DRAFT/PRE-RELEASE/CONFIDENTIAL User Manual PN 550650-09 Rev. A 2014.
Copyrights © 2014 Intuitive Surgical, Inc. All rights reserved. Portions of this software provided by QNX Software (www.qnx.com). © 2014 QNX Software. All rights reserved. Portions of this software provided by The FreeType Project (www.freetype.org). © 2014 The FreeType Project. All rights reserved.
iii Terms and Conditions of End User Software License Agreement 2 RESTRICTIONS. (a) Buyer shall not (i) use, copy, translate, modify, create derivative works of, or transfer, (ii) merge with any other product, (iii) sublicense, lease, rent, loan, or otherwise transfer, (iv) reverse engineer, decompile, disassemble, attempt to derive the source code for, or otherwise manipulate, or (v) disclose, permit to be disclosed or publicly display or perform, the Software, in whole or in part, or any copy thereof.
iv Contents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1 •1.2 General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 • Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 • Compliance and Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
v •2.4 Patient Cart Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-8 • Setup Joints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9 • Instrument Arms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9 • Camera Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
vi 5 Startup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 •5.1 Stand-Alone Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1 •5.2 Powering On the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 • Addressing Anomalous Power Behavior. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2 •5.
•7.6 Troubleshooting Image Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-20 • Missing Image (One or Both Eyes) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-20 • Image Poor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-20 • Flickering Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
viii 10 Surgeon Console Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1 •10.1 Surgeon Console Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-1 • Master Controllers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2 • Stereo Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
•10.5 Dual Console Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-39 • Dual Console Connection and Startup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-39 • Comparison Between Consoles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-39 • Instrument Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
x C Appendix C: Illuminator Information. . . . . . . . . . . . . . . . . . . . . C-1 •C.1 General Safety Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-1 •C.2 Illuminator Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-2 •C.3 Basic Troubleshooting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-5 •C.4 Fuse Replacement. . . . . . .
xi •E.10 Wireless Connectivity Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-9 • Wireless Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-9 • Wireless Network Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E-9 • Wireless Coexistence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
xii I Appendix I: Natural Rubber Latex . . . . . . . . . . . . . . . . . . . . . . . . I-1 J Appendix J: Glossary of Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . .J-1 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction 1 Introduction This da Vinci Si Surgical System User Manual provides information specific to the use of the da Vinci Si Surgical System, also known as the Endoscopic Instrument Control System, Model IS3000, including the da Vinci Si-e Surgical System. The operating instructions and feature descriptions herein are specific to the software version listed on page ii.
1-2 Introduction • Chapter 12 Cleaning and Maintenance: Gives instructions to clean and maintain the system, instruments and accessories, and to change the Illuminator lamp module. Each appendix contains reference material as indicated by its title. Note that Appendix B: da Vinci Si-e Surgical System, Appendix D: VisionBoom™ Use Instructions and Appendix E: OnSite™ for da Vinci® Surgical System are applicable only if your system is configured with the required hardware and/or software.
Introduction Intuitive Surgical Sàrl 1, chemin des Mûriers, 1170 Aubonne Switzerland Compliance and Classifications The Intuitive Surgical da Vinci Si Endoscopic Instrument Control System, Model IS3000, is in conformance with the Medical Device Directive, 93/42/EEC. The da Vinci Si System is designed to be in compliance with IEC 60601-1, with the following mode of operation, and type and degree of protection against electric shock.
1-4 Introduction System Labels Note: The unit identification label includes the serial number, electrical ratings, and date of manufacture. It may be necessary for the reader to be as close as 6 in (15 cm) from the label to read this information. Model IS3000 system components have individual system labels as shown below, all of which repeat the same information except to specify the model (at upper right) and power requirements (at lower right).
Figure 1.2 System Labels: IEC 3rd Edition Power Requirements 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Introduction The da Vinci Si System has three main components requiring electrical power: the Surgeon Console, the Patient Cart, and the Vision Cart. To ensure optimum performance, make sure each component of the da Vinci Si System is connected to a dedicated, noise-free and well-grounded AC power outlet.
1-6 Introduction The integrated power strip in the Vision Cart also has the label below: 100/120/230V~ 50/60 Hz 150 VA Continuous” Figure 1.4 Vision Cart integrated power strip caution label A label wrapped around the Vision Cart power cord also reinforces this point: Caution: Vision Cart requires dedicated circuit. Do not connect auxiliary equipment to the circuit powering the Vision Cart. Figure 1.
