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The da Vinci X and Xi surgeon console and vision cart components are d and interchangeable. The da Vinci SP has a unique surgeon console and da vinci xi user manual pdf cart. However, the standardized design across the vicni allows a familiarity throughout our fourth-generation platforms. Serious complications may occur in any surgery, including surgery with a da Vinci system, up to and including death.

Converting the procedure could result in a longer operative time, a longer time under anesthesia, and could lead to /4964.txt complications. Contraindications applicable to the use of conventional endoscopic instruments also apply to the use of all da Vinci instruments. For important safety information, including surgical risks and considerations, please also refer to www.

Search intuitive. Contact Us. Da Da vinci xi user manual pdf. My Intuitive. Da vinci xi user manual pdf Staff. Executive Education Perioperative Education Intuitive Referring Physicians. Da Vinci Robotic-Assisted Surgery. What to Expect About the Systems. Provider Locator. Find a Provider. Press Releases Press Resources. Da Vinci Surgical Systems Integrated technologies for robotic-assisted surgery.

Performance that counts. Fourth-generation da Vinci surgical systems continue to advance minimally invasive surgery MIS across a wide spectrum of surgical procedures.

Standardization of instruments and components can help manage finci and improve overall OR efficiency. Da Vinci Xi: Our most capable system. Get your hands on our most advanced instrumentation, vision, and features such as integrated table motion. The da Vinci Xi is versatile and flexible, больше на странице setup automation and guidance that promotes OR efficiency.

It provides multiquadrant access and is used for a variety of complex procedures. Da Vinci X: Upgradable and value-oriented. Take advantage of a system featuring cost-conscious options but with the same arm architecture as the da Vinci Majual so you can use the latest instruments and vision technologies. The da Vinci X also includes streamlined setup and port placement.

And with modular, common components, the system can grow with you. Da Vinci SP: For narrow access surgery. Focus your approach with a system designed for single-port access.

With the da Vinci SP, a single arm delivers three multi-jointed instruments and a fully wristed 3DHD camera for visibility and control in narrow surgical spaces. This versatile 2 and high-performance single-port system can help empower you to perform procedures with a range of complexity. Learn more. Three components make up a system. Unique for the system, choose either the Xi, X, or SP. Universal component for X and Xi, unique for SP.

Standardized design. Operating from the surgeon console. The surgeon console adjusts in multiple ways to help you get a good fit for da vinci xi user manual pdf height and reach. You have total control of the wristed instrument on each of four arms, and can customize settings at the console.

See the surgical field in 3DHD and da vinci xi user manual pdf from built-in innovation, vinic as tremor filtration. Connecting through the vision cart. The vision cart houses advanced vision and energy technologies, and provides communications across da Vinci system components. It also includes a large HD display that shows a /8751.txt feed of ,anual procedure, visible to everyone in the OR.

Integrated da Vinci products. Explore our da Vinci portfolio that includes systems with advanced instruments and technologies that bring vision, energy and innovation to your OR.

Additional resources. Intuitive for surgeons Check out our surgeon resources. Find your clinical specialty, see da Vinci procedure videos and discover events. For surgeons. Intuitive for hospitals Hospital concerns are our concerns. Explore programs for executives, robotics coordinators and healthcare teams.

For hospitals. Based on Intuitive analysis of Q1 Q1 Premier Healthcare data listing inguinal hernia repair as the primary procedure. Data on file. Indicated for urological and TORS procedures. Important safety information Serious complications may occur usfr any surgery, including surgery with a da Vinci system, up to and including death. Home Da Vinci Systems. You are navigating away from this website.

If you continue, please be aware that not all technologies have regulatory approval or are commercially available in all regions. /11333.txt Continue.

 
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Intuitive | Da Vinci | Robotic Surgical Instruments.da Vinci Xi System User Manual() –

 

All rights reserved. Portions of si software provided by QNX Software www. Portions of this software provided by The FreeType Project www. Third Party Acknowledgments: Portions of the software may utilize or include third party software and other copyrighted material. Intuitive Surgical, Inc. Buyer may not alter, obscure or remove any copyright, trademark, proprietary rights, disclaimer, or warning notice included on or embedded in any part of the Software including those of third parties. The Usfr is licensed, not sold, по этому сообщению buyer.

There is no implied license, right or interest granted in any copyright, patent, trade secret, Trademark, invention or other intellectual property right. This license will begin on si date the Software is delivered to buyer, and will continue until the end of the useful life of the System. Notwithstanding the foregoing, this license shall terminate immediately upon written notice to buyer by Intuitive if buyer materially breach any term or condition of this license.

The Software and related technology are subject to U. Buyer agrees to strictly comply with all such laws and regulations and acknowledge that buyer have the responsibility to obtain such licenses to export, re-export or import as may be required.

Consistent with 48 C. Government end users acquire the Software with only those rights set forth therein. Contents 1 Introduction.

A-1 A. A-2 A. A-6 A. A-8 A. A A. B Appendix B: System Troubleshooting. B-1 B. B-2 B. B-4 B. B-6 B. B-7 B. C-1 C. C-3 C. D-1 D. D-2 D. E Appendix E: System Di. E-1 E. E-5 E. E-6 E. E-7 E. F-1 F. H Appendix H: Representative Uses. H-1 Manuaal. I Appendix I: Glossary. The operating instructions and feature descriptions da vinci xi user manual pdf are specific to the software version listed on page ii.

Note: Users must follow all yser for use supplied with the system, нажмите чтобы прочитать больше components, instruments and accessories, including the Instruments and Accessories User Manual, the Reprocessing Instructions and any instructions for use IFUs provided with instruments or accessories.

Includes general precautions, and precautions specific to procedures. Appendices Each appendix contains reference material as indicated by its title. Contact Information For Customer Service and Download photoshop cc portable kuyhaa of Complaints or Adverse Events Use the following information for customer /18917.txt, including ordering, reporting complaints or adverse events, and general information regarding Intuitive Surgical or our products and services.

In the U. In Europe: Intuitive Surgical, Inc. Use the following information if the system requires da vinci xi user manual pdf or service. Preventive maintenance is required and must be performed by authorized Intuitive Surgical personnel. There are no user-serviceable parts on the da vinci xi user manual pdf system components, with the exception of system accessories.

In Europe: Toll free: 1. About this Manual This manual uses the following conventions. In electronic перейти на страницу, cross-references are active, clickable links.

Caution: Alerts the reader about a potentially hazardous situation which, if not avoided, may result in da vinci xi user manual pdf or по этому сообщению injury to ;df user or patient or damage to the equipment or other property. It may also be used to alert against unsafe practices.

This includes the special care necessary for the da vinci xi user manual pdf and effective use of the device and the care necessary to avoid damage to a device that may occur as a result of use or misuse.

Warning: Alerts the reader about a situation which, if not avoided, could result in death or serious injury. The system can also be employed with adjunctive mediastinotomy to perform coronary anastomosis during cardiac revascularization. The system is indicated for adult and pediatric use. It is intended to be used by trained physicians in an operating room environment адрес страницы accordance with the representative, приведенная ссылка procedures set forth in the Professional Instructions for Use.

Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon. For more information on these procedures, see Appendix H: Representative Uses. Note: For additional information and precautions related to cardiac редкая windows free 10 product key free download что ablation, refer to the Instruments autodesk recap 2019 serial number and product key Accessories User Manual.

As is appropriate with any da vinci xi user manual pdf procedure, consideration must be given to patient size and workspace volume when using the system and instruments. In order da vinci xi user manual pdf minimize forces on the body wall, care must be taken to ensure the remote center is properly aligned with the body wall. Training WARNING: Only trained users and those who have developed adequate robotic skills to perform the tasks associated with each procedure should use the system. Training provided by Intuitive Surgical is limited to the use of the da Vinci Xi System and does not replace the necessary medical training and experience required to /1018.txt surgery.

The system should only be pddf for CABG when there is direct surgical access to the surgical field. Performance characteristics for conduct of totally endoscopic mitral valve repair using the da Vinci Xi System have not been established. CAUTION: The friable nature of pulmonary tissue enhances the risk of vascular, bronchiolar, or other injury that will be difficult to control when using this device.

The da Vinci Xi System is to be used in accordance with this manual and should not be moved or used by any person who has not been trained by an Intuitive Surgical, Inc. Read all instructions carefully. Failure to properly follow instructions, notes, cautions, and warnings associated with this equipment may lead to serious injury or surgical complications for the patient.

While these messages appear throughout the manual, this chapter provides some general precautions. Any and all relative and absolute contraindications to endoscopic, thoracoscopic, laparoscopic, and transoral otolaryngology surgical techniques applicable to the use of conventional endoscopic surgical instruments apply da vinci xi user manual pdf the use of the da Vinci System.

The device is not intended for use when endoscopic techniques are contraindicated. Examples of improper practices include: dropping of equipment, collisions, and improper cleaning and sterilization techniques.

A damaged instrument may result in fragments falling into the patient. Falk, et al. The mnaual Vinci Xi System should not be used in the vicinity of these devices due to the EMI hazards posed by these manuak. System to be unavailable. The surgical team should always have backup equipment and instrumentation available, and be prepared to convert to alternative surgical techniques.

The potential risk of such conversion should be communicated to the patient. Endoscopic Procedure Precautions Only physicians having adequate training and experience with endoscopic techniques should da vinci xi user manual pdf endoscopic procedures with the da Vinci Xi System. Medical literature should be consulted regarding techniques, complications, and hazards before performing any endoscopic procedure.

Insufflation should only be performed by personnel having adequate training and experience with this technique. Eye hazards may exist from the high-energy light radiated by the endoscope and illumination system. Only personnel having adequate training and experience with the endoscope and illumination system should da vinci xi user manual pdf such equipment. As with any endoscopic vincii, the surgeon should rely on visual cues to enhance force feedback. If an instrument tip requires cleaning, remove the instrument from the cannula and gently clean the tip.

High Frequency Electrosurgery Precautions The safe and effective use of endoscopic electrosurgery largely depends vimci factors solely under the control of the operating surgeon.

Only surgeons having adequate training and experience with endoscopic electrosurgery should perform endoscopic procedures involving electrosurgery. The instructions, warnings and cautions provided with the electrosurgical unit must be followed or else serious injury or surgical complications may occur to the patient. Only compatible electrosurgical units have been tested to ensure that they support this limit. Do not attempt to use the footswitch on the Surgeon Janual with electrosurgical units that are not compatible for use with the da Vinci Xi System.

