Over the next several days, we will be working on the da Vinci Si System, Intuitive Surgical’s

robotic platform designed to enable complex surgery using a minimally invasive approach.

1
The da Vinci Si is Intuitive’s third generation system and was launched in 2009.
It features enhanced 3D HD vision, an upgraded surgeon console with dual
console capability, and OR integration.

2
The system activities will include detailed demonstrations as well as hands-on practicum
sessions with experienced trainers. We will focus on the technical information for the da Vinci
Si system, including delivering the In-Service to the OR Staff and Surgeon. The written
evaluation is focused on the technical information. The hands-on evaluation is focused on
effectively delivering the In-Service.

3
The left column shows all the materials available for the da Vinci Si System and where they are
located in your CAST materials. The column on the right is a summary of the materials that you
need to study for the exams.

4
The Si System Overview In-Service Guide is designed to be used as a guide while training the
surgeon and operating staff. During the in-service, the sales representative will guide the staff
through hands-on practice to build the staffs’ competency with use of the da Vinci Si system.

Any activity should be demonstrated by the indicated participant. For

discussions, tailor your facilitation style (Q&A vs. didactic) based on the
participants’ level of
preparation. As the facilitator, read all notes, warnings, and cautions.

Note to trainer: Ask the class to take out the da Vinci Si System Overview In-Service: OR Staff
and da Vinci Si System Overview In-Service: Surgeon. Review the layout and format of the in-
service with the class.

5
For OR Staff training, the System Overview In-Service Guide contains thirteen topics the team
will need to know to successfully complete a robotic procedure. It usually takes about 4 hours
to complete an OR Staff in-service.

6
The Surgeon In-Service focuses on the nine topics that a surgeon needs to understand to
successfully utilize the da Vinci Si system. The overview of these topics includes a skills drills
session where the surgeon can practice using the system by performing dry skills drills and
simulation. The surgeon In-Service usually lasts a minimum of 4 hours.

7
We will now cover Section 1 of the OR Staff System Overview Script: System Component
Overview.

Note to the Trainer: Have participants follow with the in-service.

8
The Vision Cart houses the system's central processing and vision equipment. It includes a 24”
touchscreen monitor, a 3D High Definition (HD) Camera and the CORE (the system’s central
connection point).

9
The Surgeon Console is the control center for the da Vinci Si system. The surgeon sits at the
Surgeon Console and views the surgical field in 3D through the 3D viewer. The Surgeon
Console is ergonomically designed and includes two master controllers with Intuitive® motion:
tremor filtration, motion scaling, endoscope and instrument control.

10
The Patient Cart is the operative component of the da Vinci Si system, and its primary function
is to support the instrument arms and camera arm.

The da Vinci Si system uses remote center technology. The remote center is a fixed point in
space around which the Patient Cart arms move. Remote center technology enables the
System to maneuver instruments and endoscopes in the surgical site while exerting minimal
force on the patient's body wall.

EndoWrist instruments give surgeons natural dexterity and more than natural range of motion,
compared to unaided human hands. This allows for greater precision when operating in a
minimally invasive environment.

11
We will now cover Section 2 of the OR Staff System in-service: OR Setup, System
Connections, and Startup

12
Vision Cart: OR Setup and Power Considerations
 Located in the non-sterile field where it can be viewed by the patient-side assistant and is
accessible by the circulator
 1 power cable that must be connected to its own dedicated power circuit – validated by a
biomedical engineer
 Camera cable is 15 feet long, so the Vision Cart is positioned at a distance from where the
camera can be installed on the Patient Cart

13
Vision Cart: Movement and Positioning
 Only use the handles in front of the Vision Cart for movement and positioning in the OR. Do
not push or pull on the sides of the Cart
 Once moved to desired position, press the wheel locks to lock the brakes

Vision Cart standalone mode (blue fiber cable not connected) can be used for training OR staff
on touchscreen menus and settings that are accessed by non-sterile circulating staff during a
da Vinci case.

14
Surgeon Console: OR Setup and Power Considerations
 Located outside of the sterile field while maintaining view of the operative field and has a
clear line of communication with the patient-side assistant
 One power cable connected to a dedicated circuit - validated by a biomedical engineer

15
Surgeon Console: Movement and Positioning
 To move or reposition the surgeon console use the handles labeled “PUSH” on both sides
 Brakes (indicated by “BRAKE” label) are located on each side of the base on the Surgeon
Console. The Surgeon Console should be locked once it is positioned for surgery. Step on
the brake pedal to apply that brake; the lock symbol will become visible when the pedal is
depressed, indicating the brake is applied. Step on the depressed brake to release it. Both
brakes must be released to raise the footswitch panel and enable Surgeon Console
transport.

Note to trainer: Demonstrate to the class how to move the Surgeon Console using the side
handles

If a da Vinci Si Simulator is available, it can be connected to the Surgeon

Console via the short blue cable. Then, the Surgeon Console can be powered
on in standalone simulator mode and used for skills practice.

16
Patient Cart: OR Setup and Power Considerations
 Initially located outside the sterile field. After draping the arms and positioning the patient for
surgery, it is moved into the sterile field where it is docked to the cannulas on the patient.
 One power cable plugged into its own dedicated circuit – validated by a biomedical engineer
 Backup battery that takes 14 hours to charge and gives 5 minutes of battery life in an
emergency. Ensure that the Patient Cart is always connected to power supply even when
the system is not powered on.

17
Patient Cart: Movement and Positioning
 To manually move the Patient Cart over long distances, place the shift switches in the (N)
(neutral) position
 To move it down a slope, or within the OR when driving it from the non-sterile to the sterile
field, place the shift switches in (D) (motor drive)
 To move the Patient Cart in motor drive, press and hold the throttle enable switch and gently
turn the throttle – away from you to move forward and toward you to move backward.
Placing the shift switches in (D) also locks the brakes
 Once you have finished moving the cart, place both shift switches in the drive (D) position to
set the Patient Cart brakes

WARNING: For patient safety, both shift switches must be kept in the drive (D) position so that
the motor drive remains engaged during surgery. This ensures that the brakes are engaged
when docked to the patient.

Patient Cart standalone mode can be used to transport the Patient Cart
between operating rooms or over long distances (with sufficient battery power)
in a hospital

18
During the system overview section in the in-service it is important to discuss these topics with
the OR Staff/Surgeon:
 Position of anesthesiologist
 Location of other equipment in the OR such as ESU’s, recording devices etc.
 Cable management so the OR Staff has access to the system while maintaining the sterile
field

19
Check the power connections for the system components. Verify that the illuminator and CCU
cables are connected. These should always remain connected and never unplugged.

The camera head has two cables: one for video and one for illumination
• Leave the cables connected to the camera head and front of CORE when not in use
• To plug camera cable into Camera Control Unit (CCU), match the alignment arrow on the
cable to the arrow on the top of the CCU receptacle, then tighten the metal nut on the
camera cable
• To plug in the light guide cable, insert the cable into the front of the illuminator

Note to the Trainer: Walk over to the Vision Cart and point out the CCU cable connection and
illuminator connection

20
Next connect the blue fiber optic cables. The system cables have a fiber-optic core. Care
should be taken to avoid bending the cable, as kinks can damage the cable and may prevent
system operation. The OR Staff must always check for debris before plugging in the cables. If
there is debris in the cable, compressed air must be used to clean the cable. When the cables
are not connected to the system, it’s important to attach the protective caps on the cable. The
protective caps prevent the connectors from getting damaged and filled with debris. During the
In-Service be sure to practice connecting and disconnecting the blue fiber optic cable.

Note: Once the system is connected and powered on, the system cables should not be
unplugged until the system has completely powered down. If the system cables become
unplugged during use, a non-recoverable fault will occur. To restore system functionality, plug
in the cable, remove all instruments, and restart the system.

21
This is an image of the back of the CORE on the Vision Cart. The CORE is the central
connection point for the system. The main components are:
 CORE Connections: video output and audio input/output
 CCU Connections
 Video Expansion Kit (VEK)
 ESU connections

We will be discussing the details of each connection in upcoming slides

22
This is the back of the CORE. It does not matter which cable connection is used for each of the
blue cables.

The details on the other connections will be covered next.

Note: The only connections you should access on the back of the Vision Cart are the power
cords, blue system cables, auxiliary device cables, and audio/video cables as described in this
chapter. Other cables on the back of the Vision Cart should remain connected at all times and
should only be accessed by authorized ISI personnel.

23
Connect the video input and output options at the back of the CORE.

Output: one (1) video output bay Aux is available on the back of the Core
Audio: three (3) connectors are provided on the audio bay: RCA output (Line Out), RCA input
(Line In), 2.5 mm input/output headset jack (Headset)

Note to the trainer: While you are discussing the video and audio input and output options,
show the class how to connect them.

24
Here is a close up of the VEK, which adds the following to the base da Vinci® Si™ System.
Note that even with all of the additional options available with the VEK, only two TilePro inputs
should be connected to the system at any one time, as only two can be viewed on the system
at one time

Video Expansion Kit (VEK):

Outputs: two (2) additional multi-format outputs (HDSDI or DVI or S-video)
Inputs: two (2) TilePro™ multi-image display inputs (HDSDI or DVI or S-video) at the vision
cart

NOTE: The VEK can be purchased separately. It is included with the purchase
of a dual console system.

25
There is a video output at back of the CCU. Since this output is coming directly from the CCU,
it’s an unfiltered image that has not been processed by the CORE and has no icons. This
output should be used only if the other video outputs are not available, or if a raw video image
with no icons is desired.

