da Vinci Surgical System

What is more fascinating than the constant interplay of art and science that was the life and work of Leonardo da Vinci? His paintings, of course, together with Michelangelo's, represent the fullest flowering of the Italian Renaissance. But it is his notebooks that have always been most fascinating to me. His designs for flying machines which would have worked had he access to modern materials and construction techniques. His day dreams, his flights of fancy. His obsessions.

Intuitive Surgical Inc., a revolutionary medical instrument company located in Sunnyvale, California, has chosen to name their flagship product after the world's greatest scientist-artist. The da Vinci Surgical System^TM is the first totally "intuitive" laparoscopic surgical robot in the world.

It was designed to provide the flexibility of open surgery while operating through tiny incisions or "ports". The benefits of such an approach should be obvious:

• Reduced trauma to the body
• Less anesthesia
• Often less blood-loss and need for transfusions
• Less post-operative pain and discomfort
• Less risk of infection
• Shorter hospital stay
• Faster recovery and return to work
• Less scarring and improved cosmesis.

The system consists of a Surgeon Console, the Patient-side Cart, and a full range of EndoWrist^TM Instruments.

The surgeon operates while seated at the console and viewing a 3-D image of the surgical field which is controlled by foot pedals. The surgeon's fingers grasp the master controls, which replicate surgery motions and are oriented below the display, with mechanical wrists naturally positioned relative to his or her eyes. The technology translates the surgeon's movements into precise real-time movements of the surgical instruments inside the patient. Thus, if the surgeon twists the control clockwise, the robot's instruments twist clockwise, unlike the "counter-intuitive" processes of standard laparoscopic systems, which are like operating while looking in a mirror. The system is so sensitive it is able to filter out a surgeon's hand tremors. The da Vinci software makes long-distance "remote control" surgery possible.

"It's almost like the movie Fantastic Voyage," says Mani Menon, M.D, Director of the Vattikuti Urology Institute in Detroit Michigan. "It's as if you are diving into the patient and you have these very tiny and precise instruments that allow you to manipulate tissue with great precision."

The dual-lens 3-chip digital InSite^TM Vision System immerses the surgeon in a true-to-life three-dimensional image providing extraordinary depth perception. The field of view is easily changed, moved, zoomed, or rotated.

The patient-side cart contains two robotic arms and the endoscope arm which execute the surgeon's commands. The laparoscopic arms pivot at the one centimeter operating port, and thus eliminate the use of the patient's body wall for leverage during the operation. This in turn further minimizes tissue and nerve damage. Surgical team members install the correct instruments, prepare the 1 cm port in the patient, and supervise the arms and tools being used.

The EndoWrist^TM Instruments utilize seven degrees of motion that mimic the dexterity of the human wrist. Each of the attached instruments has a specific surgical function—clamping, suturing, and tissue manipulation. They are provided with quick-release levers that speed instrument changes during the operation.

The system was originally developed through a Pentagon initiative, exploring ways for military surgeons to operate at a distance from the battlefield, by the Stanford University Research Institute, a nonprofit R & D center created by Stanford University. It costs about one million dollars and was first utilized in an experimental remote-control heart bypass in September 1999. Since then it has been approved by the Food and Drug Administration for use in general laparoscopic surgery, thoracoscopic (chest) surgery, and laparoscopic radical prostatectomies (prostate removal). Cardiac clinical trials are presently being conducted in formitral valve repair, atrial septal defect repair, and totally endoscopic coronary artery bypass graft surgery.

In the future vascular, orthopedic, spinal, and neurological surgeons will be able to offer their patients the option of minimally invasive surgery for the first time.

Presently there are more than 89 da Vinci Surgical Systems in major hospitals throughout the United States, Europe, and Japan. Routine procedures are performed quicker and easier. Difficult rarely-performed operations heretofore unavailable except at the hands of highly skilled (and expensive) surgeons will be performed more often. And new procedures that have never been done in a minimally invasive manner will become commonplace.

Imagine, all you caffeine-drenched, non-exercising, highly-stressed, poorly-fed techies: a quintuple bypass through a one centimeter hole in your chest, with minimal recovery and no scar. That beats Star Wars and The Matrix in a real-world gee-whiz contest any day.

The whole idea is worthy of the greatest artist-scientist who ever lived.

The da Vinci Surgical System^TM
Intuitive Surgical, Inc.
950 Kifer Road
Sunnyvale, CA 94086
Phone: (408) 523-2100
Fax: 9408) 523-1390
ir@intusurg.com