For a list of compatible electrosurgical units, see the Instruments and Accessories User Manual. Electrosurgery may cause these devices to enter an asynchronous mode or may inhibit pacemaker operation entirely.

Consult the pacemaker manufacturer for further information when using electrosurgery in patients with cardiac pacemakers. Maximum power levels to stay below this limit are listed in a table in the Instruments and Accessories User Manual. Energizing other endoscopic instruments may cause tissue damage inside or outside the field of view.

 
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Intuitive Surgical – Indications for Use.

 

Tip Shaft White label 8 mm marking. The endoscope has two release levers on the sides of the base for removing the endoscope from the Patient Cart arm. Buttons Endoscope LED. Release lever one on each side. The endoscope cable connects directly to the Endoscope Controller on the Vision Cart to provide communication and illumination to the endoscope.

The first aperture is on the Endoscope Controller. When an endoscope is removed from the Endoscope Controller, a shutter in the Endoscope Controller closes and blocks the light output. The other apertures are located at the tip of the endoscope, as shown in Figure 7.

Light aperture on the Endoscope Controller Light apertures on the endoscope. Direct eye exposure to emitted light can cause permanent eye injury. WARNING: Do not use an optical instrument magnifying glass or similar to examine the optical fibers at the tip of the endoscope when it is connected to the Endoscope Controller.

If the light becomes activated, permanent eye injury can occur. High powered light sources can cause permanent eye injury. All repairs and maintenance must be performed in an authorized repair facility. Attempting to connect unauthorized third-party light guides to the light port on the Endoscope Controller could result in permanent eye injury or other serious injuries to the patient.

CAUTION: In order to avoid excessive heating of the cannula, do not leave the endoscope tip that is, the distal 25 mm inside a cannula for a prolonged period of time while the Endoscope Controller is on. The endoscope is delicate and can be broken if dropped or struck. Adhere to the sterilization, inspection, and connection requirements.

Failure to ensure properly installed cover may result in fluid ingress and damage to the endoscope. Refer to the Reprocessing Instructions User Manual for reprocessing methods and parameters.

Calibration and White Balance The endoscope is calibrated and white balanced at the factory. If white balance requires adjustment, see Image Too Bright or Dark on page for instructions. Confirm Live Image in 3D Viewer Each time an endoscope is installed, and after changing view modes or settings during a procedure, look in the 3D viewer to confirm a live image is present and has the desired orientation.

Adjust endoscope orientation as necessary. Serious injury or surgical complications may occur to the patient. There should be no visual contamination of the device for example, adherent soil.

If the device has any residual contamination, do not use it. Remove the endoscope from the sterilization tray. Remove the cover from the cable connector. These areas should be clean and free of any deposits, residues, or haze to ensure a bright and clear image. For example, dropping equipment, collisions, and improper cleaning and sterilization techniques can cause damage. A damaged endoscope may result in fragments falling into the patient. When the system detects that the endoscope has been connected, the LED next to the connector is lit, indicating a proper connection Figure 7.

Connect the Endoscope to the Endoscope Controller Note: When the endoscope is powered on and outside of the body, the tip emits a purple tinted light. Note: Some endoscopes are supplied with a connector cover, and some endoscopes are supplied without a connector cover. If not already done, remove the cover from the connector. Plug the connector into the Endoscope Controller Figure 7. Once the cable is fully connected, the LED next to the connector illuminates Figure 7.

It is not necessary to wait until the endoscope finishes calibrating to begin using it. Dynamic Illumination The system automatically determines and adjusts the amount of light output based on the surgical scene. This reduces the ability of the light to affect tissue at close working distances.

Take Photo. Targeting Press and hold to activate the targeting feature. Press to capture an image from the endoscope view. The system records the left or right image based on which image is currently displayed on the touchscreen.

Illumination Press and hold to turn illumination on or off. There is no need to adjust the focus of the endoscope. Digital Zoom The digital zoom setting increases the magnification of the image. The normal endoscope zoom setting is 1x magnification but 2x and 4x are also available. When 2x or 4x digital zoom is active, the image resolution decreases, which may impact image quality.

The 1x setting provides the maximum resolution. When the surgeon enters digital zoom, the Vision Cart touchscreen continues to display the 1x view. To change digital zoom settings: 1. From the Surgeon Console touchpad Settings tab, touch Display. Select 1x, 2x, or 4x. See Image on page The system defaults to Normal working distance. To enable Close-up working distance: 1.

Touch Close-up. Touch Normal to enable Normal working distance. Targeting The targeting button is used to orient and align the Patient Cart to the center of the surgical workspace boundary. For additional information, guidelines and steps, see Chapter 9, Targeting, on page The endoscopic image displays on the Vision Cart touchscreen to aid with visualizing during handheld use.

After handheld use, the Patient Cart is docked to the patient, and the endoscope is attached to a Patient Cart arm. The endoscope senses when the base is pointed up or down and flips the video accordingly. If the tip of the endoscope and the base are both pointing down, the displayed image will be upside-down.

Hash mark Hash mark Figure 7. This enables the surgeon to change between the up and down orientations without patient-side assistance. Avoid contact with skin, tissue, and clothing when the Endoscope Controller is turned On, as damage may occur. Do not attempt to clean the tip of the endoscope by wiping with tissue. The tissue can be damaged because of the heat, and the tip of the endoscope may develop tissue deposits that can decrease light output. Note: The endoscope produces a usable image during calibration, but the system may make visible corrections to the image while the data is loading.

Endoscope Cable Management For improved cable management throughout the procedure, place the cable between the endoscope shaft and the arm before inserting the endoscope into the cannula. This minimizes the length of cable that is free to swing around during the procedure.

The ability to install the endoscope on any of the arms is referred to as Port Hopping. When interchanging an endoscope with an instrument on any arm, Guided Tool Change is canceled.

The arm status pods adjust to display the arm on which the endoscope and instruments are installed. Moving the endoscope between any arm does not change the left and right hand control assignments: arms 1 and 2 are controlled by the left hand; arms 3 and 4 are controlled by the right hand. Therefore, if the endoscope moves from arm 3 to arm 2, the instrument that went from left hand control on arm 2 changes to the right hand control on arm 3. Endoscope Installation onto Patient Cart Arm Before installing the endoscope to an arm or Port Hopping to a different arm during the procedure, make sure the surgeon is ready and knows which arm will house the endoscope.

Also, ensure that the arm is draped and the drape sterile adapter is attached. Inspect the endoscope for broken, cracked, chipped, or worn parts. Do not use an endoscope if it is damaged.

Insert the endoscope tip into the cannula and press the base into the sterile adapter. Audible completion beeps signal that the endoscope is engaged. Use the instrument clutch button to manually advance the endoscope. Position the endoscope to view the target anatomy before inserting instruments. To protect the endoscope connectors during this exchange, there are two holders on the Vision Cart Figure 7. Remove the endoscope from the Patient Cart arm by squeezing both release levers on the endoscope base and pulling the endoscope up and away from the arm.

Unplug endoscope cable from the Endoscope Controller. When switching endoscopes: A. Place the removed endoscope cable connector in the holder on the Vision Cart Figure 7.

Connect the new endoscope cable to the Endoscope Controller. Attach the new endoscope to the Patient Cart arm. If applicable, after the procedure, attach the cover onto the connector and tighten the screws.

Place the endoscope into a validated sterilization tray before reprocessing. Refer to the Reprocessing Instructions User Manual for detailed reprocessing instructions. This can result in overheating and damage to the endoscope. Endoscope fogging occurs when there is a difference between the temperature of the endoscope tip and the pneumoperitoneum. The da Vinci Xi endoscope is designed to keep the tip of the endoscope warm which reduces the likelihood of fogging. Deactivate after use.

Intraoperative Endoscope Cleaning As necessary due to fogging or smudging of the tip, remove the endoscope and wipe the tip with moistened sterile gauze. Remove the endoscope from the arm. Carefully wipe the tip of the endoscope with moistened sterile gauze. To further reduce the likelihood of fogging, briefly submerge the endoscope into a container of warm water and wipe dry with sterile gauze optional. Reinstall the endoscope onto the arm.

Advance the endoscope into the patient. The right side of the touchscreen provides a menu for settings. Arm, instrument, and endoscope status area Menu tabs Display tab selected Figure 7. Not all technologies may have regulatory approval or may be commercially available in all geographies. For availability in your coun- try, please check with your local representative. When applicable, the menu includes a Guided Setup and Fault tab.

When a tab is highlighted, it is active. A grayed out tab is not active. In Figure 7. See Chapter 9, Guided Setup on page Hidden Touch to capture an image from the endoscope view.

The system records the left or right image based on which eye is being displayed on the touchscreen.

Touch Console to display the Surgeon Console view. Touch Endoscope to display the endoscope view. Touch TilePro 1or TilePro 2 to display auxiliary input 1 or auxiliary input 2 in full screen. Down Touch to turn Firefly1, 2 on or off. Move slider to change the visibility of the green Firefly Intensity fluorescing tissue relative to the non-fluorescing Slider tissue.

Turn Illumination Turn on or off the illumination from the touchscreen. Erase Telestration Touch to erase telestration marks. Table Touchscreen Settings tab Control Adjustment Description Provides an inventory overview of the instruments used Uses Remaining during the procedure. See F. Displays the system software version and provides access to event logs, color bars for vision Troubleshooting troubleshooting, color balance adjustment, factory default vision settings, and manual 3D alignment if needed.

Provides information on energy presets. For more information, see VIO dV 2. Energy presets are only available with VIO 2. Volume volume. Not normally required – used for troubleshooting only. Controls for performing manual white balance of the White Balance endoscopic camera. Slider control for adjusting the color balance of the endoscopic image. Moving the slider to the left Color Balance increases the red tones in the image.

Moving it to the right increases the blue tones in the image. Displays a color bar image in either the left or right eye Color Bars of the endoscope view.

Used only for troubleshooting. The status of the network connection is shown here. Software Version Lists the current system software version number. System Identification. Guided Setup Displays Guided Setup messaging, steps, and status. Fault Displays system status and troubleshooting information.

