove any extra
drawstring, or tuck the extra drawstring inside the pouch located
near the cuff of the drape.
7. Align the drape window to the monitor's display with the Intuitive
label centered on the top of the monitor. Press the drape so that it
clings smoothly to the display.
8. Secure the Velcro straps to both sides of the monitor
9. Wrap the white drape straps snugly around the monitor arm, and
attach the straps to themselves.
Vision Cart Overview 2 of 2
da Vinci S System Overview Script
P/N 210069 Rev. A
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IV. Draping the Patient Cart
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Review
Patient Cart
Components
1. Stand Alone Mode vs. Integrated Mode
2. Center Column
3. Camera Arm
a. Camera Arm Clutch Button
b. Camera Arm Port Clutch Button
c. Camera Arm Sterile Adapter
d. Camera Arm Quick Click Cannula Mount
e. Camera Arm Cannula Mount Molding (integrated into drape)
4. Instrument Arms
a. Instrument Arm Clutch Button
b. Instrument Arm Port Clutch Button
c. Instrument Arm Sterile Adapter Carriage
d. Instrument Arm Sterile Adapter (integrated into drape)
e. Instrument Arm Quick Click Cannula Mount
f. Instrument Arm Cannula Mount Molding (integrated into drape)
g. Movement of arm around Remote Center
5. 3rd Instrument Arm
a. Review how to move the from Stow position and prepare
Instrument Arm for surgery
b. If 3rd arm is moved from the Stow position after the Homing
process is complete, the 3rd arm completes a mini-mechanical
integrity test and telescopes the arm (i.e. System does not
require a shutdown and re-start or re-homing)
6. Instrument Arm LEDs:
a. Solid white: Not ready for Surgeon Console control
b. Alternate side-to-side blinking green and white: Guided Tool
Change
c. Alternate side-to-side blinking white: Clutching
d. Bright blue: Ready for Surgeon Console control
e. Yellow: Intervention required
f. Red: System fault
g. Fast blinking green: Downloading new instrument information
7. Motor Drive
a. Cart Power
b. Throttle
c. Throttle Enable Switch
8. Base and Shift Switches (N and D)
9. Optional Touchscreen Monitor
Draping the Patient Cart 1 of 3
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P/N 210069 Rev. A
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Draping the
Instrument Arm
Draping the
Touchscreen
(if located on
Patient Cart)
1. A scrub nurse and a circulator are recommended for draping
2. Drape the Patient Cart from right Æ left or left Æ right
3. Using the Port Clutch buttons, separate out one Instrument Arm and
drape the separated Instrument Arm first
4. With the assistance of a circulator, remove the drape packaging
5. The scrub nurse unfolds the drape on a sterile table, with the
Instrument Arm Sterile Adapter facing the ceiling
6. Release tear away tabs, then tent the opening of the drape and grip
the outside with your finger and thumb. Hold the top of the drape
with the other hand
7. Lower the drape over the Instrument Arm Insertion Axis
8. Place the base of the Sterile Adapter into the Instrument Arm
Carriage. Using both thumbs, push the Sterile Adapter into the
Instrument Arm until it clicks into place
9. The wheels on the Instrument Arm Sterile Adapter will spin, and you
will hear three beeps, indicating that the system recognizes the
Sterile Adapter
10. Release the two tear-aways on the front of the drape
11. Using the drape cuff, move the drape back along the Instrument Arm
toward the center column (the blue band on the drape indicates the
sterility barrier)
12. Seat the Cannula Mount Molding. Open the wings of the Cannula
Mount and make sure the molding cleanly folds over the cannula
mount
13. Wrap all white drape straps around the Instrument Arm, and attach
each strap to itself
14. Bend the blue flex-strips to create a clear U-shaped instrument
insertion path along the axis of the Instrument Arm
15. Move the draped Arm away from the undraped Arm
1. Remove the monitor drape from the sterile packaging
2. The scrub nurse places the drape on a sterile table with the da Vinci S
label facing up. Remove and discard the paper insert
3. Release the tear-aways at the bottom of the drape and then place one
hand in the bottom opening of the drape and hold the top of the
drape with the other hand
4. Lower the drape over the monitor with the da Vinci S label facing
towards you
5. Use the drape cuff to move the drape all the way down to the base of
the monitor arm
6. Tighten the drawstring around the base of the monitor arm, using the