Outputs: two (2) component video outputs are available on the back of the Camera Control
Unit. The left-eye (L) and right-eye (R) video outputs provide the surgical image without icons
or text messages.

26
Finally, connect the ESU cables. There are three ESU connections at the back of the CORE
and the system will automatically detect the ESU connected. For the da Vinci Si system, there
is an Intuitive specific cable that connects the ESU to the CORE. Make sure that the hospitals
purchase this cable from Intuitive. The list of approved generators can be located on the Online
Community.

WARNING: Make sure the electrosurgical unit (ESU or generator) is properly functioning
before connecting it and using it with the system.

Note to the trainer: While you are discussing the ESU connections, show the class where they
are and plug them in.

27
Surgeon Console
Inputs: two (2) video input bays are provided on the back of the Surgeon Console to enable
multi-image mode (TilePro). Each video input bay is capable of accepting a single DVI, HD-
SDI, or S-Video signal. Remember that only two TilePro inputs can be plugged in at any one
time.
Outputs: two (2) video output bays are provided on the back of the surgeon console. The
Video Out L and Video Out R bays on the Surgeon Console support transmission of the left and
right eye video seen in the Surgeon Console via DVI connection
Audio: the Audio bay supports transmission of Surgeon Console audio with connectors for:
RCA output (Line Out), RCA input (Line In), 2.5 mm input/output headset jack (Headset)

28
29
During the startup sequence, a system integrity test is performed. As part of this test, the
master controllers and all Patient Cart arms that are not stowed perform a self-test. The
masters move to their start position and must arrive there for the system to work. If a master is
impeded somehow, simply move it by hand to free it and it will move to its start position. The
instrument arms of the Patient Cart will blink green, move slightly and perform a short
mechanical integrity test, if no cannula is installed and they are not in stow position. If an arm
bumps into something during the test, use the port clutch button to move the arm clear of the
obstacle. When clear, press and release the port clutch button to enable the test to resume.
Once the system integrity test is successfully completed, the arm LEDs (of all arms not stowed)
will be lit white.

Note to the trainer: Turn on the system so that the class can observe the start-up and homing
process.

30
We will now cover Section 3 of the OR Staff System Overview Script: Vision Cart Overview

31
Note to the trainer: Connect the DVI video output bay 1 to the DVI input in the wall plate in the
training room. In the touchscreen tab go to Video Setting  Advanced Video Adjustments. For
Video Output bay 1 select the format as DVI and select the graphics as Patient Side View.

32
Discuss the touchscreen monitor:
 The screen is 24”/61 cm and offers a wide screen view
 The 1080i resolution offers improved vision and clarity, especially during instrument
insertion and retraction
 Telestration is always on and is visible in the Surgeon Console
 All the system settings: video, audio, and utilities are available on the touchscreen monitor
tab menu

33
Review the icons on the touchscreen monitor:
 Endoscope type and angle displayed next to the camera assembly icon at the bottom of the screen
 The camera horizon icon indicates the rotation of the camera and endoscope assembly in the surgical field
 Just above these icons is the da Vinci OnSite Icon
 A green checkmark next to the icon indicates that the system is correctly connected to the remote
Onsite network, allowing the customer service department and field service engineers to access
diagnostic information about the robot
 The numbered icons correspond to each of the Patient Cart instrument arms
 If an instrument is in active control, a right or left hand will appear next to the number icon
 A yellow lightening bolt indicates a correctly installed energized instrument and a grey lightening
bolt indicates a non-energized instrument or an incorrectly installed energized instrument
 Underneath each numbered icon, the name of the installed instrument appears
 Underneath the instrument name, the surgeons name will appear. This feature is particularly useful
during a dual console procedure, where two surgeons may be operating in tandem
 The area around the numbered icons will change color if the surgeon’s foot is hovering over an
energy pedal (the area turns blue), or firing and energy pedal (the area turns orange)
 At the top of the screen are icons indicating the master controllers. This area will relate any messages
regarding the master controllers, indicates which master controller is in control of each instrument arm, and
also shows the energy icons

Note to the trainer: On the projector, display the touchscreen view from the Vision Cart. This way the class
can see all the icons/tabs on the touchscreen. You may also ask another trainer to assist you by pressing the
touchscreen tabs as you are speaking about them.

34
Touchscreen Menu Access: Telestration and Video Source Tab

At the bottom of the screen is the telestration eraser and the tab menu. Telestration is always active.

The tab menu is currently open to the Video Source tab which displays the following options:
 The Endoscope View displays the wide screen view from the endoscope
 TilePro 1 and 2 allow you to toggle between view of either TilePro image on the screen
 The Surgeon Console view displays the screen and icons from the Surgeons Console, and can be used to
access either console view in a dual console procedure
 You can also toggle between the Left eye view (L) and the Right eye view (R)

35
The Video Settings tab is the next selection on the tab menu, which includes:
 Advanced Video Adjustments
 Camera Scope Setup
 Video Output

36
Advanced Video Adjustments
 The brightness of the camera can be adjusted in two areas on the touchscreen. The first,
and easiest to access way, is using the brightness slider bar or the +/- buttons located in the
main menu bar. Camera brightness can also be adjusted in the options that appear after
selecting the Advanced Video adjustments button.
 Please note that the illuminator setting should always remain at 100% for optimal camera
performance, even when using these buttons to adjust the camera brightness.
 In addition to the brightness settings, for advanced users there are several other video
settings that can be adjusted here. If needed, press Restore Factory Settings to restore all
advanced video adjustments to default values, which should be appropriate for most clinical
scenarios.

Camera Scope Setup

Ability to perform white balance, scope calibration and to manually set the scope angle (when
the system does not detect it automatically).

Video Output
Enables you to specify the video output format and graphics source for up to three video
outputs.

37
Camera/Scope Setup
The Camera/Scope Setup button is the next option available on the Video Settings tab. When
setting up for a procedure, the OR staff will typically use buttons on the camera head to perform
white balance and automatic calibration. Access to these same functions on the touchscreen
allows for manual calibration, if needed. The illuminator can also be turned on/off from this tab.

The endoscope selection also appears here, with the installed endoscope highlighted in blue.
When the RFID chip reads an installed endoscope, this selection on the touchscreen monitor
will be “locked,” preventing anyone from selecting the incorrect endoscope angle. However, the
scope angle can be manually set when the system does not detect it automatically.

38
Video Output
The last button on the Video Settings tab allow you to select the Video Output options. It’s
important to verify that the format selected on the touchscreen corresponds to the video output
connection at the back of the CORE. The Graphics options should then be selected, so that the
desired icons appear on the third party monitor or recording device. The Surgeon Console
selection will display the icons and messages that appear in the Surgeon Console stereo
viewer, the Patient Side selection will display the icons and messages that appear on the Vision
Cart Monitor, and the Endoscopic View shows the surgical image without any icons.

This is the view that you would see on the back of the Vision Cart CORE for a single console
configuration.

39
Video Output
Displayed here are the Video Output options for a dual console system. The Video Out 1 and
Video Out 2 correspond to the video output bays on the VEK. Video Out Aux corresponds to
Video out Aux at the back of the CORE. It’s important to verify the format that is selected
corresponds to the video output connection at the back of the CORE. If the system detects that
there are two Surgeon Consoles, the Graphics options will allow you to select between Console
1 Overlay, Console 2 Overlay, Patient-Side View, or Endoscopic View.

The VEK also allows you to select between out putting single independent signals, or a stereo
pair. When the Independent button is selected, each Video output acts separately. When
Stereo Pair is selected, it ties Video output 1 and 2 which can be used for 3D recording or
viewing on a 3D monitor.

40
Audio Tab
The Audio tab enables you to adjust touchscreen speaker volume (how loud you hear the
surgeon) and mute the touchscreen microphone (the surgeon will not be able to hear you).

41
Utilities Tab: The last tab on the touchscreen monitor is the Utilities tab. Under the Utilities tab
you can find the following options:
 Inventory Management
 Event Logs
 Troubleshooting

42
Inventory Management: Provides an overview of the instruments used during
the procedure. This menu can be accessed at any time during the procedure.
 Viewing Lamp Hours: To view usage hours of the lamp module (on non-
Fluorescence Imaging Systems), select Inventory Management (on the
touchscreen or touchpad). You can also view the lamp hours on the
Illuminator by pressing the decrease (–) and increase (+) buttons
simultaneously on the illuminator.
Event Logs: Provides access to the system event logs, including error logs. The system logs
all events, even events such as system start-up and shut down. These Event Logs can be
accessed at any time during a procedure. Use page up/down to access the events within a log.
The last line in the log is the most recent event. Use previous log button to access the previous
procedure log.

44
Troubleshooting: Contains the system serial number and software version installed on the
system. These are important when calling dVSTAT to discuss an issue. You can also
troubleshoot the Right (R) and Left (L) eye vision system connections using the color bar
selections for L and R eyes.

Note: Several times a year, a new patch is released. Patch releases are to introduce new
features or fix issues. The installed patch number appears here, next to the system serial
number and is denoted by the letter “P” followed by the patch number.

45
The Vision Cart has three shelves to hold auxiliary equipment. Each shelf can support up to 40
lbs. (18.2 kg) provided that the total loading of all shelves not exceed 60 lbs. (27.2 kg).