Arm Status from the Vision Cart Touchscreen The arm and instrument status area displays real-time information about the endoscope and instruments installed on the Patient Cart.

The Patient Cart arms are shown in status pods numbered 1 through 4. Instruments on arms 1 and 2 map to the left hand control and are controlled by the left set of foot pedals, and instruments on arms 3 and 4 map to the right hand control and are controlled by the right set of foot pedals.

If arm 4 is on the left side, then the instruments on arms 4 and 1 map to the left hand control and the left set of foot pedals, and the instruments on arms 2 and 3 map to the right hand control and the right set of foot pedals. The status area provides arm, hand control, and the status of the instruments and endoscope in use. Arm number Activation status no activation available Instrument name and status Hovering, but no activation available. Hovering and activation available.

Activating associated blue pedal. Activating associated yellow pedal. Endoscope type and direction. Activation status bar. See Chapter 10, section The status area for a specific arm pops up to display extended information or warnings.

Endoscope Horizon Indicator This icon indicates the orientation of the endoscope in the surgical field. Horizon Figure 7. Off -Screen Indicator When an instrument is out of view, the off-screen indicator appears as a colored border that provides a guide for the user to point the endoscope towards the out of view instrument s. If the instrument out of view is active associated , for example arm 1, the border is yellow and black with the number 1.

If the instrument out of view is not active, for example arm 4, the border is gray and black with the number 4 Figure 7. To use the off-screen indicator: Adjust the endoscope view so that it points towards the indicator until the instrument is in view. Instrument arm 4 is off-screen not active.

Intrument arm 1 Instrument arm 3 is off-screen is off-screen active active. The icons appear over or around the instrument wrist at the approximated corresponding depth in the 3D viewer for example, when the icon is larger, the instrument is closer to the endoscope, and when the icon is smaller, the instrument is farther from the endoscope. The icons, which appear when the user is head-in the 3D viewer and prior to matching grips, provide a reference to know if an instrument is visually obstructed.

For example, the icon may be visible in the 3D viewer, but the instrument tip is not, because it is behind tissue. Take Photo This feature enables the user to capture a still image of the endoscope view. Vision Cart Photo 1. This may take several seconds. From the Display tab, touch Take Photo to capture the image.

The Saving Image message appears on the touchscreen while the image is being saved. Endoscope Photo 1. Press the Take Photo button on the endoscope to capture the image. Wait a few seconds for the image to save before pressing the Take Photo button again to capture another image. An error beep sounds if the Take Photo button is pressed while an image is being saved. Surgeon Console Touchpad Photo 1. From the Instrument tab, touch the Take Photo Quick-setting to capture the image.

The Take Photo icon has various states. Telestration The touchscreen also has a telestration feature that permits using a finger to draw a colored line over the video image.

Telestration can be performed on the video image from the main surgical field or from an optional video input. To telestrate, press and drag a finger on the monitor to draw a colored line on the video image.

The telestration drawn also appears in the Surgeon Console viewer, overlaid on whichever video channel left or right is being used at the touchscreen. The surgeon cannot block the appearance of telestration, but can remove the line s by pressing the endoscope foot pedal.

Use it only to facilitate communication during surgery. Image Too Bright or Dark Correct an Overly Bright Image Use the brightness slider on the touchscreen or touchpad to decrease the brightness to the desired level.

Correct a Dark Image 1. Use the brightness slider on the touchscreen or touchpad to increase the overall brightness to the desired level, or use the Dynamic Contrast slider to increase the localized brightness. When clinically feasible, check the tip of the endoscope for smudges or soiling, and clean the tip if necessary. Blood or other protein may have accumulated on the tip, diminishing light throughput.

Try another endoscope and contact Intuitive Surgical for a replacement. If the problem persists contact Intuitive Surgical Customer Service. Check for cautery interference. If flickering only happens during cautery, move any external ESUs away from the Vision Cart and move all of the cautery cords away from the Vision Cart cables. Replace the ESU. Restart the system. Power down the system. Power up the system. Correct Blurry Image 1. When clinically feasible, check the tip of the endoscope for smudges or soiling, and wipe the tip with sterile gauze if necessary.

White Balance the Endoscope Typically, the endoscope will not need to be white balanced; this is set automatically by the system. If for any reason white balancing is needed, follow these steps: 1. If not already done, connect the endoscope cable to the Endoscope Controller on the Vision Cart.

Point the distal tip of the endoscope about 4 in. Touch the White Balance button on the touchscreen. The system sounds audible beeps when white balance is complete.

Patient Cart arms should be arranged to avoid contact with the patient or equipment. Note: The patient should be positioned before docking. Table movements are most easily performed before driving the Patient Cart into position. It is good practice to lower the table height before positioning the Patient Cart for docking. Serious injury could result. If intraoperative OR table movement is necessary, remove all instruments and the endoscope, undock the da Vinci Xi System, move the OR table, and re-dock the system.

All port placement should be done under endoscopic vision. The obturator tips should remain in view at all times during cannula insertion under endoscopic visualization. Contact your Intuitive Surgical representative for available Specialty Guides. Note: The target anatomy is the center of the surgical workspace boundary, not necessarily the location of the pathology. This is important if instrument reach behind the ports or in line with the ports is required.

Triangulated port placement may also be used. Straight line Triangulated. Red oval: instrument reach area for red port. Figure 8. Insufflate the abdomen before measuring port placement. Following insufflation, mark the locations of instrument and accessory ports.

Place the initial endoscope port cm from the target anatomy. This avoids losing perspective over the surgical workspace. Place remaining ports cm apart 8 cm recommended in a perpendicular line relative to the target anatomy. Place assistant ports as needed, as far away as possible at least 7 cm from robotic ports.

Consider which side of the patient the assistant will be on. Ensure the assistant is facing the target anatomy and can access the arms for instrument exchanges and intraoperative endoscope cleaning. Assistant port. Robotic port. Initial endoscope port. Docking is the process of moving the Patient Cart to the OR table and connecting the Patient Cart arms to the cannulae.

Specific applications may warrant placement of the cannula while connected to the Patient Cart arm for example, Cardiac and Thoracic procedures. In these applications, the Patient Cart needs to be positioned before cannula insertion.

The remote center is the pivot point around which the da Vinci Xi System moves the arms. Remote center technology enables the system to precisely maneuver instruments in the surgical site while exerting minimal force on the patient’s body wall.

The remote center is indicated by the thick, center black band on the cannula. Moving the arms with the remote center placed incorrectly increases friction, reduces precision, and increases tissue trauma at the port site Figure 8. The Surgeon Console operator cannot move the remote center.

The patient-side assistant can adjust the remote center by repositioning the arm using the port clutch button. It is recommended to check the position of the arms throughout surgery to ensure there is no tension on the port sites. For instructions to release tension see Chapter 9, Port Clutch on page To help ensure patient safety the Patient Cart operator actions take precedence over Surgeon Console operator actions.

For full descriptions of Patient Cart components, see Chapter 2, section 2. Laser Indicators The Patient Cart has laser indicators that provide users information about the positioning of the Patient Cart during transportation and positioning to the patient.

The horizontal laser projects a horizontal line in front of the Patient Cart, highlighting possible collisions during powered Patient Cart movement. Figure 9. Additionally, the positioning laser activates during draping, when it is helpful to have a reference line for adjusting arm position see Chapter 6 Drape the System, on page The cart drive enable switches adjust the motion speed according to the amount of force applied by your hands.

Note: The boom control joysticks adjust the speed according to the button limit. That is, pressing the joystick to its furthest limit results in the fastest speed.

To enable the adjustments below, press and hold Enable Joysticks on the Patient Cart touchpad. Push down to lower the boom. Push down to retract the boom. To stop system operation at any time, press the red Emergency Stop button. Emergency Stop initiates a recoverable fault, which can be overridden by pressing Recover on the touchpad.

The touchpad also provides a means for system fault notification and recovery. Home Settings Figure 9. This is the default behavior. If Reduced is selected, a message appears informing that tutorial voice prompts are turned off. System Height Limit: The system height limit feature aids the use of the Patient Cart in environments with low overhead clearance. The system height limit prevents users from inadvertently raising the boom to heights that may interfere with ceiling-mounted OR equipment.

There are two possible settings for System Height limit: On and Off. System Height Limit Selecting On restricts the maximum height of the system to On default minimize the likelihood of colliding with ceiling-mounted objects, such as OR lights. Selecting Off allows the system to extend to its full height, which may be necessary in some circumstances, such as with very large Off patients.

Selecting Modify provides controls for the user to manually set Modify the system height limit, so that it can be set appropriately for the relevant operating room s.

Modify System Height Limit The system height limit is set for its maximum setting by default, so that vertical motion of the boom is unrestricted. However, trained personnel can set or modify this limit as needed, which will persist across uses of the Patient Cart.

Select Modify from the Settings tab on the Patient Cart touchpad. Press and hold Enable Joysticks and use the boom height control joystick to raise or lower the boom. The horizontal laser will illuminate and can be used as a guide to identify potential overhead obstacles. Adjust the boom height so the horizontal laser illuminates the lowest point on any obstacle s near, or in the path to, the operating table, and then adjust the laser so it is below the obstacle s.

Press Save. Corresponding icons and graphics depicting system status appear simultaneously on the Vision Cart touchscreen and 3D viewer. The meanings of the arm LED indicators are defined in Table The Boom LEDs are located on the underside surface of the boom, as shown. The battery LED indicator meanings are defined in Table Patient Cart movements are performed using either of two methods: Guided Setup see Guided Setup, on page or manual control see Manually Adjusting the Patient Cart Arms on page The boom is adjustable in height, extension closer or further from the base , and rotation.

The arms flex a joint that allows spacing of the arms from each other and can be extended and adjusted for appropriate placement and range of motion for surgery. Guided Setup Guided Setup and targeting simplifies preparing, positioning, and docking the Patient Cart for intraoperative use.

Patient Clearance adjustment. For information regarding draping the system, see Chapter 6 Drape the System, on page For information regarding stowing, see Chapter 11, section Consider positioning the patient such that these obstacles are out of the way. Contact your local Intuitive Surgical representative for available Specialty Guides. During Guided Setup, the da Vinci Xi System deploys to a preset position for docking based on the anatomy and cart location selections made from the Patient Cart touchpad.