fastener to keep it secure. Cut and remove the extra drawstring
7. Align the drape window to the monitor display. Press the drape so
that it clings smoothly to the display
8. Secure the Velcro straps to both sides of the monitor
9. Wrap the white drape straps snugly around the monitor arm, and
attach the straps to themselves
Draping the Patient Cart 2 of 3
da Vinci S System Overview Script
P/N 210069 Rev. A
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Draping the
Camera Arm
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Draping the
Remaining
Instrument Arms
1. Remove the drape from the sterile packaging
2. The scrub nurse unfolds the drape on a sterile table, with the arrowside facing up, and unfolds the drape
3. Release the tear-aways at the bottom of the drape and then insert
one hand into the bottom opening of the drape and hold the top of
the drape with the other hand. Lower the drape over the insertion
axis
4. Using the drape cuff, move the drape down along the Camera Arm
Setup Joint. If the system is configured with the Patient Cart
Touchscreen, extend the drape around the base of the Touchscreen
monitor arm
5. Extend the drape to the center column of the Patient Cart and press
the Velcro pads to one another (like clapping your hands together)
6. Seat the cannula mount molding. Make sure the molding cleanly folds
over the cannula mount
7. The sterile staff member takes the Camera Arm Sterile Adapter to the
drape, removes the adhesive strip cover and presses the backside of
the camera arm sterile adapter to the adhesive strip
8. Line up the Camera Arm Sterile Adapter with the carriage on the
Camera Arm. Create room for the Endoscope to pass through, and
push the Camera Arm Sterile Adapter into place
9. Wrap the white drape straps snugly around all the way down the
Camera Arm, attaching each strap’s end to itself
10. Bend the blue flex-strips to create a clear path for the Endoscope
along the Arm’s insertion axis
1. Moving from one side of the da Vinci System to the other
(right Æ left or left Æ right) and drape the remaining Instrument
Arms
Draping the Patient Cart 3 of 3
da Vinci S System Overview Script
P/N 210069 Rev. A
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V. Draping and Calibrating the Camera and Endoscope
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Draping the
Camera
1. Open the sterile Camera Drape package, place the arrow towards your
body, and unfold according to the arrows
2. Attach the Camera Head Sterile Adapter (Endoscope Sterile Adapter)
to the sterile Endoscope
3. Insert the Endoscope into the drape, Sterile Adapter end first
4. Insert the Endoscope (Sterile Adapter end first) through the elastic
end of the drape until it fits around the Sterile Adapter
5. Fix the drape to the Endoscope with the supplied adhesive tape,
folding under the end of the tape as a tab
6. While holding the Camera head, the circulator connects the Sterile
Adapter to the Camera head
7. While holding the Camera head, the circulator inverts the drape over
the Camera head and pulls it along the cables, while the sterile
person loops the draped cable over a sterile surface (such as a Mayo
stand) in an S-shape
8. Attach the sterile Light Guide Cables to the light ports on the
Endoscope
9. The circulator connects the single end of the Bifurcated Light Guide
Cable to the Illuminator
10. Use the drape straps to secure the Light Guide Cables along the length
of the Camera Cable (secure at least 4 straps/8 feet of cable)
1. Note: Every Camera should be calibrated prior to each procedure
2. Select and attach an Endoscope to the Camera
3. Select the SCOPE ANGLE and SCOPE TYPE of the installed Endoscope
(located on the Left-side Pod of the Surgeon Console or on the Scope
Configuration Window on the Touchscreen)
4. For the CCUs:
a. Standard CCU (Panasonic Standard Camera Head): Switches
should be in the pinch, center, up, up position, and all dials
should be set to the 12 o’clock position
b. Panasonic High Definition CCU: default settings (no dials to set)
c. Ikegami High Definition CCU: default settings and all dials
should be set to the 12 o’clock position
Calibrating the
5. Automatic Black Calibration (ABC): Required for SD Cameras only
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a. Set Illuminator to 0%
Camera
b. Completely cover the Endoscope tip with a piece of gauze
c. Press and release the Automatic Black Calibration (ABC) button