46
Discuss the illuminator:
 The illuminator has a fan that runs whenever the Vision Cart is on, so the lamp bulb can be
tuned on using the On/Off button right before a procedure. The illuminator lamp can also be
turned on from the camera head, Video Setting Camera/Scope set up tab on the
touchscreen and Video Camera/Scope set up tab on the touchpad.
 The +/- buttons adjust the illuminator intensity. One tap adjusts the settings by 10%.
 To view the lamp hours, press and hold the +/- buttons at the same time. The lamp hours
can also be accessed from the Utilities  Inventory Management from the touchscreen and
touchpad.
 The lamp module has a 1000 hours. Once the lamp module exceeds a 1000 hours, a
message will be displayed on the touchscreen. This does not prevent the OR from
continuing with a procedure, but the message will only be cleared once the lamp module has
been replaced and the system restarted.

Note to the trainer: While you are discussing each point, show the class how to:
 Turn the lamp On/Off from the illuminator
 Turn the lamp On/Off from the touchscreen
 Adjust illuminator intensity
 Check lamp hours from the illuminator and from the touchscreen

47
The integrated camera control unit (CCU) has a simple user interface, i.e. there are not buttons
on the front of the CCU and only one cable connection. This cable connection runs from the
CCU to the camera head and should stay connected unless a camera or cable needs to be
replaced.

48
We will now discuss the difference between brightness and illuminator settings.
 If the surgical field is too bright or too dark, the surgeon or OR staff should adjust the
camera brightness from the touchscreen or touchpad
 Both the Brightness slider (video brightness) and the Illuminator slider (lamp intensity) will
affect the brightness of the image seen in the stereo viewer. To minimize fogging, maintain
heating of the endoscope tip by setting the Illuminator slider to maximum and then adjust
image brightness using the Brightness slider. If working close to tissue, decrease the
Illuminator intensity using the Illuminator slider, and increase image brightness as necessary
using the Brightness slider. If the image is too dark, check both the Illuminator and
Brightness sliders, making sure each is far enough to the right, given the working distance of
the endoscope tip from tissue.
 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.

49
Some of the features and of the 3D-HD camera are:
 The next generation 3D-HD camera head provides high resolution and clarity. The RFID
chip automatically reads the endoscope type
 The buttons on the camera head allow one person to white balance the camera head and
3D calibrate the camera head and endoscope
 The grip makes it easy to handle
 The protective handles protect the cable and cable connectors from getting damaged

Note to trainer: Take out the camera head from the Vision Cart drawer and point out each
component as you are talking about it

50
The camera head buttons and their functions are:
 The illuminator lamp button turns the illuminator on and off
 The focus control buttons are used to focus the camera (while the surgeon’s head is NOT in
the stereo viewer) or navigate through the Vision Setup menu
 The Vision Setup button allows access to the white balance and auto calibration menus
 This button allows the scrub nurse to perform calibration after camera draping
without the assistance of the circulating nurse

51
The HD Vision on the da Vinci Si system enables the following 3 key features:
 High resolution
 Wide view
 Digital zoom

52
52
Let’s look at the potential benefits of a wide screen view:
 The 16:9 aspect ratio (wide screen) view provides an image that is 30% wider than
the full screen view and provides 20% more viewing area
 This wider image can be used by the patient-side assistant to more easily guide in
needles or laparoscopic instruments as it provides additional information about
periphery of the surgical field.

53
53
Digital zoom is a feature that allows the surgeon to magnify the surgical image without
physically moving the endoscope closer. This feature allows the surgeon to view
anatomy very close and to a much greater detail than ever before.

Let’s review digital zoom features and potential benefits:

Features
 Full-screen & wide-screen views and 2 additional levels of digital zoom (without
physically moving the endoscope tip)
 Magnification without scope movement
 Controlled by masters (haptic zoom) and Touch Pad of the Surgeon Console
 zoom indicator

Potential Benefits:
 Allows optimal placement of scope in surgical field
 Reduces interference between endoscope and instruments

54
54
Store the camera head in its custom cutout in the Vision Cart drawer below the CCU. Coil the
camera cable pair and hang the excess cable on the hook on the side of the Vision Cart.
 The light guide cable and HD camera cable are very delicate, and have to be stored
carefully on the cable hook. This allows the cable to be wound loosely and prevents the
cable from kinking and getting damaged.

Note to trainer: Turn the Vision Cart towards the class so they can see the hook where the
camera cable should be stored.

55
Some of the endoscope features are:
 The RFID chip recognizes the scope angle and configuration (not size), which helps the
system remember scope calibration. This reduces setup and exchange time
 The light guide cable is integrated with the camera head so it is not sterilized or connected
to the endoscope as on the da Vinci S system. This makes intra-operative endoscope
exchange easier
 The 8.5 mm scope allows for a significant reduction in camera port size, which can improve
cosmesis. The smaller scope can also be placed in an 8 mm da Vinci instrument cannula.
This is beneficial at the start procedures, where many hospital sites have been using an
additional laparoscopic scope and vision cart for conducting initial anatomy assessment

56
Some additional features on the Vision Cart are:
 The integrated tank holders are adjustable and can accommodate the various tank sizes
used for the insufflation tanks
 The empty shelves on the Vision Cart can be used to store the ESU, insufflator, recording
devices etc. Any equipment stored on the shelves of the Vision Cart must be connected to a
dedicated circuit (i.e. the ancillary equipment should not be connected to the same circuit as
any of the system components)
 There are two storage drawers on the Vision Cart. The top drawer is used to store the
camera head and the second drawer is used to store user documentation or backup
equipment
 On the side of the Vision Cart there is also a large cable hook to store and manage all
camera, system, ESU, and electrical cables

Note to trainer: Point out each of these components on the Vision Cart

57
We will now cover Section 4 of the OR Staff System in-service: Draping & Calibrating the
Camera & Endoscope

58
In this section:
 Camera and endoscope inspection
 Camera control buttons
 Draping the camera
 White balancing the camera
 Calibrating the endoscope

59
Prior to each procedure the OR Staff must always:
 Inspect the camera head and camera cables for damage. Always check the cable for kinks
and bends
 On the endoscopes, inspect the light guide cable ports
 Inspect the lenses for damages which is evident by a dark eye or broken lens or dirty
deposits
 WARNING: Do not use endoscopes with any defects or signs of damage, including damage
to the light ports or fiber surfaces, as serious injury or surgical complications may occur to
the patient.

Note to trainer: Demonstrate to the class how to inspect the camera head and endoscope

60
The steps to draping the camera head are:
Step 1: Deliver the camera drape to the scrub nurse in a sterile fashion
Step 2: Unfold the drape and break the tabs.
Note to trainer: Demonstrate how to drape and calibrate the camera head and endoscope.
Use a mayo stand or draped cart to display all sterile accessories the camera head drape. Be
sure to follow sterile technique during the demonstration. Ask someone in the class to be the
circulating nurse and assist you. Ask another person in class to progress through the slides as
you are draping and calibrating the endoscope. Make sure you are in the a location where all
members of the class can see you.

61
Note: Before draping the camera head, the circulating nurse should wipe the lenses to remove
any debris or smudges
Step 3: Then insert a hand into the open end of the drape and grab the camera head sterile
adapter firmly
Step 4: Attach the sterile adapter to the camera head. Since the camera head and camera
cables are not sterile, the circulating nurse must assist with attaching the camera head to the
sterile adapter and draping the camera head assembly. You must align the pins in the camera
head with the channels in the sterile adapter, push down and turn to lock into place. Icons on
the camera head ring-nut indicate the direction you must turn to lock or unlock the sterile
adapter to the camera head.
Step 5: The scrub nurse then inverts the drape and pulls it all the way over the camera head
and prepares to pass the drape off to the circulating nurse

62
Step 6a: The scrub nurse holds on to the camera head while the circulating nurse pulls the
drape down over the length of the camera cables, while holding the drape behind the blue
sterility barrier.

Step 6b: The scrub nurse should assist in arranging the draped camera cables over the sterile
table by coiling the draped cables. Keep at least eight feet of the draped cable on the sterile
table. Keep all accessories arranged neatly to ensure that neither the draped cable nor any of
the accessories hang over the edge of the table.

63
Step 7: After the camera assembly is fully draped, the scrub nurse attaches the sterile
endoscope to the sterile adapter by aligning the pins on the endoscope with the
channels on the camera head sterile adapter

For 30 degree up and for the 0 degree scope, align the Intuitive logo on the endoscope to the
buttons on the camera head. The RFID chip will automatically read the endoscope type.