Consider how much room the patient-side assistant may need for comfortable ergonomics. Using Guided Setup, there are three basic Patient Cart positions, each based on the boom pivot angle and the rotation of the arms: straight, toward the head, or toward the feet. The boom may need further adjustment once docked. After draping, once cannulae are inserted in the patient, a non-sterile person moves the Patient Cart into the sterile field to prepare for docking.

Manual Positioning: While Guided Setup is the simplest and most accurate way to position the Patient Cart, if Guided Setup does not achieve the desired positioning, the manual controls can be used. See section 9. The Patient Cart touchpad provides Guided Setup instructions for the non-sterile Patient Cart operator through positioning and docking. The Vision Cart touchscreen provides images and text to assist the sterile assistant at the OR table with the completion of each step.

Patient Cart touchpad Vision Cart touchscreen. Only one person should give directions to the Patient Cart operator about potential collisions and for positioning when approaching the patient.

Select the desired anatomical region from the Select Anatomy screen on the Patient Cart touchpad. Select the desired cart location the side of the patient where the Patient Cart will be positioned from the Select Cart Location screen on the Patient Cart touchpad. If not already done, confirm all of the arms are positioned behind the green laser line. The Waiting on Sterile tasks screen appears until sterile tasks are complete.

When ready to move towards the patient: From the Patient Cart touchpad, press and hold Deploy for Docking. The boom rises, extends, and rotates.

The arms move to the proper orientation for the selected approach. Move any overhead lights, booms, and equipment. Note: If Guided Setup does not provide the required system configuration, it is possible to position the boom using manual controls as described in section 9. Note: The setup may be changed as needed by selecting a new anatomy and cart location and pressing and holding Deploy for Docking again. Squeeze one or both of the cart drive enable switches on the Patient Cart Helm to start the cart drive.

A green positioning laser is projected from the boom toward the floor. Confirm that the positioning laser is visible on the floor before positioning the Patient Cart.

If the laser is not visible, push all arms behind the laser lines. Slowly drive the Patient Cart to the OR table. Position the Patient Cart base next to the OR table where patient-side access is not required. Watch for potential collisions with the non-sterile field. Ensure there is sufficient clearance between the patient and the lowest point of the Patient Cart arms.

Slowly drive the Patient Cart to position the laser lines within 5 cm of the initial endoscope port. The orientation of the Patient Cart with respect to the OR table is not critical. Make further adjustments using the manual controls on the Patient Cart Helm see page Raise the arms, if needed, using the port clutch button. Docking Docking is the process of moving the Patient Cart to the OR table and connecting the arms to the cannulae.

Once cannulae are inserted in the patient, a non-sterile person moves the Patient Cart into the sterile field. Ensure that the patient-side assistant can see all arms during the procedure and can alert the surgeon when the arms are close to contacting the patient.

Note: If, while operating, you move the hand controls and no instrument motion occurs, there may be interference between instruments or arms, or between an arm and the patient. Resolve the interference before proceeding with the surgery.

Note: If collisions between the arms occur, it may be possible to slightly adjust the position of setup joints using the port clutch button to create more space between arms. Remove the instruments before pressing the port clutch button and use care to prevent sliding of the cannula out of the port site while you adjust the arm positions. Note: If collisions between the arms occur, ensure that the instruments are still fully engaged on the arm.

If needed, use the instrument clutch and port clutch buttons to manually adjust the position of the arm that will hold the endoscope. Note: Arms that are not docked to a cannula can be positioned by grabbing the arm and moving as desired grab and move feature.

Port clutch Cannula mount lever. Make sure the cannula sterile adapter on the drape is properly aligned with the cannula mount. Press and hold the cannula mount lever and insert the cannula fin.

Release the lever. An audible tone indicates a properly docked cannula. Once a cannula is docked, the Surgery in Progress screen appears on the Patient Cart touchpad.

Prompts to install the endoscope for targeting appear on the Vision Cart touchscreen. Install the endoscope on the arm by inserting the endoscope tip into the cannula and pressing the endoscope onto the sterile adapter until it clicks into place. Use the instrument clutch button and manually advance the endoscope. Position the endoscope to view the target anatomy, using the targeting icon as a guide. Perform Targeting: See Step 4. Once the Patient Cart is deployed and the initial endoscope arm is docked, perform targeting.

While the da Vinci Xi System can be positioned manually, targeting ensures the system is oriented and aligned to the center of the surgical workspace boundary established during port placement. Note: While the boom is moving, watch all undocked arms to ensure they do not contact objects in the environment sterile or non-sterile. The undocked arms may enter a state similar to port clutch to soften potential collisions with the patient or environment and may drift.

Note: Hold the cannula with one hand to support it during motion and hold the Targeting button with the other hand. Targeting does not change the position of the flex joints, patient clearance joints except for da Vinci Xi Single-Site1 , or the arms. To optimize setup, manually adjust the arms once targeting is complete.

Note: The positioning laser remains on after targeting is complete so it can be used as a guide to align the initial endoscope arm. The positioning laser turns off after a brief period of time, or when a second cannula is installed on the system whichever occurs first. Dock the initial endoscope port. Ensure the remote center is appropriately placed within the body wall. Install the endoscope, and use the instrument clutch button to point the target icon lines that appear on the touchscreen at the target anatomy Figure 9.

Support the cannula with one hand, and use the other hand to press and hold the targeting button on the endoscope. Continue holding until the audible signal completes and motion stops. After targeting completes, confirm target anatomy placement. If targeting does not complete, confirm boom placement and rotation with respect to the target anatomy. If any of the above requirements are not met, follow the instructions on the touchscreen, or contact Intuitive Surgical Customer Support.

Use the port clutch button to adjust the flex joint of the initial endoscope arm to be in line with the target anatomy. This centers that arm so the rest of the arms can be adjusted. Dock the remaining arms: align each cannula mount to a cannula and connect. This helps resolve and avoid potential arm collisions during a procedure. It is recommended to posi- tion the arms as close together as possible while still allowing each axis to move without interference. If needed, use the patient clearance button on each arm to adjust the arm angle.

This ensures sufficient space for the arms to work in parallel, and for patient clearance adjustment. The flex label indicates the range of motion for each arm, but it is not meant for setting up or arranging the arms.

After the arms are spaced, lower the patient clearance joints with about a fist’s space to the patient or other sterile obstacles. This ensures maximum instrument reach. Note: Patient clearance adjustment is optional.

Consider patient access and instrument reach needs and adjust patient clearance joints accordingly. Note: The relative position of each patient clearance joint can vary from arm to arm. First, navigate to the Patient Cart touchpad Home screen. Then, press and hold the Enable Joysticks button Figure 9.

Home Figure 9. The arms include a series of clutch buttons, links and joints, which allow the user to connect the arms to the cannulae during setup. The Patient Cart arms are locked in position unless specifically moved from the patient-side or as controlled by the Surgeon Console.

Grab and move feature: Prior to docking to a cannula, the arm can be positioned by grabbing the arm by its gray handle and moving as desired. The entire length of the arm is free to move Figure 9.

The types of motions allowed by pressing arm control buttons changes as the cannulae are attached to the arms. When any cannula is installed, the Patient Cart operator can no longer rotate the boom.

When more than one cannula is installed, only instrument clutch, patient clearance, and port clutch options are available. In addition to the controls available on all of the arms, the outer two arms 1 and 4 are equipped with boom rotation buttons, Figure 9.

Instrument clutch. Patient clearance C. Boom rotation. Port clutch Figure 9. CAUTION: To prevent a change in the endoscope or instrument insertion depth, hold the arm steady by grasping the top of the instrument whenever the instrument clutch button is pressed.

Note: When the port clutch button is used, use care to prevent sliding the cannula out of the port site. See 9. Continue to hold the port clutch while the system begins a 3-second countdown accompanied by audio indications. Patient clearance Figure 9. Steep angles are used to make more room under the arm patient clearance , whereas shallow angles are used to achieve the maximum working range of motion instrument reach. Steep angle. Shallow angle. Boom Rotation The outer two arms 1 and 4 provide a boom rotation button Figure 9.

Note: The boom can also be rotated by pressing and holding the Targeting button on the endoscope. See Targeting on page If adjustment of the flex joint is desired, and instruments are installed on the system: 1.

Ensure that the instruments are not grasping tissue. Remove all instruments. With one hand, support the arm and cannula while the flex joint is adjusted. With the other hand, press the port clutch button, and carefully move the flex joint closer to or further from the adjacent arm.

Port clutch Cannula. If an inner arm needs to be stowed, perform Step 4 below before docking. Drape the arm to stow when draping all other arms, see Chapter 6. Dock the arms to be used for the procedure, see section 9. Once the arms that will be used are docked, collapse the stow arm onto itself using the instrument clutch button. Use the port clutch button to fully rotate and move the arm up and away from the surgical field. CAUTION: The system will detect the position of the stowed arm during any boom motions; however, it is up to the Patient Cart operator to ensure that the arm is placed out of the way of the other arms during surgery.

Dual docking can be used in procedures requiring a surgical workspace larger than two quadrants for example, if the initial endoscope port can not be placed cm from the target anatomy, and two targets are necessary , and when working beyond the level of the ports does not provide enough instrument reach.

If it is determined that dual docking is needed after initial port placement, skip to step 6. Identify the surgical workspace. If larger than two quadrants, or if the initial endoscope port cannot be placed cm from the target anatomy, split the surgical workspace in half.

Identify a target anatomy in each half. Place the initial endoscope port at equal distance between the two target anatomies approximately cm from each target. Place remaining ports in a line between the two target anatomies. The lateral port not docked to an arm can be used as an assistant port. This may affect how the surgical workspace is divided and what target anatomies are identified. Using the guidelines for targeting and docking, set up the system for the first target anatomy see Targeting, on page , and Docking and Arm Alignment after Targeting, on page This allows the most access to the patient.

When ready to dual dock for example, access the second target anatomy or additional workspace , remove all instruments and undock all arms.

Position the boom to reach the target anatomy. Rotate the boom towards the column, this avoids a range of motion limit. Dock the initial endoscope port and perform targeting and docking following the Dual Docking guidelines see page First surgical workspace. Each instrument is used to perform a specific surgical task such as grasping, suturing, or tissue manipulation. Instrument housing B. Flush ports D.