Introduction Environmental Specifications Environmental Conditions: Operating 10 to 30 °C (50 to 86 °F) Humidity: 10 to 85% non-condensing The IS3000 shall function properly in atmospheric pressures ranging from 523 mm HG (10,000 ft) to 774 mm HG (-500 ft). For every 1000 feet above sea level, the 30 °C operational temperature Atmospheric Pressure – System: limit specified above will be reduced by 1 °C.
1-8 Introduction pediatric use (except for transoral otolaryngology surgical procedures). It is intended to be used by trained physicians in an operating room environment in accordance with the representative, specific procedures set forth in the Professional Instructions for Use.
CAUTION: The clinical evaluation of the da Vinci Si Surgical System supporting its use for mitral valve repair was not performed totally endoscopically. Introduction and manipulation of the endoscopic instruments were controlled by the da Vinci Si Surgical System through port incisions (< 1 cm) while accessory technologies, e.g., atrial retractor and cardioplegia line, etc., were introduced through a mini-thoracotomy.
1-10 Introduction CAUTION: Although the da Vinci Si System is safe and reliable, anatomical characteristics of a patient may preclude using minimally invasive techniques. Environmental or equipment failures may cause the da Vinci Si 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.
Introduction CAUTION: The Intuitive Surgical monopolar electrosurgical instruments are designed for use with a maximum peak voltage of 3kV (6kV peak-to-peak). Do not use settings on the ESU that exceed a 3kV peak. Do not attempt to use the footswitch on the Surgeon Console with ESUs that are not compatible with the da Vinci Si System. Consult with your Intuitive Surgical representative regarding compatible models.
1-12 Introduction Installation and Service Precautions WARNING: No modification of this equipment is allowed. WARNING: To avoid risk of electric shock, this equipment must only be connected to a supply mains with protective earth. Building Vibrations It is possible for ambient vibrations in the building to be transmitted through the operating room floor to the instrument tips.
Introduction Note: Use extreme care when moving or positioning the Patient Cart to ensure the arms do not hit any objects. If an arm hits an object while the Patient Cart is being moved or positioned, contact Intuitive Surgical Technical Support to have the Patient Cart inspected for damage. CAUTION: The Surgeon Console and Patient Cart are heavy and may present a hazard if control is lost when moving. Only trained personnel should attempt to move the da Vinci Si System.
1-14 Introduction CAUTION: Leakage currents from other endoscopic instruments may be additive. To ensure maximum safety for the patient, only Type CF endoscopic accessories should be used with the da Vinci Si System. Where required by national laws or local regulations, equipotential bonding of equipment may be accomplished by connecting an potential equalization conductor to the equipotential terminals located near the mains inlet on each sub assembly of the system.
Introduction In the event of suspected interference from other equipment, which prevents the proper functioning of the da Vinci Surgical System, contact Intuitive Surgical and/or discontinue use of the system until the problem can be remedied. FCC Compliance Note: This equipment has been tested and found to comply with the limits for a Class A digital device, pursuant to Part 15 of the FCC Rules.
1-16 Introduction EMC Tables The following tables contain the Manufacturer’s declaration and additional information required by IEC60601-1-2. The IS3000 is intended for use in the electromagnetic environment specified below. The customer or the user of the IS3000 should assure that it is used in such an environment.
Introduction Table 2: Manufacturer’s Declaration – Electromagnetic Immunity The IS3000 is intended for use in the electromagnetic environment specified below. The customer or the user of the IS3000 should assure that it is used in such an environment.
1-18 Introduction Table 3: Manufacturer’s Declaration – Electromagnetic Immunity The IS3000 is intended for use in the electromagnetic environment specified below. The customer or the user of the IS3000 should assure that it is used in such an environment. IEC 60601 test level Compliance level 3 Vrms 150 kHz 3 Vrms to 80 MHz 3V/m 3 V/m 80 MHz to 2.
Introduction The IS3000 is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled. The customer or the user of the IS3000 can help prevent electromagnetic interferences by maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the IS3000 as recommended below, according to the maximum output power of the communications equipment.