64
The steps to white balance the camera head are:
White balance sets a white/color benchmark for the Vision System, and only needs to be
performed once prior to each procedure
 The non-sterile staff will confirm the illuminator is set to 100%. You can do so by pressing
the illuminator button on the vision cart, touchscreen monitor or the touchpad.
 Then using a sterile white piece of paper from the drape package, point the endoscope tip
10 cm away from the paper
 DO NOT use gauze, as the camera head will recognize all the whites, grays, and
shadows on the gauze and will not white balance properly
 Next, the scrub nurse will press the Vision Setup button on the camera head
 Note: if the illuminator is not already on, the illuminator will turn on when the Vision
Setup button is pressed
 If needed, white calibration can also be performed from the touchscreen monitor or
the touchpad on the Surgeon Console
 Use the arrow buttons on the camera head to navigate to the White Balance selection on the
menu
 Press the Vision Setup button again to initiate white balance
 A message will appear on the screen when the white balance is complete, and a green
checkmark will appear next to the White Balance selection on the menu

65
Next, calibrate the endoscope and camera head.
 First, insert the endoscope fully inside the Universal Alignment Target, using the proper hole
and orientation for the tip angle, so that the target cross-hairs are visible on the center of the
touchscreen

66
Next, initiate 3D calibration by using the arrow button to navigate to the Auto 3D Calibration
option on the touchscreen monitor, and then selecting the option by pressing the Vision Setup
button
 Automatic 3D calibration can only be performed from the camera head
 Manual calibration can be performed using the touchscreen or touchpad

67
 Once automatic calibration is complete, check the alignment of the pink and green arrows
on the touchscreen, and if calibration look correct, use the Vision Setup button to select Yes
from the menu
 If the calibration does not look correct, select No from the menu and then perform automatic
3D calibration again
 If needed, manual calibration can be performed using the options on the touchscreen or
touchpad
 Complete endoscope calibration for every endoscope that will be used in the procedure

68
The steps to manually calibrate the endoscope from the touchscreen or touchpad are:
 To manually calibrate the endoscope (if needed), begin by inserting the endoscope fully
inside the Universal Alignment Target, using the proper hole and orientation for the tip angle,
so that the target cross-hairs are visible on the center of the touchscreen
 Using the touchscreen or touchpad tab menu navigate to the 3D calibration options by
selecting the Video Settings tab (on the touchscreen) or the Video tab (on the touchpad)
 Initiate the 3D calibration by pressing the Manual Calibration button
 Adjust the alignment, using the arrows on the touchscreen or touchpad
 When you are satisfied with the alignment, press the Finish Calibration button to save the
settings
 Complete endoscope calibration for every endoscope that will be used in the procedure

Note to trainer: Demonstrate how to manually calibrate the endoscope. Ask someone in the
class to be the circulating nurse and assist you.

69
We will now cover Section 5 from the OR Staff System Overview in-service: Patient Cart
Overview

70
In this section:
 Patient Cart components
 Draping the instrument arms
 Draping the camera arm
 Other Considerations

71
Instrument Arm:
 There are three instrument arm setup joints

72
Camera Arm:
 “Sweet Spot”: To set, move the camera arm so that the blue arrow points between the limits
of the blue bar on the camera arm setup joint (left or right side)
 The “Sweet Spot” maximizes the range of motion for the camera arm

73
Camera Arm:
 Camera arm clutch button (press and hold vs. quick click)
 Camera arm port clutch buttons (press and hold)
 Camera arm quick click cannula mount

74
Instrument arm components – terminology check

75
Describe and demonstrate LED indicator colors (whichever ones are possible to show) with
examples of scenarios when they would occur.

Instrument arm LEDs:

 Solid white: not ready for Surgeon Console control
 Alternate side-to-side blinking green and white: guided tool change (see Guided Tool
Change section)
 Alternate side-to-side blinking white: clutching
 Bright blue: ready for Surgeon Console control
 Yellow: Recoverable Fault - intervention required (see Emergency Procedures: Fault Modes
section)
 Red: Non-recoverable Fault - system fault (see Emergency Procedures: Fault Modes
section)
 Fast blinking green: system start-up and new instrument information downloading

76
3rd instrument arm – if it is to be used in the case, un-stow it from behind the center column.
Telescoping axis opens out, completing a mini-mechanical integrity check. Un-stow this arm in
the side in which it is to be docked, using the lever at the back.

77
78
Motor drive: designed to provide faster/easier docking and operating room
configuration
 Power button
 Throttle enable switch
 Throttle: rotate the throttle away from you to move forward, or towards you to move
backwards. Control the drive speed by how for you rotate the throttle in each
direction.
 Cannula installed LED: For safety, motor drive will not engage if cannulas or
instruments are installed
 Base and shift switches (N and D)
WARNING: For patient safety, shift switches must be kept in the Drive (D) position so
brakes remain engaged during surgery

Note to the trainer: Demonstrate how to move the Patient Cart within the OR in motor
drive.

79
79
We will now cover Section 6 from the OR Staff System in-service: Draping the Patient Cart
Arms

80
3-arm drape kit: 2 x instrument arm drapes, 1 x camera arm drape, 1 x camera head drape, 2 x
8mm cannula seals

4-arm drape kit: 3 x instrument arm drapes, 1 x camera arm drape, 1 x camera head drape, 3 x
8mm cannula seals

81
Intuitive Surgical recommends covering the Patient Cart column with a three-quarter drape for
procedures where fluid may splash onto the column.
 Minimum length and width for three-quarter drape: 75 inches x 50 inches (190.5 cm x 127
cm)
 Maximum length and width for the three-quarter drape: 80 inches x 60 inches (203.2 cm x
152.4 cm)

Step 1: Prepare the Patient Cart for draping by exposing the column
Step 2: Wrap a three-quarter drape around the Patient Cart column. Use the drape in
landscape orientation.
 Place the drape in the following areas: a. Over the setup joint ledge for instrument arms 1, 2
and the camera arm.
 Between instrument arm 3 (stowed) and the Patient Cart column. This configuration allows
for a mid-procedure third arm deployment.

82
Step 3: Tighten and secure the drape behind the Patient Cart column
 Roll the drape ends together to tighten
 Secure with a towel clamp. Make sure to place the rolled drape with clamp on the opposite
side of the instrument arm → setup joint.

Step 4: After moving any instrument or camera arm setup joint up or down, adjust drape.
Always ensure drape remains tight and secure above the setup joint ledge for instrument arms
1, 2 and the camera arm.

83
Drape the Patient Cart from right → left OR left → right
Step 1: Move and straighten each arm to provide plenty of room to maneuver around the arms
Step 2: Deliver the instrument arm drape to the scrub nurse in a sterile fashion
Step 3: Unfold the drape on a sterile table, with the instrument arm sterile adapter facing the
ceiling
Step 4: Release the first tear away tabs

84
Draping an instrument arm continued:
Step 5: Grab, but do not break, the tear away tabs along the drape cuff and spread to expose
opening
Step 6: Grab drape above sterile adapter and fold down to hold it with the drape cuff in the
same hand
Step 7: Tent the drape open with the other hand
Step 8: Carefully lower drape over instrument arm
Step 9: Insert the base of the sterile adapter into the instrument arm carriage.
Step 9a: Using both thumbs, push the sterile adapter into the instrument arm sterile adapter
carriage until it clicks into place
Step 9b: Confirm proper engagement using the Sterile Adapter Engagement Verification
Reference Guide (PN 551618-01)

85
Sterile Adapter Engagement Verification continued:
 If any open notch does not match the position above, use the closed tip of a sterile Kelly
Forceps or Hemostat instrument to manually rotate the disc
 Rotate the disc in either direction until it clicks into place. The disc should no longer rotate
once it is fully engaged

86
Draping an instrument arm continued:
Step 10: Insert hands inside the drape cuff. Move drape along the instrument arm toward the
center column
Step 10a: The blue band on the drape indicates the sterility barrier. If a non-sterile staff
member is assisting, he or she must not grasp the drape anywhere beyond the blue band.
Step 11: Seat the cannula mount molding, making sure the molding cleanly folds over the
cannula mount

87
Draping an instrument arm continued:
Step 12: Bend the blue flex-strips to create a clear U-shaped instrument insertion path along
the telescoping axis of the instrument arm
Step 13: Wrap all white drape straps around the instrument arm and attach each strap to itself
with one strap per joint
Step 14: Move the draped arm away from the undraped arms to avoid contamination

88
Draping the Camera Arm:
Step 1: Position camera arm for draping
Step 2: Deliver the camera arm drape to the scrub nurse in a sterile fashion
Step 3: Unfold and orient the drape with the camera arm sterile adapter facing the ceiling.
Remove the cardboard piece.

89
Draping the Camera Arm continued:
Step 4: Fold over the top of the drape. Find the center of the drape and hold the drape open
with both hands.
Step 5: Carefully, lower the drape over the camera arm insertion axis.
Step 6: Install the camera arm sterile adapter into the sterile adapter mount on
the camera arm. Create room for the endoscope to pass through, then firmly
push the camera arm sterile adapter into place. Pull up on the sterile adapter to
confirm proper engagement.

90
Draping the Camera Arm continued:
Step 7: Use the drape cuff to move the drape down along the camera arm towards the center
column. Attach Velcro tabs behind the last joint.

91
Draping the Camera Arm continued:
Step 8: Seat cannula mount molding. Make sure the molding cleanly folds over the cannula
mount.
Step 9: Bend blue flex-strips to create a clear path for the endoscope along the arm’s insertion
axis

92
Draping the Camera Arm continued:
Step 10: Wrap each white drape strap snugly around camera arm, attaching each strap’s end
to itself
Step 11: Insert the camera cable flex strips into the strain relief support
Step 12: Move the draped arm away from the undraped arms to avoid contamination
Step 13: Drape remaining arms

93
After the Patient Cart is draped, make sure that the cart is out of the way of other procedure
preparations, and in a location where sterility of the draped cart will not be compromised.

94
95
Instrument Arm cannulas, Obturators & Accessories:
The instrument cannulas are available in 8 mm and 5 mm diameters (for use with 8 mm and 5
mm instruments).
 da Vinci cannula 8 mm: reusable, 11 cm and 16 cm lengths
 The 8 mm cannula has a green cannula seal with a reducer cap that allows it to be
reduced to a 5 mm seal when required to be used with 5 mm laparoscopic
instruments
 The green cannula seals are disposable and are also available in the drape kits
 The 5 mm cannulas are used with the 5 mm white seals - these are not part of the
drape kit and need to be ordered separately
 White cannula seal: disposable, for 5 mm cannula
 5 mm : 11 cm cannula length
 The 5 mm cannulas are used with the 5 mm white seals - these are not part of the
drape kit and need to be ordered separately
 8 mm to 5 mm reducer: reusable
 Cannula mount reads cannula type

Obturator 8 mm blunt: reusable

 8 mm bladeless: disposable
 5 mm blunt: reusable

NOTE: Reducer cap on the green cannula seal is for laparoscopic instruments only, and should

96
NOT be used with EndoWrist instruments

96
Camera Arm cannulas
 The camera trocars are available in 12 mm and 8.5 mm diameters for use with the 12 mm
and 8.5 mm endoscopes respectively.

