Standard Da Vinci vs. the Da Vinci 'S' From a Nursing Standpoint
By Patricia Francois, RN, CNOR,
Surgical Robotics Coordinator at Advocate Lutheran General Hospital in Park Ridge, Illinois
At Advocate Lutheran General Hospital we currently own both robotic systems : the standard Da Vinci and the Da Vinci “S”. There are mechanical and technical differences between the two robotic systems, which makes it difficult to train new people. This article will detail the differences between the two robotic systems in five specific areas: narrow profile, patient side cart, range of motion, brake system, and the battery backup.
Narrow Profile and the Patient Side Cart
The Da Vinci “S” patient side cart has a narrow profile and is designed to have smaller arms with two inches longer instrumentation than the Standard system. The Da Vinci “S” patient side cart has a 4th robotic arm that can be counter-balanced or “homed” in its stowed position in the back of the system. This cannot occur with the Standard system; all arms must be properly positioned and “homed” before use is possible. The “S” system also has greater range of motion than the standard system with the robotic instrument arms. With the range of the instrument arms in addition to the longer instrumentation it is found easier to get into tight abdominal spaces as well as accomplishing better range of motion with suturing techniques such as a “figure eight” stitch.
Brake System
The brake is another mechanical difference between the two systems. The “S” system has a built-in auto-lock safety when docked to the surgical field. Therefore, when robotic arm cannulas on the patient side cart are attached to camera and metal trocars at the surgical field the cart has a safety lock and an alarm which will not allow the system to move when trocars are attached to it. The standard system does not have a safety lock alarm, furthermore, if you do not manually lock the wheel s upon docking the system it has the ability to move at the surgical field even if trocars are attached. Nevertheless, the standard Da Vinci side-cart weighs 1200 lbs which originally took two nurses to move the cart into the surgical field without hurting your back. An upgrade was made to the break pad system which made it 50% easier to move but can still be a nuisance especially to those with back problems. On the other hand, the Da Vinci “S” system has the ability to be moved manually or motorized by shifting the gears at the base of the cart from “D” drive to “N” neutral. The drive mode is controlled by your fingertips and a throttle mechanism built into the steering system. The system easily and slowly glides across the operating room in the drive mode which is the mode used for docking the system. The neutral option on the brake system allows faster free long distance movement of the cart. In addition, in the neutral mode this cart can be moved using one hand except when turning the cart around a corner or an object.
Battery Back-Up
Unlike the standard system, the “S” system has a backup battery for both the surgeon’s console as well as the patient side cart. The standard system only has a battery backup for the surgeon’s console because this is the primary source of power for the robot. Also, if the robot is stored incorrectly, i.e. if the robotic arms are sticking out and not protected you could change the position of the arms of the “S” system by pressing a button, which allows the robot to be powered on from the battery backup system and the arms can be moved at this time. But with the standard system, if you need to move an arm that is not stored correctly you have to connect all the heavy cables of the robot to the surgeon’s console, power on the entire system, and only then will the system allow you to move the arms into their correct stowed position.
The “S” system was created to be more technically user friendly than the standard system, starting with the button labels available on the surgeon’s console, to the LED lights available on each arm (which are color-coded for specific tasks that are done with that arm), to the built-in sterile adapters available on the drapes of the robot and the integrated touch screen monitor with telestration now available for the patient side cart (this can be utilized for teaching purposes). None of these options are available on the standard system, which makes things less user-friendly for everyone involved.
Relative Advantages and the Learning Curve
In conclusion, when I start the process of training new people, I have to decide which system to start with, and usually we start our training with the user-friendly system, which is the Da Vinci-S. Furthermore, there are numerous options available on the Da Vinci “S” which make it easier to learn how to operate the system safely and effectively. As a robotics team nurse the ability to learn quickly and efficiently is very important with moving forward in the training process of learning to use the robot.
Surgical Robotics Coordinator at Advocate Lutheran General Hospital in Park Ridge, Illinois
At Advocate Lutheran General Hospital we currently own both robotic systems : the standard Da Vinci and the Da Vinci “S”. There are mechanical and technical differences between the two robotic systems, which makes it difficult to train new people. This article will detail the differences between the two robotic systems in five specific areas: narrow profile, patient side cart, range of motion, brake system, and the battery backup.
Narrow Profile and the Patient Side Cart
The Da Vinci “S” patient side cart has a narrow profile and is designed to have smaller arms with two inches longer instrumentation than the Standard system. The Da Vinci “S” patient side cart has a 4th robotic arm that can be counter-balanced or “homed” in its stowed position in the back of the system. This cannot occur with the Standard system; all arms must be properly positioned and “homed” before use is possible. The “S” system also has greater range of motion than the standard system with the robotic instrument arms. With the range of the instrument arms in addition to the longer instrumentation it is found easier to get into tight abdominal spaces as well as accomplishing better range of motion with suturing techniques such as a “figure eight” stitch.
Brake System
The brake is another mechanical difference between the two systems. The “S” system has a built-in auto-lock safety when docked to the surgical field. Therefore, when robotic arm cannulas on the patient side cart are attached to camera and metal trocars at the surgical field the cart has a safety lock and an alarm which will not allow the system to move when trocars are attached to it. The standard system does not have a safety lock alarm, furthermore, if you do not manually lock the wheel s upon docking the system it has the ability to move at the surgical field even if trocars are attached. Nevertheless, the standard Da Vinci side-cart weighs 1200 lbs which originally took two nurses to move the cart into the surgical field without hurting your back. An upgrade was made to the break pad system which made it 50% easier to move but can still be a nuisance especially to those with back problems. On the other hand, the Da Vinci “S” system has the ability to be moved manually or motorized by shifting the gears at the base of the cart from “D” drive to “N” neutral. The drive mode is controlled by your fingertips and a throttle mechanism built into the steering system. The system easily and slowly glides across the operating room in the drive mode which is the mode used for docking the system. The neutral option on the brake system allows faster free long distance movement of the cart. In addition, in the neutral mode this cart can be moved using one hand except when turning the cart around a corner or an object.
Battery Back-Up
Unlike the standard system, the “S” system has a backup battery for both the surgeon’s console as well as the patient side cart. The standard system only has a battery backup for the surgeon’s console because this is the primary source of power for the robot. Also, if the robot is stored incorrectly, i.e. if the robotic arms are sticking out and not protected you could change the position of the arms of the “S” system by pressing a button, which allows the robot to be powered on from the battery backup system and the arms can be moved at this time. But with the standard system, if you need to move an arm that is not stored correctly you have to connect all the heavy cables of the robot to the surgeon’s console, power on the entire system, and only then will the system allow you to move the arms into their correct stowed position.
The “S” system was created to be more technically user friendly than the standard system, starting with the button labels available on the surgeon’s console, to the LED lights available on each arm (which are color-coded for specific tasks that are done with that arm), to the built-in sterile adapters available on the drapes of the robot and the integrated touch screen monitor with telestration now available for the patient side cart (this can be utilized for teaching purposes). None of these options are available on the standard system, which makes things less user-friendly for everyone involved.
Relative Advantages and the Learning Curve
In conclusion, when I start the process of training new people, I have to decide which system to start with, and usually we start our training with the user-friendly system, which is the Da Vinci-S. Furthermore, there are numerous options available on the Da Vinci “S” which make it easier to learn how to operate the system safely and effectively. As a robotics team nurse the ability to learn quickly and efficiently is very important with moving forward in the training process of learning to use the robot.
posted by John J. Otrompke | 12:40 PM
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