on both CCUs. The red page light will stop flashing when
calibration is complete (~10-12 seconds)
6. Automatic White Balance/Calibration (AWB or AWC): for all Cameras
a. Set Illuminator to 100%
b. Point the Endoscope at a clean, bright white piece of paper
(such as drape paper) so that the paper fills the Endoscope’s
entire field of view (do not use gauze)
c. Press the Automatic White Balance/Calibration (AWB or AWC)
button on both CCUs (for Panasonic HD, press and HOLD the
button. NOTE: Only one CCU needs to be calibrated). The
colored page light will stop flashing when calibration is
da Vinci S System Overview Script
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P/N 210069 Rev. A
complete
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Calibrating the
Endoscope
1. Note: Every Endoscope should be calibrated prior to each use
2. To calibrate the Endoscope, use the Left-side Pod and Stereo Viewer
on the Surgeon Console, or the Scope Configuration Window on the
Touchscreen panel
3. Attach the Endoscope Alignment Target, with the crosshairs running
vertically and horizontally, to the distal end of the Endoscope
4. Confirm the SCOPE ANGLE selection matches the angle of the installed
Endoscope
5. Confirm the SCOPE TYPE selection matches the Endoscope (2D or 3D)
6. Press the SCOPE ALIGN button
7. Use the arrow keys to align the image of the crosshairs displayed,
until the green and magenta images completely overlap (get them
aligned as close to perfect as possible)
8. When finished, press the SCOPE ALIGN button again to store the
settings
a. This process stores the calibration information for that specific
Scope Direction in memory for this procedure/case
b. Repeat for any other Scope Angle selections
9. Note: Calibrate the endoscope you will be using at the beginning of
the case LAST, so that your camera and scope are ready and the
settings on the Surgeon Console are correctly set when starting the
procedure
10. Note: Each time a new Endoscope is attached to the Camera,
Endoscopes may need to be recalibrated or re-white balanced to
optimize vision
11. Place Endoscope into cannula, and attach Camera Assembly to the
Camera Arm Sterile Adapter on the Camera Arm (Intuitive® logo
towards the center column)
12. Insert the Strain Relief Grip into the Clip Attachment on the Camera
Arm
Draping and Calibrating the Camera and Endoscope 2 of 2
da Vinci S System Overview Script
P/N 210069 Rev. A
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VI. Docking the Patient Cart
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Considerations
1.
2.
3.
4.
Lights/Anesthesia Equipment/Ancillary Equipment
Traffic Considerations: Keep pathways clear and protect cables
Consider contamination risks
Assistant must have clear view of Assistant Monitor
Cannulae and
Trocars
1. Instrument Arms
a. Reusable blunt/sharp obturators
b. Bladeless disposable obturators
c. 8 mm diameter cannula
• 10 cm and 15 cm cannula lengths
• Review how to attach seals and how to attach to cannula
mount
d. Review Remote Center boundaries
2. Camera Arm
a. Blunt/sharp obturators
b. 12 mm trocar: Review how to attach cap and how to attach to
cannula mount
3. Assistant Ports: 5 mm, 10 mm, or 12 mm ports as required
4. Ethicon vs. USS mounts and accessories
Basic Port
Placement
1. Place the camera port so that it aligns with the center column of the
Patient Cart and the target anatomy
2. Place the camera port 10-20 cm away from the target anatomy
(when possible)
3. Maintain at least 10 cm spacing between da Vinci S ports
4. Instrument ports should be 10-20 cm away from the target anatomy
5. Accessory ports should be at least 5 cm away from other ports
Setting the Sweet
Spot
1. Position Camera Arm in preparation for docking
a. The “Sweet Spot” helps maintain the arm’s optimal range of
motion
b. To set “Sweet Spot,” move the Camera Arm so that the blue
arrow lines up between the limits of the left and right blue bar
located in the middle of the Camera Arm Setup Joint
c. Position the Arm so there is approximately 20” between the
Patient Cart Center Column and the back of 1st joint of the
Camera Arm
2. Use Port Clutch buttons to position Instrument Arms to maximize
range of motion and limit collisions
a. Check arm alignment
b. Check elbow/Set-up Joint position
c. Use dinner plate analogy: Overextending arms or folding arms
in close to your body makes it difficult to eat. Position arms in
a “comfortable” position to maximize range of motion.