NOTE: The brand of the camera cannula selected for use must match the brand of the
camera cannula mount (that is in the camera arm of the Patient Cart)
 For the 12 mm cannulas, the brand options available are Ethicon, Covidien and Applied
Medical
 The 8.5 mm camera cannula is validated for use with only the Ethicon (ETH) endoscope
cannula mount

97
Demonstrate remote center and remote center boundaries and assemble the da Vinci cannula.

98
The remote center is positioned in the muscle layer in order to minimize trauma at the patient’s
body wall. When placing ports, the cannula should be inserted perpendicular to the skin to
avoid tunneling or skiving.

99
Discuss the 7 degrees of freedom and the value propositions of the EndoWrist instruments in
comparison to open and laparoscopic surgery techniques

Same basic instruments used on S and Si platforms

 540º of rotation
 7 degrees of freedom: insertion, external pitch, external yaw, roll, grip, internal pitch and
internal yaw
 Components a. Tip
 Wrist
 Shaft
 Instrument housing
 Release levers
 Discs (control movement of instrument wrist and tips)
 Emergency release socket

100
Describe instrument architecture and differences between 8mm and 5mm instruments

Components
 Tip
 Wrist
 Shaft
 Instrument housing
 Release levers
 Discs (control movement of instrument wrist and tips)
 Emergency release socket

Sizes: 5 mm, 8 mm
Instrument lives:
Most 8 mm: 10x
Exceptions: Harmonic ACE®: 20x, Fine Tissue Forceps: 15x, Black Diamond Forceps: 15x,
Snap-fit Scalpel: 30x, EndoPass Delivery Instrument: 30x, Valve Hook: 15x, EndoWrist One™
Suction Irrigator: 1x, EndoWrist One Vessel Sealer: 1x

Most 5 mm: 10x

Exceptions: Monopolar Cautery: 18x, Round Tip Scissors: 12x, Curved Scissors: 12x

101
Additional Exceptions:
 Clip applier: 100 fires
 Training instruments: 30x
 To view remaining instrument lives (at any time during a procedure): Utilities tab Inventory
Management button

Note: One instrument life is used whenever the instrument is used via the Surgeon Console
(following mode). The number of uses left on the instrument may be queried without using a
“life” by removing the instrument before entering following mode. When an instrument has no
remaining uses, it will not engage on the system and a message on the touchscreen says the
instrument has expired.

101
Instrument usage summary is available at the end of a case when the last sterile adapter is
removed – discuss total lives for 8mm, 5mm, clip appliers and training instruments. Also
describe how to check instrument lives remaining without decrementing a life.
Describe and demonstrate instrument insertion, removal, guided tool change and associated
LEDs. Describe instrument icons and messages seen in endoscopic and surgeon views on the
touchscreen monitor.

102
The tip cover provides insulation over a section of the Monopolar Curved
Scissors (MCS), so that RF energy is only available at the tip. Always use the
MCS with the tip cover installed. Correctly installed tip cover completely covers
the orange area, and stops at the border.
• If the tip cover isn’t fully installed, a portion of the orange area will be visible
and the MCS will be only partially insulated.
• If the tip cover is installed beyond the orange area, it goes over the shaft and
causes a bulge, possibly preventing the instrument from fitting through the
cannula.

The MCS tip cover is a single use product. Always inspect prior to use and
never use a damaged tip cover.

103
We will now cover Section 8 from the OR Staff System in-service: Port Placement and Docking

104
Prior to applying the basic port placement philosophy, the abdomen
must be insufflated. I nsufflation of the abdomen is the introduction of a
flow of gas in to the body cav ity. I nsufflating the abdomen creates
space betw een the abdominal w all and internal organs. Once
insufflated, make the follow ing measurements:

• Place the camera port 10-20cm from target anatomy

• I nstrument arm placement:

– Based on the line from target anatomy to camera port, draw

parallel lines w ith 8 to 10 cm line spacing

– Place ports along lines, maintaining 10-20cm from the target

anatomy and 8-10 cms from other da Vinci ports

– Triangulate tow ards or aw ay from target anatomy as needed

for the procedure. I n other w ords, mov e the instrument arm
ports tow ards or aw ay from target anatomy as needed along
parallel lines, ensuring that instrument ports don’t fall on a

105
 straight line.

• Non-robotic assistant ports should be placed at least 5cm aw ay

from other ports

• The patient cart should approach the patient with the tower of the
patient cart lined up in a straight line w ith the camera cannula and
the target anatomy.

105
Additional considerations for determining appropriate third arm and assistant
port location include the following:

For third arm placement consider:

-the location of the internal anatomy to be retracted
-placing the 3rd arm on the same side as the dissecting instrument (in order to
provide tension/counter-tension with grasping instruments)

For the assistant port:

-tasks required through assistant port
-clear trajectory to the target but outside of the “no port zone”

In this example, 3rd arm and accessory port are placed on opposite sides in
order to increase assist’s internal and external access

No Port Zone:
-the area between the robotic ports and target anatomy

106
Note: Image displays one example of 3rd arm and assistant port placement

106
Displayed is the ideal port placement for the defined surgical target area
highlighted in peach. As mentioned previously, proper port placement provides
instrument arms and endoscope with a maximum range of motion.

107
Question: What is wrong with this port placement?

Answer: Ports are too close to target anatomy

108
Question: What is wrong with this port placement?

Answer: Patient cart not aligned

109
Question: What is wrong with this port placement?

Answer: Ports too close to one another

110
Question: What is wrong with this port placement?

Answer: Ports are too far from target anatomy

111
Question: What is wrong with this port placement?

Answer: Port placed in the “no port zone”

112
 Patient positioning is procedure-specific and is at the discretion of the surgeon
 The surgeon should discuss positioning for the procedure with the anesthesiologist

113
Camera arm positioning:
 Place setup joint #2 of the camera arm opposite to instrument arm
 Set the “sweet spot”: Move the camera arm so that the blue arrow lines up between the
limits of the blue bar located in the middle of the camera arm setup joint
 The “sweet spot” helps maintain the arm’s optimal range of motion
 Align the camera arm clutch button → 3rd setup joint → Patient Cart’s center column

Instrument arm positioning:

 Position the arms so that the numbers on each instrument arm are facing forward
 Ensure that the sterile adapter carriage of each instrument arm is facing forward at a 45º
angle
 To increase efficiency, align instrument arm cannula mounts 10 cm from camera cannula
mount
 Position surgical arms high enough to clear the patient

114
Considerations
 Lights/anesthesia equipment/ancillary equipment
 Traffic considerations: keep pathways clear and protect cables
 Consider contamination risks
 Confirm patient is positioned
 Assistant must have clear view of the Vision Cart touchscreen monitor

Driving the Patient Cart

 Drive Patient Cart into position following directions given by the surgeon
 NOTE: Room landmarks should be used to avoid using “left” and “right” directional terms
 Align camera port, target anatomy, and Patient Cart center column (for straight-line docking)
 Stop the Patient Cart when the camera cannula mount is over the camera cannula

Ensure that the shift switches are set to Drive (D) to lock Patient Cart brakes

115
Dock the camera arm first, followed by instrument arms. Do not force the cannula mounts shut
– this may damage the cannula mount sensor or break the wings. Supporting the body wall,
press the port clutch button to slightly move the arm and relieve tension at the body wall.

Docking the Patient Cart

 Use two people to dock the Patient Cart

Dock camera arm

 Confirm molding is properly seated and cannula mount wings open
 With outside hand, hold back drape above mount with thumb while pressing and
holding port clutch behind the cannula mount
 With opposite hand, insert cannula into mount and pinch mount closed in front
 Once properly seated, close cannula mount wings

Dock Instrument Arms

 Confirm molding is properly seated and cannula mount wings open
 With outside hand, hold back drape above mount with thumb while pressing and holding port
clutch behind the cannula mount
 With opposite hand, insert cannula into mount and pinch mount closed in front
 Once properly seated, close cannula mount wings

116
Check system setup
 Check camera arm alignment
 Ensure that numbers on instrument arms are facing forward, and that telescoping axes are
~45° from one another
 Reposition instrument arms if necessary - stabilize cannula at level of the skin and
reposition utilizing arm port clutch and/or clutch button
 Release tension on tissue if needed Use one hand to stabilize cannula while the other
pushes and holds the upper port clutch button to allow the tension to release

Insert the camera

 Align the scope with the insertion axis as you pass it through the camera cannula and press
the endoscope into the camera arm sterile adapter (with the buttons on the camera facing
the center column). You will hear a click when the endoscope body is pressed into the sterile
adapter. Make sure the endoscope body is fully engaged by gently pulling up on the
endoscope. If properly engaged, the endoscope will not disengage from the sterile adapter.
Re-seat as necessary.
 CAUTION: If not fully engaged, the endoscope may fall out
 Insert the camera cables into the strain relief support on the camera arm
 Under direct visualization, check position of remote centers. When repositioning remote
center, stabilize cannula at the level of the skin.