Tip F. Wrist H. Grip release socket. Maximum use indicator. Note: Do not press the release buttons once an instrument is installed. Pressing the release buttons once an instrument is installed can lead to unintended consequences such as disengagement of the instrument from the arm. Refer to the Instruments and Accessories User Manual for more information on the various da Vinci instruments, accessories, and components.

Refer to the Reprocessing Instructions User Manual for cleaning and sterilization instructions. System compatibility with non-approved instrumentation cannot be guaranteed. The warranty does not cover damage to the da Vinci Xi System that occurs as a result of using non-approved instruments and accessories.

Plug and Play Newly released instruments may need to download their new parameters to the da Vinci Xi System. This process is only required once for each new type of instrument, and can take up to 15 seconds.

During this download period, the arm LED pulses blue and a message displays. If an error occurs during plug and play, re-install the instrument. Inspect the instruments for broken, cracked, chipped, or worn parts. Do not use an instrument if it is damaged. Straighten the instrument wrist and close the jaws to ensure easy insertion into the cannula and prevent damage to the instrument. Insert the instrument tip into the cannula and press the instrument housing into the sterile adapter.

Audible completion beeps signal that the instrument is engaged. Move the endoscope to visualize the instrument and use appropriate caution when inserting instruments into the patient. This visual check prevents inadvertent harm to the patient. The first instrument installed on each arm during a procedure must be manually inserted. Use the instrument clutch button to manually insert the instrument. The Surgeon Console operator cannot control the instrument until the tip is moved out of the cannula.

The LEDs blink blue when the button is clutched. The Surgeon Console operator cannot control the instrument until it is moved out of the cannula and is no longer clutched.

Note that if the clutch button is pressed and released instead of holding it down contin- uously while inserting the instrument , the clutch button must be pressed and released again after insertion through the cannula, to give control of the instrument to the sur- geon.

Guided Tool Change Guided Tool Change Overview To provide an efficient and safe method for instrument exchange or reinsertion, the system can assist the Patient Cart operator by guiding an instrument into the patient. Guided Tool Change helps guide the instrument tip to a location just short of the last position of the previously installed instrument or endoscope tip.

Guided Tool Change. The system also displays a message to advance the instrument or endoscope to return to the previous location. To install an instrument using the Guided Tool Change feature: 1.

Straighten the instrument wrist and close the jaws. Insert the instrument tip into the cannula and Press the instrument housing into the sterile adapter. Wait for the blinking green LED near the sterile adapter. Gently slide the instrument into the surgical field by pressing on the housing until there is resistance and the LEDs turn blue. The instrument is now ready for surgeon control. Best practice is to observe the instrument tip coming into view on the patient-side monitor.

Note: If Guided Tool Change is disabled or does not initiate, use the arm clutch button to insert the instrument manually, as described in Manually Insert an Instrument on page Anatomical restrictions may require alternate adjustments or Dual Docking see page To ensure maximum reach and minimum arm-to-arm interference, set up the arms in parallel using the flex joints and lower the patient clearance joints, if space is available to do so.

Note that although the arm containing the endoscope is not controlled by a hand, it will need to be reassigned, as no more than two arms can be assigned to any one hand control.

For additional information and suggested steps for working behind ports, see Increase Instrument Reach on page Arm-to-arm Interference 1. Identify the interference for example, on the front end or back end of the arm. This allows the arms to work in parallel, minimizing interference.

Interference No interference Figure 9. This increases the space between the joints and minimizes interference. Identify where reach is needed for example, in line with or beyond the level of the ports.

Arms nominal, 2. Arms reaching ports no flex adjustment , 3. This may be done by the surgeon using the hand controls, or by the patient side assistant using the port clutch button. Re-associate the hand controls. CAUTION: Removing instruments during a procedure should be performed very carefully and only when the Surgeon Console operator is informed of the removal and has the instrument in full view.

Do not remove the instrument if it is not in view. Prior to removing the instrument, the Surgeon Console operator should: 1. Ensure the instrument is free and clear of any patient anatomy. Straighten the instrument wrist. Clearly communicate to the Patient Cart operator which instrument to remove. Identify the name of the instrument or the number of the arm 1, 2, 3, 4. To remove the instrument: 1.

Ensure the instrument is positioned for removal. Squeeze the instrument release buttons and slide the instrument up and out through the cannula. Note: The Patient Cart automatically retracts the instrument carriage when the instrument is disconnected. If the instrument is not removed in time, the sterile adapter may re-engage the instrument during the retraction.

If the instrument re-engages, repeat the instrument removal steps. Note: To avoid damage to the arm drapes, use care not to scrape instruments against patient cart arms during instrument removal. Instrument carriage. If needed, clutch the arm to adjust its angle such that the instrument or endoscope clears the sterility barrier upon removal.

Non-sterile area behind color band Example of breached sterility barrier Sterile area. Failure to observe this warning may result in unintended instrument motion or damage to the grip release mechanism. When 2x or 4x digital zoom is active, the image resolution decreases, which may impact image quality. The 1x setting provides the maximum resolution.

When the surgeon enters digital zoom, the Vision Cart touchscreen continues to display the 1x view. To change digital zoom settings: 1. From the Surgeon Console touchpad Settings tab, touch Display. Select 1x, 2x, or 4x. See Image on page The system defaults to Normal working distance. To enable Close-up working distance: 1. Targeting The targeting button is used to orient and align the Patient Cart to the center of the surgical workspace boundary.

For additional information, guidelines and steps, see Chapter 9, Targeting, on page The endoscopic image displays on the Vision Cart touchscreen to aid with visualizing during handheld use. After handheld use, the Patient Cart is docked to the patient, and the endoscope is attached to a Patient Cart arm.

Touch Close-up. Touch Normal to enable Normal working distance. The endoscope senses when the base is pointed up or down and flips the video accordingly. If the tip of the endoscope and the base are both pointing down, the displayed image will be upside-down. This enables the surgeon to change between the up and down orientations without patient-side assistance. Avoid contact with skin, tissue, and clothing when the Endoscope Controller is turned On, as damage may occur.

Do not attempt to clean the tip of the endoscope by wiping with tissue. The tissue can be damaged because of the heat, and the tip of the endoscope may develop tissue deposits that can decrease light output. Endoscope Cable Management For improved cable management throughout the procedure, place the cable between the endoscope shaft and the arm before inserting the endoscope into the cannula. This minimizes the length of cable that is free to swing around during the procedure.

The ability to install the endoscope on any of the arms is referred to as Port Hopping. When interchanging an endoscope with an instrument on any arm, Guided Tool Change is canceled. The arm status pods adjust to display the arm on which the endoscope and instruments are installed. Moving the endoscope between any arm does not change the left and right hand control assignments: arms 1 and 2 are controlled by the left hand; arms 3 and 4 are controlled by the right hand.

Therefore, if the endoscope moves from arm 3 to arm 2, the instrument that went from left hand control on arm 2 changes to the right hand control on arm 3. Also, ensure that the arm is draped and the drape sterile adapter is attached.

Inspect the endoscope for broken, cracked, chipped, or worn parts. Do not use an endoscope if it is damaged. Insert the endoscope tip into the cannula and press the base into the sterile adapter. Audible completion beeps signal that the endoscope is engaged. Use the instrument clutch button to manually advance the endoscope. Position the endoscope to view the target anatomy before inserting instruments. Remove the endoscope from the Patient Cart arm by squeezing both release levers on the endoscope base and pulling the endoscope up and away from the arm.

To protect the endoscope connectors during this exchange, there are two holders on the Vision Cart Figure 7.

Unplug endoscope cable from the Endoscope Controller. When switching endoscopes: A. Place the removed endoscope cable connector in the holder on the Vision Cart Figure 7. Connect the new endoscope cable to the Endoscope Controller. Attach the new endoscope to the Patient Cart arm. If applicable, after the procedure, attach the cover onto the connector and tighten the screws. Place the endoscope into a validated sterilization tray before reprocessing.

Refer to the Reprocessing Instructions User Manual for detailed reprocessing instructions. This can result in overheating and damage to the endoscope. The electronics in the distal tip of the endoscope generate heat, which should reduce fogging. Endoscope fogging occurs when there is a difference between the temperature of the endoscope tip and the pneumoperitoneum. The da Vinci Xi endoscope is designed to keep the tip of the endoscope warm which reduces the likelihood of fogging.

Deactivate after use. Intraoperative Endoscope Cleaning As necessary due to fogging or smudging of the tip, remove the endoscope and wipe the tip with moistened sterile gauze. Remove the endoscope from the arm. Carefully wipe the tip of the endoscope with moistened sterile gauze. To further reduce the likelihood of fogging, briefly submerge the endoscope into a container of warm water and wipe dry with sterile gauze optional. Reinstall the endoscope onto the arm. Advance the endoscope into the patient.

The right side of the touchscreen provides a menu for settings. System status message area Options Arm, instrument, and endoscope status area Menu tabs Display tab selected Figure 7.

Not all technologies may have regulatory approval or may be commercially available in all geographies. For availability in your country, please check with your local representative.

The touchscreen main menu includes a Display tab, a Settings tab, and a Table tab. When applicable, the menu includes a Guided Setup and Fault tab. When a tab is highlighted, it is active. A grayed out tab is not active. In Figure 7. See Chapter 9, Guided Setup on page The system records the left or right image based on which eye is being displayed on the touchscreen. Touch Console to display the Surgeon Console view.

Touch Endoscope to display the endoscope view. Touch TilePro 1or TilePro 2 to display auxiliary input 1 or auxiliary input 2 in full screen.

If Firefly is already on, then the button will turn off Firefly. Firefly Intensity Slider Move slider to change the visibility of the green fluorescing tissue relative to the non-fluorescing tissue. Turn Illumination Turn on or off the illumination from the touchscreen. Table Touchscreen Settings tab Control Adjustment Description Uses Remaining Provides an inventory overview of the instruments used during the procedure.

See F. Troubleshooting Displays the system software version and provides access to event logs, color bars for vision troubleshooting, color balance adjustment, factory default vision settings, and manual 3D alignment if needed. Presets Provides information on energy presets. For more information, see VIO dV 2. Energy presets are only available with VIO 2.