Docking the Patient Cart 1 of 2
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Docking
1. Ensure Camera Arm elbow and Sweet Spot are set and Instrument
Arms are in position to maximize range of motion and minimize
collisions
2. Align the Endoscope port Æ target anatomy Æ Patient Cart’s Center
Column
3. With arms positioned high enough to clear the patient, drive the
Patient Cart in, maintaining the Sweet Spot and alignment with
Endoscope Æ 3rd elbow Æ Patient Cart’s Center Column
a. Position the cart using two people: one to drive the cart and
one to direct cart movement
4. Stop the Patient Cart when Camera Cannula Mount is in position over
the Camera Port Cannula incision
5. Dock the Camera Arm using the Port Clutch buttons
6. Insert the Endoscope into the cannula and assess the surgical site
7. Dock the Instrument Arms using the Port Clutch buttons
a. Note: Make sure Patient Cart is in D to set brakes when docked
to a patient
Docking the Patient Cart 2 of 2
da Vinci S System Overview Script
P/N 210069 Rev. A
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VII. EndoWrist Instrument Overview
1. 540° Range of Motion: Greater range of motion than the human hand
and wrist
2. 7 degrees of freedom
a. Insertion, external pitch, external yaw, roll, grip,
WRIST: internal pitch and internal yaw
3. Components:
a. Tip
EndoWrist
b. Wrist
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Instrument
c. Shaft
Overview
d. Release Levers
e. Instrument Housing
4. Two sizes: 8mm and 5mm
5. Instrument Life
a. Most 8 mm and 5 mm instruments: 10x (5 mm are 20x)
b. Clip applier: 100x fires
c. Training instruments: 30x
1. Before inserting EndoWrist Instrument, straighten the instrument
wrist, and close the tips of the instrument
2. Insert the tip of the instrument into the cannula and then slide the
instrument base into the Sterile Adapter until fully seated. Place one
hand on the instrument housing and one hand on the back of the
Instrument Arm, “sandwiching” the instrument and Instrument Arm
between your hands as you slide the instrument into place
3. Check icons on Assistant Monitor to ensure that instrument is engaged
(monitor will display # of instrument lives remaining)
4. Inserting EndoWrist instrument Manually for First Insertion –OR- for
clearing Guided Tool Change memory:
a. Insert EndoWrist instrument under direct vision
b. Press the Instrument Arm Clutch button
c. Remove one instrument
d. Attach the new instrument to the Instrument Arm Sterile
Adapter
EndoWrist
e. Watch the assistant monitor and slowly introduce the
Instrument
instrument until the instrument tip is just visible emerging
F
Insertion and
from the cannula, then guide it into the desired location in the
Removal
surgical field
f. Press the Instrument Arm Clutch button again
5. Instrument Removal
a. Straighten instrument wrist and slightly open instrument jaws
b. Squeeze the release levers on the instrument housing and pull
the instrument straight up and out
6. Guided Tool Change
a. Remove the EndoWrist Instrument without pressing the
Instrument Arm Clutch button
b. Attach a new instrument and slowly guide the instrument
through the cannula as you watch the Assistant Monitor (note
flashing green icon LED and green icon on monitor)
c. The da Vinci Surgical System will stop the movement of the
instrument just short of where the previous tip was located, in
order to provide a 3 mm safety margin
d. Note: Clutch button not used for Guided Tool Change
EndoWrist Instrument Overview 1 of 1
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P/N 210069 Rev. A
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VIII. Surgeon Console Overview
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Right-side Pod
View Port
Foot Switch Panel
1. POWER (On/Off): turns the da Vinci System on and off
2. EMERGENCY STOP: creates a recoverable fault and halts
communication between the Instrument Arms and Camera Arm and
the Masters
3. HOME: allows the da Vinci System to perform a mechanical integrity
test and move into Home position
4. SYSTEM STATUS
a. VISION LOSS: A yellow light indicates the detection of a loss of
Camera image (for each eye) due to a fault in the optical
components or processing equipment
b. POWER LOSS: A yellow light illuminates when a loss of AC
power occurs in either the Surgeon Console or Patient Cart
(light displays next to the component that has lost power).