116
117
 Before inserting an instrument, straighten the instrument wrist, and close the tips
 Insert the tip of the instrument into the cannula, and then slide the instrument housing into
the sterile adapter until fully seated
 Check icons on assistant monitor to ensure that instrument is engaged
 For the first instrument you install on an arm for this procedure, you must manually insert the
instrument by pressing an arm clutch button. The LEDs will blink alternating white during
arm clutch. The Surgeon Console operator cannot control the instrument until it is moved
out of the cannula and is no longer being clutched. Note that if you press and release the
arm clutch button, instead of holding it down continuously as you insert the instrument, you
must press and release the arm clutch button again after insertion through the cannula, to
give control of the instrument to the surgeon.
 Insert EndoWrist instrument manually: (i.e. when first introducing an instrument into the
surgical site)
 Quick click the instrument arm clutch button so the LED is alternately blinking white
side-to-side
 Insert EndoWrist instrument under direct vision: watch the assistant monitor and
slowly advance the instrument until the tip is just visible emerging from the cannula,
then guide it into the desired location in the surgical field
 WARNING: The instrument may not be immediately visible when being moved from
the cannula into the patient. Use appropriate caution when manually inserting
instruments into the patient.
 Press the instrument arm clutch button again to lock it into place while stabilizing it
 When using energy instruments, attach the cautery cable to the EndoWrist instrument
before inserting into the patient

118
 Before instrument removal, the surgeon should do the following:
 Ensure that the instrument tip is in view and is free of any patient anatomy
 Straighten the instrument wrist
 Clearly communicate to the patient-side assistant which instrument to remove.
Identify the name of the instrument or the number of the instrument arm (e.g.,
instrument arm 1, 2, 3).
 Once the instrument is positioned for removal, the patient-side assistant should
squeeze the release levers on the sides of the instrument and pull the instrument
out
 Removal of instruments during a procedure should be done very carefully and only
with the knowledge of and full view of the Surgeon Console operator. Do not remove
the instrument if it is not in view.

118
Demonstrate Guided Tool Change
 During guided tool change, use constant communication between operating room staff and
surgeon
 Remove the EndoWrist instrument using the release levers
 Install a new instrument without pressing the clutch button
 Instrument arm LED will alternately blink green and white side to side, and the guided tool
change icon will appear on the touchscreen monitor
 Watch the assistant monitor and slowly guide the instrument through the cannula
 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
 Pressing the clutch button will clear memory and disable guided tool change
 If Guided Tool Change is disabled or does not initiate, use the arm clutch button to insert the
instrument manually

WARNING: During an instrument exchange, including using Guided Tool Change, the surgeon
must not remove his/her hands from the masters until he/she has removed his/her head from
the stereo viewer.

119
We will now cover Section 10 in OR Staff System Overview in-service: Troubleshooting

120
121
Discuss fault modes and examples of situations when they occur. Also describe safety
associated with intra-operative system restart

When a fault occurs, the system determines whether the fault is recoverable or non-
recoverable. The system takes the following actions when a fault occurs:
 Locks all the Patient Cart arms. In this state the Patient Cart arms and setup joints can be
clutched but are slightly harder to move and can not be left in clutch mode.
 Sounds a series of error beeps. You can silence the beeps by touching Silence on the
touchpad or touchscreen. the touchpad or touchscreen.

Non-recoverable fault: red LED

 Instruments must be removed, da Vinci Surgical System must be shut down and restarted
 DOES NOT necessitate undocking the Patient Cart from the patient

Recoverable fault: yellow LED

 Read on-screen message and address the issue
 Fault may be overridden by pressing the Recover Fault button on the Surgeon Console
touchpad or Vision Cart touchscreen monitor
 Examples:
 Difficulty determining instrument arm position
 Excessive force on surgical arms
 Collisions between surgical arms

122
  Power fluctuation detected
 da Vinci System functioning with battery backup low
 May require a restart

NOTE: The da Vinci System is conducting over 1300 checks/second and will err on the side of
giving a fault in order to ensure patient safety and avoid system damage

122
The Emergency Stop button will cease robotic control of the instruments and endoscope
 The instruments and endoscope will stay in their last commanded position
 If the instrument grips are closed when the Emergency Stop button is pressed, the grips will
remain closed. However, the gripping force of the instrument may decrease.
 Pressing Emergency Stop initiates a recoverable fault, which you can override by pressing
Recover on the touchscreen or touchpad

123
To release the instrument grips manually, perform these steps while visualizing the surgical
site:
 Press Emergency Stop on the right-side pod of the Surgeon Console
 Insert the grip release tool into the grip release socket on the instrument housing. Ensure
that the tool engages with the socket. Once engaged, you will feel slight resistance when
you gently rotate the tool.
 For 8 mm Clip Appliers and Harmonic instruments, carefully turn the grip release tool
clockwise (approximately 1/4 turn) to open the instrument grips. For other instruments,
carefully turn the grip release tool counter-clockwise (approximately 1/4 turn).
 Under visualization, clear tissue from the grips. If needed, adjust the instrument arm to
position the instrument away from tissue: support the instrument arm before clutching, to
prevent unintended instrument motion.
 Once tissue is cleared from the grips, remove the grip release tool from the instrument
 Squeeze the release levers on the sides of the instrument housing and pull the instrument
out. Do not reuse the instrument.

WARNING: Do not reuse an instrument that has had its grip released with the instrument
release kit. Reusing an instrument after use of the instrument release kit could result in critical
failure of the instrument and injury to the patient.

WARNING: Do not use the emergency grip release wrench on a non-faulted system without
first pressing the Emergency Stop button. Failure to observe this warning may result in
unintended instrument motion.

124
Discuss and demonstrate steps for conversion to open and laparoscopic surgery. Also discuss
situations that result in a conversion.

125
If the power buttons on any system component fail to turn the system on or off:

 Switch off circuit breaker on the back of the

Surgeon Console and Vision Cart
 Press EPO on back of the Patient Cart
 After at least 2 seconds, press EPO again on
the back of the Patient Cart
 Switch on the circuit breaker on the Surgeon
Console and Vision Cart
 Use any power button to turn on the system (if
needed)

126
We will now cover Section 11 in the OR Staff System in-service: End of Procedure

127
Describe steps to undock the Patient Cart

128
Discuss disposable and reusable accessories. Describe and demonstrate how to undrape
camera head, instrument arms and camera arm and touchscreen monitor (if draped). Discard
drapes in accordance with hospital protocol

129
 Dispose of soiled drapes, cannulas seals, and other single use items in a designated
biohazard waste container
 Remove any disposable tips from the instruments including the Monopolar Curved Scissors
tip cover
 Keep the instrument tips moist both intra-operatively and post-operatively before
reprocessing
 Excessive soil should be removed immediately after use
 Keep soiled instruments moist and do not allow debris to dry on or inside the device
 Ask the site their process for prepping materials for cleaning and sterilization and
then help the site select one of the following 3 methods:
 Soak – Soak instruments (tip down) in a tray of distilled water or enzymatic
cleaner
 Damp Towel – Wrap or cover instrument tips with a disposable damp towel
(use distilled water or enzymatic cleaner)
 Prep Cleaner – Apply enzymatic prep cleaner to tips (in spray or foam). The
enzymatic cleaner will work on breaking down the bio burden until the
devices arrive at a reprocessing center.

NOTE: Using the prep cleaner is the preferred method as it ensures the instruments are kept
moist, there is no need to discard any towels, and there is no extra contaminated liquid to spill

 Place instruments and accessories back in procedure tray (if instruments are not soaking in
another tray)

130
  Protection – Make sure the instruments and accessories are secured
 Layout – Ensure there is nothing loose that can roll around and damage other
accessories (like the universal alignment target)
 Validated – Check with the site to make sure that the tray is validated for use with
Intuitive instruments and accessories

 Clean the endoscope tip with a lint free cloth and distilled water
 DO NOT use anything abrasive to clean the endoscope tip
 Place the endoscopes back in the endoscope tray
 Protection –The endoscope shaft and tip should be secured and base should be
cushioned and secured as the endoscope is extremely fragile
 Layout – Ensure there are no accessories in the tray with the scopes, (i.e. universal
alignment target)
 Validated – Check that the tray is validated for the method of sterilization used

 Identify and mark any instruments that need to be disposed of (expired instruments) or
returned (defective instruments)

130
Demonstrate how to prepare the Patient Cart for storage by putting instrument arm 3 in the
stow position and folding remaining setup joints against the cart. Collapse remaining arms to
the footprint of the base.
Describe and demonstrate steps to shutdown the system

132
 Check inventory management (instrument lives, illuminator lamp hours) from the
touchscreen or touchpad under Utilities → Inventory Management
 Prepare the Patient Cart for storage by putting instrument arm 3 in the stow position and
folding remaining setup joints against the cart. Collapse remaining arms to the footprint of
the base.
 Press the Power button on any system component to power the entire system off
 The system will begin the ten second shutdown process and the following message will be
displayed: Preparing to shutdown. Shutting down in 10 seconds. Press POWER
button to cancel.