Volume Drag the slider to adjust the Patient Cart speaker volume. Not normally required – used for troubleshooting only. White Balance Controls for performing manual white balance of the endoscopic camera. Color Balance Slider control for adjusting the color balance of the endoscopic image. Moving the slider to the left increases the red tones in the image. Moving it to the right increases the blue tones in the image.

Color Bars Displays a color bar image in either the left or right eye of the endoscope view. Used only for troubleshooting. OnSite The status of the network connection is shown here.

The connection states are disconnected, connected, or active session in progress. Software Version Lists the current system software version number. Displays Guided Setup messaging, steps, and status.

Displays system status and troubleshooting information. Arm Status from the Vision Cart Touchscreen The arm and instrument status area displays real-time information about the endoscope and instruments installed on the Patient Cart.

The Patient Cart arms are shown in status pods numbered 1 through 4. Instruments on arms 1 and 2 map to the left hand control and are controlled by the left set of foot pedals, and instruments on arms 3 and 4 map to the right hand control and are controlled by the right set of foot pedals.

If arm 4 is on the left side, then the instruments on arms 4 and 1 map to the left hand control and the left set of foot pedals, and the instruments on arms 2 and 3 map to the right hand control and the right set of foot pedals. The status area provides arm, hand control, and the status of the instruments and endoscope in use. Activation status bar Figure 7. The status area for a specific arm pops up to display extended information or warnings.

This icon indicates the orientation of the endoscope in the surgical field. Horizon Figure 7. If the instrument out of view is active associated , for example arm 1, the border is yellow and black with the number 1.

If the instrument out of view is not active, for example arm 4, the border is gray and black with the number 4 Figure 7. Instrument arm 4 is off-screen not active Intrument arm 1 is off-screen active Instrument arm 3 is off-screen active Figure 7. The icons appear over or around the instrument wrist at the approximated corresponding depth in the 3D viewer for example, when the icon is larger, the instrument is closer to the endoscope, and when the icon is smaller, the instrument is farther from the endoscope.

The icons, which appear when the user is head-in the 3D viewer and prior to matching grips, provide a reference to know if an instrument is visually obstructed. For example, the icon may be visible in the 3D viewer, but the instrument tip is not, because it is behind tissue. Vision Cart Photo 1. This may take several seconds. From the Display tab, touch Take Photo to capture the image.

The Saving Image message appears on the touchscreen while the image is being saved. Endoscope Photo 1. Press the Take Photo button on the endoscope to capture the image.

An error beep sounds if the Take Photo button is pressed while an image is being saved. Surgeon Console Touchpad Photo 1. The Take Photo icon has various states. It is grayed out for a few seconds while the image saves, it also indicates whether or not a scope is installed, a USB is detected, a USB is full or not recognized, and if there is a save error.

Telestration The touchscreen also has a telestration feature that permits using a finger to draw a colored line over the video image.

Telestration can be performed on the video image from the main surgical field or from an optional video input. To telestrate, press and drag a finger on the monitor to draw a colored line on the video image. The telestration drawn also appears in the Surgeon Console viewer, overlaid on whichever video channel left or right is being used at the touchscreen. The surgeon cannot block the appearance of telestration, but can remove the line s by pressing the endoscope foot pedal.

From the Instrument tab, touch the Take Photo Quick-setting to capture the image. Use it only to facilitate communication during surgery. Do not use telestration as a graphics aid for performing surgery for example, making telestration marks to indicate where to cut.

Correct a Dark Image 1. Use the brightness slider on the touchscreen or touchpad to increase the overall brightness to the desired level, or use the Dynamic Contrast slider to increase the localized brightness. When clinically feasible, check the tip of the endoscope for smudges or soiling, and clean the tip if necessary. Blood or other protein may have accumulated on the tip, diminishing light throughput.

Try another endoscope and contact Intuitive Surgical for a replacement. If the problem persists contact Intuitive Surgical Customer Service. Check for cautery interference. If flickering only happens during cautery, move any external ESUs away from the Vision Cart and move all of the cautery cords away from the Vision Cart cables. Restart the system. Power down the system.

Power up the system. Correct Blurry Image 1. When clinically feasible, check the tip of the endoscope for smudges or soiling, and wipe the tip with sterile gauze if necessary. White Balance the Endoscope Typically, the endoscope will not need to be white balanced; this is set automatically by the system.

If for any reason white balancing is needed, follow these steps: 1. If not already done, connect the endoscope cable to the Endoscope Controller on the Vision Cart. Replace the ESU. Point the distal tip of the endoscope about 4 in. Touch the White Balance button on the touchscreen.

The system sounds audible beeps when white balance is complete. Patient Cart arms should be arranged to avoid contact with the patient or equipment. Note: The patient should be positioned before docking. Table movements are most easily performed before driving the Patient Cart into position.

It is good practice to lower the table height before positioning the Patient Cart for docking. Serious injury could result. If intraoperative OR table movement is necessary, remove all instruments and the endoscope, undock the da Vinci Xi System, move the OR table, and re-dock the system. All port placement should be done under endoscopic vision. The obturator tips should remain in view at all times during cannula insertion under endoscopic visualization.

Contact your Intuitive Surgical representative for available Specialty Guides. Note: The target anatomy is the center of the surgical workspace boundary, not necessarily the location of the pathology. This is important if instrument reach behind the ports or in line with the ports is required.

Triangulated port placement may also be used. Straight line Triangulated Red oval: instrument reach area for red port Figure 8. Insufflate the abdomen before measuring port placement. Following insufflation, mark the locations of instrument and accessory ports.

Place the initial endoscope port cm from the target anatomy. This avoids losing perspective over the surgical workspace. Place remaining ports cm apart 8 cm recommended in a perpendicular line relative to the target anatomy. Consider which side of the patient the assistant will be on. Ensure the assistant is facing the target anatomy and can access the arms for instrument exchanges and intraoperative endoscope cleaning.

Place assistant ports as needed, as far away as possible at least 7 cm from robotic ports. Figure 8. Docking is the process of moving the Patient Cart to the OR table and connecting the Patient Cart arms to the cannulae.

Specific applications may warrant placement of the cannula while connected to the Patient Cart arm for example, Cardiac and Thoracic procedures.

In these applications, the Patient Cart needs to be positioned before cannula insertion. The remote center is the pivot point around which the da Vinci Xi System moves the arms. Remote center technology enables the system to precisely maneuver instruments in the surgical site while exerting minimal force on the patient’s body wall.

The remote center is indicated by the thick, center black band on the cannula. Moving the arms with the remote center placed incorrectly increases friction, reduces precision, and increases tissue trauma at the port site Figure 8. The Surgeon Console operator cannot move the remote center. The patient-side assistant can adjust the remote center by repositioning the arm using the port clutch button.

It is recommended to check the position of the arms throughout surgery to ensure there is no tension on the port sites. For instructions to release tension see Chapter 9, Port Clutch on page A patient-side assistant in the sterile field helps the surgeon by exchanging instruments and endoscopes on the arms.

To help ensure patient safety the Patient Cart operator actions take precedence over Surgeon Console operator actions. For full descriptions of Patient Cart components, see Chapter 2, section 2. Laser Indicators The Patient Cart has laser indicators that provide users information about the positioning of the Patient Cart during transportation and positioning to the patient. Additionally, the positioning laser activates during draping, when it is helpful to have a reference line for adjusting arm position see Chapter 6 Drape the System, on page The horizontal laser projects a horizontal line in front of the Patient Cart, highlighting possible collisions during powered Patient Cart movement.

Figure 9. The cart drive enable switches adjust the motion speed according to the amount of force applied by your hands. Note: The boom control joysticks adjust the speed according to the button limit. That is, pressing the joystick to its furthest limit results in the fastest speed. To enable the adjustments below, press and hold Enable Joysticks on the Patient Cart touchpad.

Push down to lower the boom. Push down to retract the boom. To stop system operation at any time, press the red Emergency Stop button. Emergency Stop initiates a recoverable fault, which can be overridden by pressing Recover on the touchpad. The touchpad also provides a means for system fault notification and recovery.

The Patient Cart touchpad includes a Guided Setup feature on the home tab that provides a series of context sensitive prompts and controls to prepare the Patient Cart for draping, stowing, and docking see Guided Setup, on page This is the default behavior.

If Reduced is selected, a message appears informing that tutorial voice prompts are turned off. The system height limit prevents users from inadvertently raising the boom to heights that may interfere with ceiling-mounted OR equipment.

Selecting Off allows the system to extend to its full height, which may be necessary in some circumstances, such as with very large patients. Modify Selecting Modify provides controls for the user to manually set the system height limit, so that it can be set appropriately for the relevant operating room s. Modify System Height Limit The system height limit is set for its maximum setting by default, so that vertical motion of the boom is unrestricted. However, trained personnel can set or modify this limit as needed, which will persist across uses of the Patient Cart.

Select Modify from the Settings tab on the Patient Cart touchpad. To make a selection, navigate to the Patient Cart touchpad Settings Tab, and under System Height Limit select the desired option summarized in Table , below : 2. Point the Patient Cart near where it will be used for surgery but not directly underneath a low ceiling obstacle. Press and hold Enable Joysticks and use the boom height control joystick to raise or lower the boom. The horizontal laser will illuminate and can be used as a guide to identify potential overhead obstacles.

Adjust the boom height so the horizontal laser illuminates the lowest point on any obstacle s near, or in the path to, the operating table, and then adjust the laser so it is below the obstacle s. Press Save. Corresponding icons and graphics depicting system status appear simultaneously on the Vision Cart touchscreen and 3D viewer.

The Boom LEDs are located on the underside surface of the boom, as shown. The battery LED indicator meanings are defined in Table Patient Cart movements are performed using either of two methods: Guided Setup see Guided Setup, on page or manual control see Manually Adjusting the Patient Cart Arms on page The boom is adjustable in height, extension closer or further from the base , and rotation.

The arms flex a joint that allows spacing of the arms from each other and can be extended and adjusted for appropriate placement and range of motion for surgery. For information regarding draping the system, see Chapter 6 Drape the System, on page For information regarding stowing, see Chapter 11, section Consider positioning the patient such that these obstacles are out of the way.

Contact your local Intuitive Surgical representative for available Specialty Guides. During Guided Setup, the da Vinci Xi System deploys to a preset position for docking based on the anatomy and cart location selections made from the Patient Cart touchpad.