2-1 System Overview System Overview The da Vinci Si Surgical System is a sophisticated robotic platform designed to enable complex surgery using a minimally invasive approach. The da Vinci Si System consists of three main components, shown in Figure 2.1 below, from left to right: the Surgeon Console, the Patient Cart and the Vision Cart. Patient Cart Surgeon Console Vision Cart Figure 2.
System Overview 2.1 The da Vinci Si System Main Components The Surgeon Console (Figure 2.2) is the control center for the da Vinci Si System. The surgeon sits outside the sterile field at the Surgeon Console, using eyes, hands and feet to control a 3D endoscope and EndoWrist® instruments, by means of two master controllers and foot pedals. Figure 2.
2-3 System Overview Patient Cart Figure 2.3 Patient Cart The da Vinci Si System uses remote center technology. The remote center is a fixed point in space around which the Patient Cart arms move. Remote center technology enables the System to maneuver instruments and endoscopes in the surgical site while exerting minimal force on the patient's body wall. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The Patient Cart (Figure 2.
System Overview EndoWrist instruments are multi-use instruments available in 12 mm, 8 mm, and 5 mm diameters. For a complete listing of EndoWrist instruments, please refer to the current Instrument and Accessory Catalog (PN 871145). Vision Cart The Vision Cart (Figure 2.5) houses the system's central processing and vision equipment. It includes a 24” touchscreen monitor and provides adjustable shelves for optional ancillary surgical equipment such as ESUs and insufflators.
2-5 System Overview Table 2-1 da Vinci Si vs. Si-e Comparison Available Feature OnSite™ remote service 3DHD Vision System 2-way audio system VisionBoom™ Dual console TilePro™ multi-image display video input Telestration Vision Cart interactive touchscreen Configurable video outputs yes yes yes yes yes yes yes yes yes yes da Vinci Si-e yes yes yes yes yes no no no no no 2.
System Overview Figure 2.6 Master controllers Stereo Viewer The stereo viewer (Figure 2.7) provides the video image for the Surgeon Console operator. The ergonomically designed view port provides head and neck support for added comfort during extended procedures. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL and endoscope inside the patient by moving the hands and/or arms.
2-7 System Overview Touchpad Figure 2.8 Touchpad Left-Side Pod and Right-Side Pod The left-side and right-side pods (Figure 2.9) are located on either side of the Surgeon Console armrest. The left-side pod provides ergonomic controls while the right-side pod is the location for the Power button and Emergency Stop button. (See Ergonomic Setup on page 10-10 and 5.2 Powering On the System on page 5-2 for details.) 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The touchpad (Figure 2.
System Overview Footswitch Panel Figure 2.10 Footswitch panel 2.4 Patient Cart Overview This section provides overviews for the following Patient Cart components: • Setup Joints, page 2-9 • Instrument Arms, page 2-9 • Camera Arm, page 2-10 • Motor Drive, page 2-11 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The footswitch panel (Figure 2.10) is located on the floor directly beneath the Surgeon Console operator and provides the interface for various surgical activities.
2-9 System Overview Setup Joints Setup Joint Telescoping Axis Vertical range of motion Figure 2.11 setup joint Instrument Arms 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Setup joints (Figure 2.11) are used to position the Patient Cart arms in order to establish the remote center in the surgical field. Setup joints are designed with limited freedom of movement to facilitate port placement. (See 9.2 Moving the Patient Cart Arms on page 9-3 for details.) Instrument arms (Figure 2.
System Overview The instrument arm remote center is indicated by the thick, center black band on the instrument cannula. When the Patient Cart is docked to a cannula inserted in the patient, the instrument arm remote center should be in the patient’s body wall. This remote center location minimizes both port-site trauma and stress exerted on the EndoWrist instruments during surgery. The Surgeon Console operator cannot move the instrument arm remote center.
2-11 System Overview Motor Drive Figure 2.15 Motor drive steering column 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The da Vinci Si Patient Cart has a motorized drive (Figure 2.15), which is designed to provide faster and easier docking and OR re-configuration. The motor drive interface includes a steering column, throttle, throttle-enable switch and shift switches. (See Motor Drive Operation on page 3-3 for details.) 2.
System Overview Core The da Vinci Si Core is the system’s central connection point where all system, auxiliary equipment, and AV connections are routed. (See Chapter 4 System Connections for details.) If installed, the following information is applicable. The ICB is a hardware upgrade installed by an Intuitive Surgical field engineer on the lower shelf of the Vision Cart. It powers certain functions of advanced EndoWrist instruments such as the Vessel Sealer.