Either component will operate on battery power for 5 minutes
with a fully charged battery pack before turning off in a power
loss situation
c. Battery level icon will display on screen
1. Stereo Viewer with 3-D Vision
a. Head Rest
b. Infrared Sensor
c. Stereo Viewer
d. Speaker/audio
2. Adjust the following beneath the Stereo Viewer:
a. Intra-ocular Spacing
b. Audio Intercom System Volume
1. Adjust Foot-switch panel: lower to the floor if needed
2. Clutch
a. Master Clutching (to allow repositioning of the Master
Controllers to a more comfortable position): to activate
depress and hold clutch
b. Auxiliary Arm Swapping: Depress and release quickly
3. Camera
a. Camera Clutching: (to allow repositioning Camera): Depress
and hold camera clutch
b. TilePro: to switch between full-screen and multi-image modes,
depress and release camera clutch quickly
4. Focus: (+/-) Press and hold or tap + or - to adjust the focus
5. BI: Bipolar cautery, that activates the application of bipolar energy
to the tip of the instrument
6. MONO: Monopolar cautery, that activates the application of
monopolar energy to the tip of the instrument
Surgeon Console Overview 1 of 3
da Vinci S System Overview Script
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Master
Controllers
1. Master Controllers follow the surgeon’s movements precisely,
translating movements to the Surgical Arms in real time
2. Repositioning the Masters
a. Press and hold the Clutch pedal to disengage the Masters from
the instruments
b. Reposition the Masters for surgeon comfort
c. Release Clutch pedal to re-engage the Masters with the
instruments
3. Match Grips
a. When a new instrument is inserted, the blue Match Grips icons
will appear
b. Make an intentional movement (open or close Masters, or
slightly rotate the grips on the Masters), then match the Master
grip angle to the instrument grip angle
4. Repositioning Camera
a. Press and hold the Camera Clutch Pedal
b. Move the Masters to reposition the image
• To move the camera towards the target anatomy, pull
the Masters toward you (like pulling a newspaper closer
to your eyes)
• To move the camera away from the target anatomy, push
the Masters away from you (like moving newspaper away
from your eyes)
• To change the angle of the camera, rotate both Masters
to the left or right (like driving a car)
• To move camera from side to side, move both arms
together to the left or right (like moving a newspaper to
the right or left)
5. Digital Zoom
a. Press and hold the Camera Clutch Pedal
b. To increase Digital Zoom, push Masters towards each other (like
a clapping motion)
c. To decrease Digital Zoom, pull Masters apart from each other
(like a clapping motion)
Surgeon Console Overview 2 of 3
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Left-side Pod
1. Error Status
a. SILENCE ALARM: Temporarily silences alarm, status LED will
remain lit until end of procedure and restart of system
b. FAULT OVERRIDE: This function clears a previous “recoverable”
fault and allows the da Vinci System function to resume. If
there is a continuation of the condition that caused the fault, it
will stop the da Vinci System again
2. WORKING DISTANCE: Optimizes the surgeon’s ability to see a fused
3D image
a. NEAR
b. NORMAL
3. SCALING: used to set the motion scaling such that a movement by the
Master is translated into a smaller movement of the instrument tip
a. NORMAL: 2:1
b. FINE: 3:1 the default setting that most closely corresponds with
the Stereo Viewer magnification
c. ULTRA-FINE: 5:1
4. MASTER ASSOCIATION: assigns the right and left Masters to specific
instrument arms
a. Instrument Arm 1: Right Master (default, but can be
reconfigured)
b. Instrument Arm 2: Left Master (default, but can be
reconfigured)
c. Instrument Arm 3: Can be configured for the right or left
Master
5. DISPLAY: button toggles between views in the Stereo Viewer
a. 2D (2-dimensional)
Æ Note: 2D view shows right eye view only, in addition to icons
and text overlay
b. 3D (3-dimensional)
6. SCOPE ALIGN: Used to perform and save Endoscope alignment and
calibration
7. Arrows
a. Camera Calibration and Alignment: Used to adjust right and
left eye images
b. Image Scaling: resize the 3D surgical image (and any auxiliary
images) by pushing the up or down arrows when TilePro is
activated
c. Digital Zoom (HD only): the left arrow decreases the level of
digital zoom, the right arrow increases the level of digital zoom
8. SCOPE TYPE: configures Endoscope type
a. 2D: 5 mm Endoscope
b. 3D: 12 mm or 8.5 mm Endoscope
9. SCOPE ANGLE: allows the user to toggle between camera angles
a. 30° UP
b. 0° STRAIGHT
c. 30° DOWN
10. Viewer Height controls: located on left side (outer edge) of left side
pod
Surgeon Console Overview 3 of 3
da Vinci S System Overview Script
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IX. Emergency Procedures
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Fault Modes
1. Non-Recoverable Fault
a. Instruments must be removed, da Vinci Surgical System must
be shut down, restarted, and homed
b. DOES NOT necessitate the removal of the da Vinci Surgical
System from the patient
2. Recoverable Fault
a. Overridden by pressing the FAULT OVERRIDE button
b. Examples:
• Difficulty determining Instrument Arm position
• Excessive force on Surgical Arms
• Collisions between Surgical Arms
• Power fluctuation detected
• da Vinci System functioning with battery backup low
3. Note: The da Vinci System is conducting over 1300 checks/second and
will err on the side of giving a fault in order to avoid system damage
F
Disabling a Patient
Cart Arm
1. In the event of an arm-specific malfunction, an Instrument Arm or
Camera Arm can be disabled
2. To disable a Patient Cart Arm, simply press and hold the HOME
button. Once the 3 second countdown has finished, the arm will be
disabled until the next power cycle
3. After the Instrument Arm is disabled, the Instrument Arm Clutch
Button and Instrument Arm Port Clutch Buttons can still be used to
move the arm out of the way
4. NOTE: If the Camera Arm is moved after being disabled, it will
adversely affect the intuitive relationship between the instruments
and the master controllers. This may result in non-intuitive
movement of the instruments. The Camera Arm should only be
disabled in situations where the camera position will be monitored
and maintained by the patient-side assistant.