Consider how much room the patient-side assistant may need for comfortable ergonomics. Using Guided Setup, there are three basic Patient Cart positions, each based on the boom pivot angle and the rotation of the arms: straight, toward the head, or toward the feet. Toward the head Toward the feet Figure 9. The boom may need further adjustment once docked.

See section 9. Patient Cart touchpad Vision Cart touchscreen Figure 9. The Vision Cart touchscreen provides images and text to assist the sterile assistant at the OR table with the completion of each step. Only one person should give directions to the Patient Cart operator about potential collisions and for positioning when approaching the patient. Select the desired cart location the side of the patient where the Patient Cart will be positioned from the Select Cart Location screen on the Patient Cart touchpad.

Select the desired anatomical region from the Select Anatomy screen on the Patient Cart touchpad. When ready to move towards the patient: From the Patient Cart touchpad, press and hold Deploy for Docking. The boom rises, extends, and rotates. The arms move to the proper orientation for the selected approach.

If not already done, confirm all of the arms are positioned behind the green laser line. The Waiting on Sterile tasks screen appears until sterile tasks are complete.

Move any overhead lights, booms, and equipment. Note: If Guided Setup does not provide the required system configuration, it is possible to position the boom using manual controls as described in section 9.

Note: The setup may be changed as needed by selecting a new anatomy and cart location and pressing and holding Deploy for Docking again. Squeeze one or both of the cart drive enable switches on the Patient Cart Helm to start the cart drive.

A green positioning laser is projected from the boom toward the floor. Confirm that the positioning laser is visible on the floor before positioning the Patient Cart. If the laser is not visible, push all arms behind the laser lines. Slowly drive the Patient Cart to the OR table. Position the Patient Cart base next to the OR table where patient-side access is not required. Watch for potential collisions with the non-sterile field. Ensure there is sufficient clearance between the patient and the lowest point of the Patient Cart arms.

Slowly drive the Patient Cart to position the laser lines within 5 cm of the initial endoscope port. The orientation of the Patient Cart with respect to the OR table is not critical.

Make further adjustments using the manual controls on the Patient Cart Helm see page Docking Docking is the process of moving the Patient Cart to the OR table and connecting the arms to the cannulae. Once cannulae are inserted in the patient, a non-sterile person moves the Patient Cart into the sterile field. Ensure that the patient-side assistant can see all arms during the procedure and can alert the surgeon when the arms are close to contacting the patient.

Raise the arms, if needed, using the port clutch button. Ensure there is adequate room for instruments to move inside the patient. Note: If, while operating, you move the hand controls and no instrument motion occurs, there may be interference between instruments or arms, or between an arm and the patient.

Resolve the interference before proceeding with the surgery. Note: If collisions between the arms occur, it may be possible to slightly adjust the position of setup joints using the port clutch button to create more space between arms. Remove the instruments before pressing the port clutch button and use care to prevent sliding of the cannula out of the port site while you adjust the arm positions.

Note: If collisions between the arms occur, ensure that the instruments are still fully engaged on the arm. If needed, use the instrument clutch and port clutch buttons to manually adjust the position of the arm that will hold the endoscope. Note: Arms that are not docked to a cannula can be positioned by grabbing the arm and moving as desired grab and move feature. Port clutch Cannula mount lever Figure 9. Make sure the cannula sterile adapter on the drape is properly aligned with the cannula mount.

Press and hold the cannula mount lever and insert the cannula fin. Release the lever. An audible tone indicates a properly docked cannula. Once a cannula is docked, the Surgery in Progress screen appears on the Patient Cart touchpad. Prompts to install the endoscope for targeting appear on the Vision Cart touchscreen.

Vision Cart touchscreen Figure 9. Install the endoscope on the arm by inserting the endoscope tip into the cannula and pressing the endoscope onto the sterile adapter until it clicks into place. Use the instrument clutch button and manually advance the endoscope. Position the endoscope to view the target anatomy, using the targeting icon as a guide. Perform Targeting: See Step 4. While the da Vinci Xi System can be positioned manually, targeting ensures the system is oriented and aligned to the center of the surgical workspace boundary established during port placement.

Note: While the boom is moving, watch all undocked arms to ensure they do not contact objects in the environment sterile or non-sterile.

The undocked arms may enter a state similar to port clutch to soften potential collisions with the patient or environment and may drift. Note: Hold the cannula with one hand to support it during motion and hold the Targeting button with the other hand.

Targeting does not change the position of the flex joints, patient clearance joints except for da Vinci Xi Single-Site1 , or the arms. To optimize setup, manually adjust the arms once targeting is complete. The positioning laser turns off after a brief period of time, or when a second cannula is installed on the system whichever occurs first.

Rotate Adjust Figure 9. Dock the initial endoscope port. Ensure the remote center is appropriately placed within the body wall. Install the endoscope, and use the instrument clutch button to point the target icon lines that appear on the touchscreen at the target anatomy Figure 9. Support the cannula with one hand, and use the other hand to press and hold the targeting button on the endoscope.

Continue holding until the audible signal completes and motion stops. After targeting completes, confirm target anatomy placement. If targeting does not complete, confirm boom placement and rotation with respect to the target anatomy. If any of the above requirements are not met, follow the instructions on the touchscreen, or contact Intuitive Surgical Customer Support. Use the port clutch button to adjust the flex joint of the initial endoscope arm to be in line with the target anatomy. This centers that arm so the rest of the arms can be adjusted.

Ensure the flex joint is not at a range of motion limit. Note: The positioning laser remains on after targeting is complete so it can be used as a guide to align the initial endoscope arm.

Dock the remaining arms: align each cannula mount to a cannula and connect. This helps resolve and avoid potential arm collisions during a procedure.

It is recommended to position the arms as close together as possible while still allowing each axis to move without interference. If needed, use the patient clearance button on each arm to adjust the arm angle.

This ensures sufficient space for the arms to work in parallel, and for patient clearance adjustment. The flex joint range of motion varies depending on the boom rotation target anatomy. The flex label indicates the range of motion for each arm, but it is not meant for setting up or arranging the arms. After the arms are spaced, lower the patient clearance joints with about a fist’s space to the patient or other sterile obstacles.

This ensures maximum instrument reach. Note: Patient clearance adjustment is optional. Consider patient access and instrument reach needs and adjust patient clearance joints accordingly. Note: The relative position of each patient clearance joint can vary from arm to arm. First, navigate to the Patient Cart touchpad Home screen. Then, press and hold the Enable Joysticks button Figure 9.

Home Figure 9. The types of motions allowed by pressing arm control buttons changes as the cannulae are attached to the arms. When any cannula is installed, the Patient Cart operator can no longer rotate the boom.

When more than one cannula is installed, only instrument clutch, patient clearance, and port clutch options are available. The Patient Cart arms are locked in position unless specifically moved from the patient-side or as controlled by the Surgeon Console. Grab and move feature: Prior to docking to a cannula, the arm can be positioned by grabbing the arm by its gray handle and moving as desired. The entire length of the arm is free to move Figure 9.

In addition to the controls available on all of the arms, the outer two arms 1 and 4 are equipped with boom rotation buttons, Figure 9. Instrument clutch B. Patient clearance C. Boom rotation D. Port clutch Figure 9.

Note: When the port clutch button is used, use care to prevent sliding the cannula out of the port site. See 9. Continue to hold the port clutch while the system begins a 3-second countdown accompanied by audio indications. Hold the arm at the limit of travel to the end of the countdown, and the system enters an extended mode: when the arm is raised, the boom rises, and when the arm is lowered, the boom descends.

Patient Clearance Patient clearance Figure 9. Steep angles are used to make more room under the arm patient clearance , whereas shallow angles are used to achieve the maximum working range of motion instrument reach. Steep angle Shallow angle Figure 9. To use patient clearance: Note: The boom can also be rotated by pressing and holding the Targeting button on the endoscope. See Targeting on page If adjustment of the flex joint is desired, and instruments are installed on the system: 1.

Ensure that the instruments are not grasping tissue. Remove all instruments. With one hand, support the arm and cannula while the flex joint is adjusted. With the other hand, press the port clutch button, and carefully move the flex joint closer to or further from the adjacent arm.

Port clutch Cannula Figure 9. If an inner arm needs to be stowed, perform Step 4 below before docking. Drape the arm to stow when draping all other arms, see Chapter 6. Dock the arms to be used for the procedure, see section 9.

Once the arms that will be used are docked, collapse the stow arm onto itself using the instrument clutch button. Use the port clutch button to fully rotate and move the arm up and away from the surgical field. Dual docking can be used in procedures requiring a surgical workspace larger than two quadrants for example, if the initial endoscope port can not be placed cm from the target anatomy, and two targets are necessary , and when working beyond the level of the ports does not provide enough instrument reach.

If it is determined that dual docking is needed after initial port placement, skip to step 6. Identify the surgical workspace. If larger than two quadrants, or if the initial endoscope port cannot be placed cm from the target anatomy, split the surgical workspace in half. Identify a target anatomy in each half. Place the initial endoscope port at equal distance between the two target anatomies approximately cm from each target. The lateral port not docked to an arm can be used as an assistant port.

This may affect how the surgical workspace is divided and what target anatomies are identified. Using the guidelines for targeting and docking, set up the system for the first target anatomy see Targeting, on page , and Docking and Arm Alignment after Targeting, on page This allows the most access to the patient.

When ready to dual dock for example, access the second target anatomy or additional workspace , remove all instruments and undock all arms. Position the boom to reach the target anatomy. Rotate the boom towards the column, this avoids a range of motion limit. Dock the initial endoscope port and perform targeting and docking following the Dual Docking guidelines see page Place remaining ports in a line between the two target anatomies.

First surgical workspace Figure 9. Instrument housing B. Each instrument is used to perform a specific surgical task such as grasping, suturing, or tissue manipulation. Flush ports D. Discs G. Tip F. Wrist H. Grip release socket E. Shaft I. Maximum use indicator Figure 9. Pressing the release buttons once an instrument is installed can lead to unintended consequences such as disengagement of the instrument from the arm. System compatibility with non-approved instrumentation cannot be guaranteed.

The warranty does not cover damage to the da Vinci Xi System that occurs as a result of using non-approved instruments and accessories.