2-13 System Overview 386 mm 65 mm 12 mm 554 mm Figure 2.17 da Vinci Si HD 12 mm endoscopes, with dimensions 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL video image of the surgical site captured by the endoscope is sent back through the left and right channels to the camera head. The camera head connects to the Camera Control Unit (CCU), as well as the Illuminator. (See 7.2 Setting Up the Vision System on page 7-5 for details.) 297 mm 65 mm 8.5 mm 464 mm Figure 2.18 da Vinci Si HD 8.
System Overview Endoscope Information Intuitive Surgical endoscopes (see list below) are made by Schoelly Fiberoptic and distributed by Intuitive Surgical. Schoelly Fiberoptic GmbH Robert-Koch-Str. 1-3 79211 Denzlingen GERMANY Distributed by: Intuitive Surgical 1266 Kifer Road, Sunnyvale, California 94086 • USA Intuitive Surgical Sàrl 1, chemin des Mûriers, 1170 Aubonne Switzerland Customer Service from USA 1.800.876.1310 Customer Service from Europe +800.0821.2020 Manufactured in Germany. Endoscopes • 8.
2-15 System Overview The HD stereo camera head is designed with a 60-degree field-of-view (FOV). When combined with an Intuitive Surgical stereo endoscope, the vision system provides 6-10x magnification of what is seen during open surgery (without loupes). (See 7.2 Setting Up the Vision System on page 7-5 for details.
System Overview Touchscreen Figure 2.21 Assistant operating touchscreen Tank Holders The Vision Cart supports use of an insufflator with two tank holders on one side (Figure 2.22). To accommodate various size tanks, the tank holders have adjustable straps above and the lower bracket slides in and out after you loosen one screw on each side with a screwdriver. The tank holders can support two tanks, each weighing up to 50 lbs. (22.32 kg).
3-1 OR Configuration 3 OR Configuration • 3.1 Surgeon Console Positioning, page 3-1 • 3.2 Patient Cart Positioning, page 3-2 • 3.3 Vision Cart Positioning, page 3-6 3.1 Surgeon Console Positioning The Surgeon Console is placed outside of the sterile field. Use the handles on either side of the Surgeon Console (Figure 3.3) for moving or positioning. Labels say “PUSH” near the handles for pushing on both sides. Figure 3.
OR Configuration Handles Brakes Handles Figure 3.3 Surgeon Console handles and brakes 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL • When possible, orient the Surgeon Console so the Surgeon Console operator will have a view of the operative field and a clear line of communication with the Patient Cart operator. Brake applied • Brakes (indicated by “BRAKE” label) are located on each side of the base on the Surgeon Console (Figure 3.3). The Surgeon Console should be locked once it is positioned for surgery.
3-3 OR Configuration • The Patient Cart brakes are designed to automatically engage when the motor drive is not in use, if the cart is not in neutral. When in neutral, the brakes do not engage automatically until a cannula is installed. CAUTION: Always use caution when moving large equipment.
OR Configuration Figure 3.5 Label on top of motor drive tiller 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The top of the motor drive tiller has the label below (Figure 3.5). This label explains and shows the N=Neutral and D=Drive positions for the motor drive shift switches. It includes the text, “IF NO CART POWER, USE NEUTRAL TO MOVE CART”. Figure 3.6 Patient Cart power panel To operate the motor drive: 1. First, make sure the Patient Cart is powered on. See 5.2 Powering On the System on page 5-2. See 5.
3-5 OR Configuration Figure 3.7 Label: How to drive the Patient Cart • The Cart Power button flashes green when the throttle enable switch is activated. • Control the drive speed by how far you rotate the throttle. 4. To stop motorized movement, release the throttle enable switch. WARNING: For patient safety, both shift switches must be kept in the drive (D) position so that the motor drive remains engaged during surgery (see Figure 3.8).
Drive motor engaged (D) Drive motor disengaged (N) Figure 3.8 Patient Cart motor drive shift switches 3.3 Vision Cart Positioning Figure 3.9 Tip hazard label on rear door of Vision Cart 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL OR Configuration CAUTION: Tip hazard during transport. Stow touchscreen and close rear door before moving cart. The Vision Cart is placed adjacent to the Patient Cart, just outside of the sterile field. Room is provided on the Vision Cart shelves to place ancillary equipment (e.