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Emergency Stop
1. Pressing the EMERGENCY STOP button will stop system operation at
any time. Pressing EMERGENCY STOP is considered a recoverable
fault and can be overridden by pressing the FAULT OVERRIDE button
Conversion to
Open or
Laparoscopic
Surgery
1. If necessary, use Release Grip Wrench to open Instrument Grip
manually
2. Remove the instruments and the Endoscope from the patient
3. Disconnect the cannulae from the Instrument Arms and Camera Arm
a. If necessary, in an emergency conversion, cannulae may be
removed with the Surgical Arms
4. Move the Instrument Arms and Camera Arms away from the patient,
then move the Patient Cart away from the patient
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Emergency Procedures 1 of 2
da Vinci S System Overview Script
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Emergency Power
Off (EPO)
1. EPO button is located under a protective covering on the back of the
Surgeon Console, above the main Circuit Breaker Switches, and on
the back of the Patient Cart
a. Pressing one of these buttons will completely cut off power to
its respective component and is classified as a non-recoverable
fault
b. The Circuit Breaker Switches will have to be thrown and the
system restarted (on Patient Cart, EPO must be depressed a
second time to restart the system)
Error Logs
1. To view Error Logs:
a. View Error Log prior to Homing or immediately after a fault or
pressing Emergency Stop
b. Hold SILENCE ALARM button and press the HOME button at the
same time to view Error Logs
c. Press HOME again to hide Error Log
2. Write down errors when they occur and report errors to your Field
Service Engineer
Emergency Procedures 2 of 2
da Vinci S System Overview Script
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X. Powering Off and Storing the da Vinci System
1. Remove the EndoWrist instruments from the Instrument Arms
2. Detach cannulae from Instrument Arms
3. Remove the Camera Assembly from the Camera Arm and remove
Endoscope cannula
4. Use the Port Clutch buttons to move the Instrument Arms and
Camera Arm away from the patient
5. Move Patient Cart away from the patient
6. Remove cannulae from the patient under direct vision
7. Remove all sterile accessories for cleaning (Endoscopes, Alignment
Target, Camera Sterile Adapter, Camera Arm Sterile Adapter,
bifurcated Light Guide Cable, cannulae and trocars)
8. Remove and dispose of drapes
9. Remove drapes from Camera/Endoscope assembly
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Prepare for da
Vinci System
Shutdown
F
Instrument Usage
Summary Display
1. At the end of a case, when all Instrument Arm drapes have been
removed, the system displays a summary table of all the instruments
used during the procedure and their remaining lives
da Vinci System
Shutdown
1. Prepare the Patient Cart for storage by folding the Setup Joints
against the cart, with Instrument Arm 3 in the Stow position
2. Press the POWER button on the Surgeon Console. The system will
begin the ten second shutdown process and the following message
will be displayed: Preparing to shutdown. Press POWER to reverse
within 10 seconds.
3. Power off the Illuminator
4. Power of the Vision Cart by flipping the switch on the isolation
transformer
5. It is now safe to disconnect all system cables
a. Remove non-system connections as necessary (auxiliary video
and audio cables, ESUs, insufflators, etc.)
b. Disconnect system cables by pulling straight back on the metal
collar and then place the protective cap the cable ends
c. Store the green and blue cables on the back of the Vision Cart.
Store the red cable on the back of the Patient Cart.
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Powering Off and Storing the da Vinci System 1 of 1
da Vinci S System Overview Script
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