NOTE: If the system remains shut down for more than 10 minutes, a restart is recorded as a
new procedure. Instrument lives will be used accordingly.
 It is now safe to disconnect all system cables
NOTE: If possible, the system cables should not be disconnected. Keeping the cables
connected will minimize exposure to contaminants
 Remove non-system connections as necessary (auxiliary video and audio cables,
ESUs, insufflators, etc.)
 If needed, disconnect the system cables by twisting counter-clockwise and pulling
straight back on the metal collar, then place the protective cap on each cable end
 Store the system cables on a cable hook on one of the system components

133
This section discusses how to successfully implement a da Vinci Surgery Program with the OR
Staff and Surgeon. The four key factors that enable successful implementation of a da Vinci
surgery program are:

 Leadership: All members of the team should be aware of their designated roles and
responsibilities, creating a reproducible process that improves efficiency over time
 Communication: Two-way verbal communication (Read Back Technique) is essential
between OR staff and the surgeon
 Task assignment: Team members are assigned specific tasks and encouraged to take
initiative when they see additional tasks that need to be completed. Emphasize task overlap
to maximize efficiency.
 Standardization: Standardizing room layouts, I&A trays and procedure-specific system
locations helps minimize variability between cases

Note to trainer: Ask the class how they see these factors benefiting their accounts.

134
135
The da Vinci Si system also represents seamless integration into the OR and is designed for
expandability. The Surgeon Console can be connected to a Simulator.

Also the da Vinci Si-e is a three arm option that is also available to customers at a reduced
cost.

136
The da Vinci Si-e is a three arm version of the da Vinci Si System. The available features in the
Si-e are Surgeon Console touchpad, 1080i HD vision, OnSite remote access and use of
EndoWrist instruments. If an account purchases the da Vinci Si-e, it can be upgraded to a da
Vinci Si. More information on the Si-E is available in the Sales Library on the daVinci Surgery
Online Community.

137
We will now cover Section 6 in the Surgeon System In-service: Surgeon Console Overview.
Please note that this section does not apply to the OR Staff.

Note to the trainer: Connect the DVI video output bay 1 to the DVI input in the wall plate in the
training room. In the touchscreen tab go to Video Setting  Advanced Video Adjustments. For
Video Output bay 1 select the format as DVI and select the graphics as Surgeon Console
view.

138
Surgeon Console Overview:
Stereo viewer with 3D vision
 Ergonomically designed
 Head rest
 Infrared sensor
NOTE: The infrared head sensor performs a safety function by preventing movement of the
Patient Cart arms when the surgeon’s head is not in the viewer
 Speaker and microphone

Right-side Pod
 Power button: turns the da Vinci System on and off
 Emergency Stop button: creates a recoverable fault and will cease robotic control of the
instruments and endoscope

Left-side Pod: ergonomic controls

 Stereo viewer height and tilt controls
 Arm rest height control
 Foot switch panel depth control (adjusts distance of foot switch panel from chair at Surgeon
Console)

Touchpad

139
139
 Main control interface of the Surgeon Console

Master Controllers
 Follow the surgeon’s movements precisely, translating movements to the surgical arms in
real time
 Allow autonomous control of the EndoWrist instruments and endoscope
 Allow a natural range of movement and ergonomic comfort, even during extended
procedures

WARNING: Once in following, the Surgeon Console operator must not remove his or her hands
from the masters until removing his or her head from the Surgeon Console viewer – thereby
taking the system out of following mode. Failure to do so may result in uncontrolled movement
of the masters, resulting in serious harm to the patient.

Footswitch panel
 Arm swap pedal
 Camera control pedal
 Master clutch pedal
 Instrument activation pedals

139
The stereoviewer has a built-in intercom system that facilitates intra-operative communication
between surgeons and OR Staff. During dual console surgery, clear communication is vital so
the intercom system allows for communication between the surgeons. It is still important for
surgeons to give verbal cues when taking or giving control of the instruments or endoscope.

140
The buttons on the right side pod are:
 Power button which turns the system on/off
 Emergency Stop button will cease robotic control of the instruments and endoscope
 The instruments and endoscope will stay in their last commanded position.
 If the instrument grips are closed when the Emergency Stop button is pressed, the
grips will remain closed. However, the gripping force of the instrument may
decrease.
 Pressing Emergency Stop initiates a recoverable fault, which you can override by
pressing Recover on the touchscreen or touchpad.

141
Left side pod has ergonomic controls:
 These controls allow you to adjust the height and tilt of the Stereo Viewer, move the armrest
up and down, and move the footswitch panel in and out.
 When the surgeon logs in at the beginning of a case, the console axes will automatically
move into position, using the unique ergonomic settings saved with the surgeon’s last login

142
The features and their benefits of the Touchpad are:
 Main control interface of the Surgeon Console
 The User Login allows surgeon to save a custom profile for quick recall of system &
ergonomic preferences
 Dual Console Control provides a quick indication of system arm status when in dual console
mode

143
143
The touchpad can store the surgeon’s unique log in information. The Display Name is
automatically filled in after the first and last name are entered in the fields above.

Login/Logout tab: unique surgeon login that saves surgeon’s preferences

 New User: If you have not logged in to the system before, setup a user account. Touch the
New User button located on the login screen of the touchpad
The New User (Step 1 of 6) screen appears, follow prompts.

 Repeat User: If you already have a user name, touch it to log in. Scroll using the arrow keys
if necessary
Press and hold to Restore Setting

144
The surgeon will use the Surgeon Console Touchpad to log in and save their ergonomic
settings. When logging into the console for the first time, the Touchpad will introduce the
surgeon to each console axis and give instructions on how to adjust that axis for maximum
comfort and ease of use.

145
After login, the Arm Status screen will open on the Touchpad. The Arm Status screen provides
access to Surgeon Console controls and settings. Along the bottom of the screen, the tabs
allow access to the video, audio, and utilities preferences.

Setting in the Arm Status screen:

Instrument Control (Dual Console Only):
 Give/Take Buttons: reads “Give” when you have control and “Take” when you do not have
control at your console. Either surgeon can Give or Take control of a specific instrument arm
by touching its Give/Take button.
 Swap All: Either surgeon can change control of all (instrument) arms by touching Swap All
 Lock: Touch Lock to lock an arm’s position

Quick Settings Buttons: Three quick settings buttons run down the center of the screen (from
top to bottom).
 Scope Status/Angle
 Zoom level
 Swap All (Dual Console Only)
 Motion Scaling Setting

146
Video Settings Tab: provides quick access to the brightness adjustment as well as Advanced
Video Adjustments, Camera/Scope Setup and Display Preferences.
 Brightness: Drag the Brightness slider (sun icon at lower left) to adjust the video brightness
(not actual illumination) in the stereo viewer.
 Advanced Video Adjustments button: to adjust Advanced video settings of the surgical
image.

NOTE: All settings except illuminator settings are saved with each surgeon’s login

147
Camera/Scope Setup button allows the White Balance and 3D Calibration from the Surgeon
Console.

148
Display Preferences button
 Zoom: Wide (16:9), Full (5:4), 2x digital zoom, 4x digital zoom
 TilePro: Off, 2D, 3D
 Selecting 2D or 3D switches the stereo viewer display from full endoscope view to
TilePro (multi-image) mode. TilePro allows display of up to two auxiliary video
inputs (PACS, ultrasound, room camera, etc.), along with the operative image.
When TilePro is active, the system detects auxiliary video inputs and arranges the
TilePro display accordingly.
 NOTE: While in TilePro mode, use the slider to scale endoscopic image relative to
auxiliary image(s).
 Viewer Mode: toggles the display of telestration between 2D and 3D mode
 Telestration Eye: toggles display of telestration overlay between the left-eye and right-eye
image
 Image Depth: optimizes the surgeon’s ability to see a fused 3D image at Normal or Far
distances. System defaults to Normal.
 Image Enhancement: optimizes sharpness of the video image display. Default is On, turning
it off may reduce noise in the image.

Note: All the settings under the Display Preferences button are saved with the surgeon’s
unique login.

149
If auxiliary inputs have been connected, the TilePro images are displayed below the surgical
image in Surgeon Console view – as shown above.

150
Audio Settings Tab
 Volume: drag slider to adjust volume in the Surgeon Console speakers.
 Mute: microphone on and off buttons. Touch to mute the Surgeon Console microphone

151
Utilities Tab
 Account management: user may change information regarding their profile or delete their
account

152
Utilities Tab
 Inventory management: reports usage status for the instruments used during the procedure
and is displayed in the viewer not on the touchpad

153
Utilities Tab
 Event logs: provides access to system event logs, including error logs and is displayed in
the viewer not on the touchpad

154
Utilities Tab
 Troubleshooting: displays the system serial number and system software version, and
provides L(left) and R(right) buttons to display the color bar test pattern

155
Utilities Tab
 Control preferences: all settings except master controller association are saved with each
surgeon’s login Allows the surgeon to configure the system controls Scaling: scales master
controller positioning movements to Quick (1.5:1), Normal (2:1) and Fine (3:1) ratios.
System defaults to Fine.
 Finger Clutch: On/Off
 TilePro Quick-click: On/Off – when on, the surgeon can switch into TilePro mode by quickly
clicking the camera pedal.
 Haptic Zoom: On/Off – method to apply digital zoom using the masters, while in camera
mode. To use, press the camera pedal to enter camera mode and push the masters closer
together to zoom in, or pull the masters apart from each other to zoom out.
 Master Associations: touch “Configure” to open the Master Association screen, which
enables you to manually associate either master with any instrument arm

NOTE: Maximum of two arms per side

156
The master association can be changed manually if needed. Instrument arm 1 defaults to the
right, instrument arm defaults to the left, and instrument arm 3 defaults to the side of the system
on which it is installed.