3-7 OR Configuration • Wheel locks are located on all wheels of the Vision Cart (Figure 3.10). These should be locked after the cart is positioned for surgery. Unlocked Figure 3.
System Connections 4 System Connections This chapter explains how to connect the individual da Vinci Si System components, including: • 4.2 System Cable Connections, page 4-3 • 4.3 Camera Head Cable Connections, page 4-6 • 4.4 Auxiliary Device Connections, page 4-9 • 4.5 Video and Audio Connections, page 4-11 System cable Vision Cart Core Connections 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL • 4.1 Power Connections, page 4-2 Connecting Surgeon Console End cap on system cable Figure 4.
4-2 System Connections 4.1 Power Connections Table 4-1 System Power Cords and Power Requirements System Component Cord Length Power Requirement Standby Power Draw 15 ft/4.6 meters 1000VA Continuous 8.4A at 115V~ 4.2A at 230V~ 1000VA Continuous 8.4A at 115V~ 4.2A at 230V~ 1500VA Continuous 12A at 115V~ 6A at 230V~ 95VA 0.8A at 115V~ 0.4A at 230V~ 75VA 0.6A at 115V~ 0.3A at 230V~ 145VA 1.1A at 115V~ 0.55A at 230V~ Surgeon Console 15 ft/4.6 meters Patient Cart 15 ft/4.
System Connections 4.2 System Cable Connections End cap on system cable Uncapped end of cable Figure 4.2 System cables The system cables: • Are identical and can connect to either the Surgeon Console or Patient Cart 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The da Vinci Si System cables (see Figure 4.2) are 20 m (65.6 ft) in length and should be kept attached to the Vision Cart.
4-4 System Connections System Cable Layout 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The cables should be arranged so that they are out of the path of OR traffic, including other equipment, to avoid damaging the cables or creating an obstacle or hazard. The location of the cables should also facilitate easy movement of the Patient Cart between its preoperative (draping) and intraoperative locations. Figure 4.
System Connections How to Connect System Cables 2. Connect the system cables between the components as shown in Figure 4.3. To connect the cables, line up the red dot on the cable connector with the red dot on the matching receptacle, flip up the receptacle cover and insert the connector. You should hear an audible click when the cable engages properly. Gently pull on the connector to verify the cable is fully seated. Red alignment mark 2. Flip up receptacle cover & insert 3.
4-6 System Connections 4.3 Camera Head Cable Connections Note: Intuitive has shipped da Vinci Si Systems with two different kinds of camera head video cable, which can be readily distinguished by having either black ends or gray ends. This section addresses use of both kinds of cable. The cables and their connectors on the camera head and CCU are not cross-compatible, that is, a cable with black ends will not work with a system designed to work with a cable that has gray ends.
System Connections 3. Once started properly, tighten (clockwise) the large metal nut around the inserted cable end. It is threaded so you can hand tighten the connector and secure it. For the cable with black ends, to ensure a good connection, tighten the nut until you can no longer see any part of the yellow ring around the base of the nut. Connecting the Light Guide Cable 4. Insert the light guide cable connector into its receptacle on the Illuminator as shown.
4-8 System Connections Installed S-hooks Figure 4.9 S-hooks to hold camera cables together Note: If you need additional S-hooks, you can acquire them from Intuitive Surgical and install them yourself. Contact Intuitive Surgical Customer Service. • Store the camera head in its custom cutout in the Vision Cart drawer below the CCU, and coil the camera cable pair loosely, and hang the excess cable on the hook on the side of the Vision Cart.
System Connections 4.4 Auxiliary Device Connections Note: If combinations of the installed energy instruments or connected ESUs make mapping of energy pedals ambiguous, the system will not map nor activate the pedals for that energy type. For instance, you cannot be in simultaneous energy control of two energized instruments of the same type (for example, bipolar and bipolar).
4-10 System Connections To connect an auxiliary device (for example, an ESU) to the system: Figure 4.13 Auxiliary device connection (back of ESU) 2. Plug the system end of the cable into any of the three Energy receptacles on the back of the Core (Figure 4.14). Align the red dot on the cable connector with the red dot to the right of the receptacle. You should hear an audible click when the cable engages properly. Gently pull on the cable connector to verify that the cable is fully seated.