Plug and Play Newly released instruments may need to download their new parameters to the da Vinci Xi System. This process is only required once for each new type of instrument, and can take up to 15 seconds.

During this download period, the arm LED pulses blue and a message displays. If an error occurs during plug and play, re-install the instrument. Refer to the Reprocessing Instructions User Manual for cleaning and sterilization instructions. Inspect the instruments for broken, cracked, chipped, or worn parts.

Do not use an instrument if it is damaged. Straighten the instrument wrist and close the jaws to ensure easy insertion into the cannula and prevent damage to the instrument. Insert the instrument tip into the cannula and press the instrument housing into the sterile adapter. Audible completion beeps signal that the instrument is engaged. Move the endoscope to visualize the instrument and use appropriate caution when inserting instruments into the patient.

This visual check prevents inadvertent harm to the patient. The first instrument installed on each arm during a procedure must be manually inserted.

Use the instrument clutch button to manually insert the instrument. The Surgeon Console operator cannot control the instrument until the tip is moved out of the cannula.

The LEDs blink blue when the button is clutched. The Surgeon Console operator cannot control the instrument until it is moved out of the cannula and is no longer clutched. Note that if the clutch button is pressed and released instead of holding it down continuously while inserting the instrument , the clutch button must be pressed and released again after insertion through the cannula, to give control of the instrument to the surgeon.

The system also displays a message to advance the instrument or endoscope to return to the previous location.

Guided Tool Change helps guide the instrument tip to a location just short of the last position of the previously installed instrument or endoscope tip. The system also displays an icon and message instructing the user to insert the instrument past the cannula tip and advance.

To install an instrument using the Guided Tool Change feature: 1. Straighten the instrument wrist and close the jaws. Insert the instrument tip into the cannula and Press the instrument housing into the sterile adapter. Wait for the blinking green LED near the sterile adapter. Gently slide the instrument into the surgical field by pressing on the housing until there is resistance and the LEDs turn blue.

The instrument is now ready for surgeon control. Best practice is to observe the instrument tip coming into view on the patient-side monitor. Note: If Guided Tool Change is disabled or does not initiate, use the arm clutch button to insert the instrument manually, as described in Manually Insert an Instrument on page Anatomical restrictions may require alternate adjustments or Dual Docking see page To ensure maximum reach and minimum arm-to-arm interference, set up the arms in parallel using the flex joints and lower the patient clearance joints, if space is available to do so.

Note that although the arm containing the endoscope is not controlled by a hand, it will need to be reassigned, as no more than two arms can be assigned to any one hand control. For additional information and suggested steps for working behind ports, see Increase Instrument Reach on page Identify the interference for example, on the front end or back end of the arm.

Back end Figure 9. This allows the arms to work in parallel, minimizing interference. This increases the space between the joints and minimizes interference. Interference No interference Figure 9. Identify where reach is needed for example, in line with or beyond the level of the ports.

As you work away from this boundary, consider moving the flex joints back towards the center of the total surgical workspace. Arms nominal, 2. Arms reaching ports no flex adjustment , 3. Arms reaching ports with flex adjustment 3. This may be done by the surgeon using the hand controls, or by the patient side assistant using the port clutch button. Re-associate the hand controls. CAUTION: Removing instruments during a procedure should be performed very carefully and only when the Surgeon Console operator is informed of the removal and has the instrument in full view.

Do not remove the instrument if it is not in view. Prior to removing the instrument, the Surgeon Console operator should: 1. Ensure the instrument is free and clear of any patient anatomy. Straighten the instrument wrist. Clearly communicate to the Patient Cart operator which instrument to remove. Identify the name of the instrument or the number of the arm 1, 2, 3, 4.

To remove the instrument: 1. Ensure the instrument is positioned for removal. Squeeze the instrument release buttons and slide the instrument up and out through the cannula. Note: The Patient Cart automatically retracts the instrument carriage when the instrument is disconnected. If the instrument is not removed in time, the sterile adapter may re-engage the instrument during the retraction. If the instrument re-engages, repeat the instrument removal steps.

Note: To avoid damage to the arm drapes, use care not to scrape instruments against patient cart arms during instrument removal. If needed, clutch the arm to adjust its angle such that the instrument or endoscope clears the sterility barrier upon removal.

Non-sterile area behind color band Example of breached sterility barrier Sterile area Figure 9. Failure to observe this warning may result in unintended instrument motion or damage to the grip release mechanism.

WARNING: In case of system failure while the instrument is grasping tissue, the grip jaws can be opened manually by inserting the grip release wrench following the Grip Release instructions. Use visualization of the surgical site when inserting the grip release wrench, opening jaws, clearing tissue from jaws, and removing instruments from the system.

WARNING: Rotating the grip release wrench in the incorrect direction can cause unintended instrument motion or damage to the grip release mechanism. Note: Whenever possible, use robotic, Surgeon Console control to release the instrument grips. The grip release mechanism facilitates removal of an instrument in the event of a system fault, or when Surgeon Console control of the instrument is not practical.

If the instrument tips are holding tissue, the grip release wrench contained on the Instrument Release Kit PN , Figure 9. Surgeon and OR staff should always know where the sterile-wrapped Instrument Release Kit is located in case it is needed to manually release an instrument. Locate the Instrument Release Kit. Press the Emergency Stop button on the right-side of the Surgeon Console. Insert the straight, long end of the wrench into the grip release socket on the instrument housing. Push to be sure the wrench engages with the socket.

Once engaged, a slight resistance will be felt when gently rotating the wrench. Support the instrument carriage to prevent accidental advancement of the instrument. Under endoscopic or direct vision, verify the grips are not grasping tissue. Once the tissue is released from the grips, remove the wrench from the instrument. Squeeze the release buttons on the sides of the instrument housing and remove the instrument.

Recover the fault on the touchscreen or touchpad, or restart the system as necessary. Do not reuse the instrument. Re-using an instrument after use of the Instrument Release Kit could result in critical failure of the instrument and injury to the patient. This feature ensures reliable and consistent performance throughout the EndoWrist instrument life. The system decrements one use from an instrument the first time it is installed and taken into following mode during a procedure.

Once an installed instrument is controlled from the Surgeon Console, the system counts down one use for that instrument. If an installed instrument does not become surgeon controlled, it may be removed without reducing the number of uses remaining.

A maximum use indicator on the instrument housing changes color when the instrument has reached its maximum uses.

Maximum use indicator: Instrument is expired Figure 9. Note: When an instrument use is based on activations, it usually has a relatively large number of activations compared to instruments that have uses based on the number of procedures.

For these instruments, the system decrements one use from the instrument each time it is installed on the system and goes into following mode. Additionally, each instrument has an indicator on the housing that changes to red when the instrument has reached its maximum uses.

Expiration and Disposal When instruments expire, they are automatically inactivated and can no longer be used. Expired instruments must be properly disposed of following all applicable national and local laws and guidelines. As with any laparoscopic instrument, these positions can allow blood or other fluids to migrate through the instrument shaft towards its proximal end.

The EndoWrist instruments are designed to resist fluid migration of this nature and minimize fluid leakage from the proximal end. However, in the event that blood or other fluid is noticed leaking out of the instrument and onto the arm drapes or sterile adapter during the surgery, take following actions: 1. Remove the instrument from the arm and hold it vertically tip down to drain any fluids. Thoroughly wipe any fluid off the sterile adapter and drape before inserting any other instrument.

On the Vision Cart touchscreen, touch the Settings tab. The Uses Remaining summary appears. After surgery, thoroughly clean the instrument following the cleaning instructions in the Reprocessing Instructions User Manual before reuse.

In addition, if any blood or other fluid is observed on the inside of the drapes on the Patient Cart arm , contact Intuitive Surgical Customer Service as soon as possible and before any future use. Intuitive Surgical personnel will provide guidance in adequately cleaning the arm. The Patient Cart is stowed when the structure is in its most compact state. For more information, see Chapter 6. Stow: If the sterile adapters are not installed, the Patient Cart automatically provides the option of the stow position.

Stow the Patient Cart for transporting through the hospital or within the operating room OR and for storage when not in use. After all drapes have been removed, press and hold Stow on the Patient Cart touchpad. The LED on the boom pulses. The Patient Cart automatically retracts until the vertical column and boom are both extended less than 12 inches from their most compact state.

The stow feature achieves a compact stow position, however the user may still need to use the port clutch buttons to get the system compact enough to fit comfortably through a doorway. This sterile stow position compacts the patient Cart with the drapes installed in order to minimize potential contact and contamination of the patient-side assistant with the sterile draped system while preparing the patient. Note: Ensure that the column drape is installed before stowing the system for surgery, as stowing without this drape installed can compromise sterility.

The Patient Cart moves into the sterile stow position: the boom moves to a sterile stow position where the arms are folded out of the way; with enough space away from the column to ensure that sterility is not breached.

Release the button when audible beeps indicate Sterile Stow is complete. The instrument tips, as seen in the 3D viewer, appear aligned with the surgeon’s hands at the controls.

If instrument motion appears to be non-intuitive, contact Intuitive Surgical Customer Service immediately. For more information on use of the hand controls, see Match Grips page , Finger Clutch page , and the Surgical Controls section starting on page Icons and text messages are overlaid on the video to provide extended information to the surgeon.

Changes to view settings take place globally in dual console mode. TilePro viewing options for the Vision Cart touchscreen can be independently controlled by the OR staff. Touchpad The touchpad is the main control interface of the Surgeon Console.

Figure The Emergency Stop button ceases robotic control of the instruments and endoscope. The instruments and endoscope stay in their last commanded position.

If the instrument grips are closed when the Emergency Stop button is pressed, the grips remain closed. However, the gripping force may decrease.

Pressing the Emergency Stop button initiates a recoverable fault, which can be overridden by pressing Recover on the touchscreen or touchpad. The Emergency Stop button illuminates when pressed and remains illuminated until the fault is recovered. Secondary yellow foot pedals endoscope control Primary blue foot pedals Swap Foot sensors Figure Rear Panels The Surgeon Console rear panels provide various connections as shown. Ergonomic Setup To adjust the Surgeon Console ergonomics at any time, perform the following steps: 1.

This ensures easy movement of the legs to activate the foot pedals. Tilting up allows for a more comfortable neck angle.

 
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