157
The features of the foot switch panel are:
 Clutch Pedal: The Master Clutch Pedal can be used to disengage the Masters from the
control of the instruments, allowing the surgeon to reposition the Masters for ergonomic
comfort
 Arm Swap Pedal: Allows surgeons to confidently swap control of instruments
 Camera Pedal: The Camera Clutch Pedal allows the surgeon to control and focus the
endoscope
 Endoscope Control: press and hold camera clutch pedal and move the Masters
 Focus: press and hold the camera clutch pedal and rotate either Master Controller

158
158
SmartPedal Technology
SmartPedal Technology assigns any instrument controlled by the right hand to the right
instrument pedals and any instrument controlled by the left hand to left instrument pedals.

159
This is the layout of the icons you will see in the Stereo Viewer.
 In this view you can see the endoscope angle, the camera rotation icon, and the screen view
in the top center of the screen
 On the right and left hand sides of the screen, you will see numbers corresponding to the
numbered instrument arms
 Arm 1 is under the control of the right master controller, and Arm number 2 is under
the control of the left master controller. Arm 3 is in the stow position
 Any messages corresponding the master controllers will appear in the bottom right or
bottom left of the screen
 Along the bottom of the screen, you will notice the names of the EndoWrist Instruments
being controlled by each arm, along with any corresponding footswitch panel map icons
 In the bottom center of the screen, you see icons representing the instrument pedals on the
footswitch panel

160
Match grips: before taking control of instruments, the surgeon must first “match grips.”
 When a new instrument is inserted, the match grips icons will appear
 The match grip icon will indicate the action needed to match master grip
angle. Open or close masters to match the position of the jaws of the
instrument, or slightly rotate the grips on the masters to match rotation of the
instrument tip.
WARNING: For patient safety, the surgeon must not match grips nor move instruments whose
tips are not visible in the stereo viewer. Failure to observe this warning can cause serious harm
to the patient.

Finger Clutch: Repositioning the masters

 To reposition both the master controllers at the same time: Press and hold the clutch pedal
on the footswitch panel OR pull back on both of the finger clutches on the master controllers
to disengage the masters from the instruments
 To reposition each master controller independently: pull back on the finger clutch on one of
the masters to disengage the master from the instrument
 Reposition the masters for ergonomic comfort
 Release the clutch pedal or finger clutch(es) to re-engage the masters with the instruments

Camera Control
 Press and hold the camera control pedal
 Move the masters to reposition the image

161
161
  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 a newspaper away from your eyes)
 To change the angle of the camera, rotate both masters to the left or right (like
turning a car)
 To move the camera from side to side, move both arms together to the left or right
(like moving a newspaper to the right or left)
NOTE: If the camera is disconnected from the patient cart, the surgeon’s head should
be out of the surgeon console to prevent unintended movement of the instruments
 Dual Console Only: Either surgeon can take control of the camera arm by pressing
the camera pedal at any time
 Use of the camera pedal by either surgeon causes the instrument arms to go out of
following mode until the camera pedal is released
 Focusing the camera: press and hold the camera control pedal, then roll a single master
 Haptic digital zoom
 Activate the setting for demonstration: from Surgeon Console touchpad, select Utilities tab
Control Preferences button. Select the Haptic Zoom On button. Remember to deactivate
haptic zoom after the demonstration.
 Press and hold the camera clutch pedal
 To increase digital zoom, push masters towards each other (like a clapping motion)
 To decrease digital zoom, pull masters apart from each other (like a clapping motion)
NOTE: The default setting for adjusting zoom levels is located on the Surgeon Console
touchpad on the Control Preferences tab or home screen.

Virtual Pointer (Dual Console Only): The virtual pointer is designed as an instructional aid, for
use during dual console surgery.
 Point and refer to specific anatomical features on the live video image intra-operatively
 Activate and control one pointer with each master that is not associated with an instrument
arm

161
In a single console procedure, the camera pedal and energy pedals can be activated at the
same time (i.e. pressing the camera pedal does not halt energy)

162
Trainer Note: Just point out that SmartPedal systems will have L an R labels on the pedals

SmartPedal systems will have “left” and “right” labels on the instrument pedals
 The 4 instrument pedals include two sensors that detect the position of the user’s foot when
lightly hovering over a set of pedals
 This information will be displayed in the stereo viewer and is used to confirm alignment of
the user’s foot with the pedal they intend to activate

163
Trainer Note: Just point out that SmartPedal systems will have a blue border around the entire
side of the screen when the surgeons foot is hovering over the pedals and the pressed pedal
icon turns orange

With SmartPedal Interface

Blue Border (Hover)
 When the surgeon’s foot is over an enabled pedal, there is a blue border around that side of
the screen
 Here you can see that the user has their foot over the right pair of instrument pedals, and
the monopolar instrument in the right hand is ready to fire
Orange Border (Fire)
 When the enabled pedal is pressed, there is an orange border around that side of the
screen. Also, the pressed pedal turns orange.

164
Trainer Note: Just point out that SmartPedal systems icons look different

With SmartPedal Interface

Image on Left
 When a non-energized instrument is installed, like the Double Fenestrated Grasper, the
footswitch panel map icons will be grayed out
Image on Right
 The footswitch panel map icons will light up in gray when a foot is detected over a set of
disabled pedals

165
Trainer Note: Just point out that SmartPedal systems icons look different

With SmartPedal Interface (difference between this slide vs. previous is the UI image)
If the disabled pedal is pressed, an orange highlight will appear around the pressed pedal and
an audio error beep will sound

166
On the patient-side view, the instrument status is displayed on the top of the screen in
instrument status and in the instrument area.

When instrument function is available, there is a yellow lightning bolt next to the instrument
name. When instrument function is not available, the lighting bolt is crossed out and changes
to grey. Note: this only gives you information about the connection from the ESU to the CORE.
It does not detect the connection of the cautery cable to the instrument.

167
Trainer Note: Just point out that SmartPedal systems icons look different

SmartPedal Interface (difference between this slide vs. previous is the UI image)
If the system does not allow you to activate the instrument if instrument function is not available
or if a non-energy instrument installed. You will hear error beeps from the system and the icons
will be greyed out.

168
Trainer Note: Just point out that SmartPedal Technology allows more instrument
configurations than previously, but still does not allow 2 ESUs of the same energy type, or 2
instruments of the same energy type controlled at the same time

There are 3 reasons that the system disables instrument activation:

 The generator is not connected to the CORE
 The generator is connected but not powered on
 It is unclear to the system which instrument the user intends to fire
 2 ESUs of the same energy type
 2 instruments of the same energy type

Without SmartPedal Technology, the system cannot support:

 2 instruments assigned to the same energy pedal (i.e. a monopolar instrument and
the EndoWrist One Vessel Sealer; or a bipolar instrument and the EndoWrist One
Suction/Irrigator)

169
When two sources of the same energy type are connected to the system, it does not know
which one is associated with the instrument therefore it disables that type of activation.

Image on Left
Without SmartPedal technology

Image on Right
With SmartPedal technology

170
Also if two instruments of the same energy type are installed for example, two Maryland Bipolar
Forceps, the system does not know which one is connected to the generator so it will disable
energy.

Image on Top
Without SmartPedal technology

Image on Bottom
With SmartPedal technology

171
Items to check before activating energy:
 ESU is connected to the CORE
 ESU is on
 ESU cable is connected from the front of the generator to the energy instrument. This has to
be verified visually as there are no indicators on the system to check this.
 Master controller is in active control of the instrument

172
The benefits of dual console surgery are:
 It returns the benefits of training in open surgery to da Vinci surgery
 It allows the two surgeons to rapidly exchange instruments and communicate during the
procedure
 It allows the second surgeon to assist with the surgery

173
173
In dual console surgery, both surgeons can see which instruments are controlled by the other
surgeon.

In this example:
 Console 1 has control and ownership of the Double Fenestrated Grasper
 Console 2 has ownership and control of Maryland Bipolar Forceps and Harmonic Curved
Shears
 Console 2 is firing the Maryland Bipolar Forceps as there is an orange highlight on the
instrument

174
Touchscreen View showing:
 Console 1 has control/ownership of the Maryland Bipolar Forceps and Monopolar Curved
Scissors
 Console 1 is firing the Maryland Bipolar Forceps
 Console 2 has control and ownership of the Double Fenestrated Grasper

175
In dual console, when a master controller is not associated with an instrument, it acts as a
pointer. This is helpful in teaching or proctoring cases.

176
 During Dual Console surgery, surgeons can exchange ownership of the instrument arms by
utilizing the Touchpad to give and take control
 On the dual console home screen, a surgeon can give and take each individual arm using
the Give and Take buttons
 Currently, this surgeon has ownership of instrument arms 1, 2 and 3
 The Swap All button will switch ownership/roles of all instruments to other surgeon (in this
example, Console 1 would give ownership of all thee arms to the other console)

177
 Currently, this console has ownership of instrument arm 1 and 2, and the other console
surgeon has control of instrument arm 3
 The Take button will allow me to take back instrument arm 3

178
 Either surgeon can take ownership of the camera arm by pressing the camera pedal and
moving the master controllers
 While one console surgeon is moving the camera, the other consoles’ instrument arms are
locked and energy is immediately halted until camera control is finished. NOTE: For the
console pressing the camera, the energy pedals are still active.
 Camera control pedal may be used as a “quick stop” pedal if necessary

179
We have concluded the presentation on the daVinci Si System. Do you have any questions
before we break out into the assigned groups? In the practicum groups, review the topics
covered in the class with your trainer. Use this time to get hands-on practice with the system.

180
181