System Connections Troubleshooting: EndoWrist Cautery not Responding to Footswitch 1. Check cable connections between the instrument and the generator. a. Check the patient return electrode (if necessary). c. Check cable connection between the generator and the da Vinci Si System to ensure proper cable orientation. 2. Power on the generator. 3. If the problem persists, power off the generator. a. Attach the generator to the manufacturer’s external footswitch. b. Power on the generator. 4.
System Connections Note: Connectors on the Core (and other components on the Vision Cart) labeled with gray text on a dull background, as those indicated by red boxes in Figure 4.15 above, are connected as necessary by authorized ISI personnel when they install and/or service the system. Therefore no instructions are provided for connecting them in this user manual, although the labels themselves are described in Appendix G: Symbols, Icons and Text Messages Reference. Do not unplug any of these connections.
System Connections Core Video Outputs The Core supports up to three video output bays (Figure 4.15). Video output from all three includes the icons and text messages displayed in the Surgeon Console. Each video output bay supports a single DVI, HD-SDI, S-Video, or Composite signal. Note: Video Out bays 1 and 2 are not available by default; they are made available in conjunction with optional upgrades, for example, with purchase of a second console to support dual console surgery.
5-1 Startup 5 Startup • 5.1 Stand-Alone Mode, page 5-1 • 5.2 Powering On the System, page 5-2 • 5.3 Startup Sequence, page 5-5 • 5.4 Preparing the Patient Cart for Draping, page 5-6 • 5.5 Stow Position, page 5-7 5.1 Stand-Alone Mode Vision Cart power button Patient Cart power button Surgeon Console power button Figure 5.1 System power buttons 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL This chapter explains how to power up the da Vinci Si System components.
Startup 1. To power on the Surgeon Console or Vision Cart in stand-alone mode, make sure the power cord is plugged in, and press the Power button (Figure 5.1). Note: Each of the Surgeon Console, Patient Cart and Vision Cart has a mains circuit breaker switch on its rear that must be in the on position (indicated by “I” near each switch) for that subsystem to power on.
5-3 Startup 2. Confirm that the mains circuit breaker switch on each of the Surgeon Console, Patient Cart and Vision Cart is correctly set to the on position (indicated by “I” near each switch). These switches are found on the rear of each component near the power cord inlet. Patient Cart Surgeon Console Vision Cart (at base) Figure 5.
Startup 2. Because the Patient Cart will operate on battery even if you switch off its mains circuit breaker, you must use the EPO (Emergency Power Off ) button—the large red button on the rear of the Patient Cart. The EPO button both disconnects the Patient Cart from AC power and exits the default standby or sleep mode. Press the EPO button once to remove all power; it will remain partially depressed.
5-5 Startup 3. Third Power button press powers on the component normally. 5.3 Startup Sequence During the startup sequence, a system integrity test is performed. As part of this test, the master controllers and all Patient Cart arms that are not stowed perform a self-test. The masters move to their start position and must arrive there for the system to work. If a master is impeded somehow, simply move it by hand to free it and it will move to its start position.
Startup 5.4 Preparing the Patient Cart for Draping Figure 5.4 Instrument arms extended for draping 1. To move instrument arm 3 from one side of the Patient Cart to the other, release the latch on the setup joint link (see Figure 5.5) closest to the Patient Cart tower. Release latch 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Prepare the Patient Cart arms for draping by moving each arm's insertion axis to a vertical position (90º).
5-7 Startup 5.5 Stow Position Note: Use extreme care when moving or positioning the Patient Cart to ensure the arms do not hit any objects. If an arm hits an object while the Patient Cart is being moved or positioned, contact Intuitive Surgical Technical Support to have the Patient Cart inspected for damage. To put instrument arm 1 or 2 in stow position: 1. Move the instrument arm close to the Patient Cart tower. 2.
Startup Arm 3 Figure 5.7 Instrument arm 3 in position to be stowed 4. Once instrument arm 3 is behind the Patient Cart tower (as shown in Figure 5.7), it can be stowed. Move the entire setup joint to the bottom of its vertical range of motion. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 3. Move the insertion axis to its fully collapsed and pitched back position, making sure the instrument arm tucks under the bottom-most link (as shown in Figure 5.7).
5-9 Startup You can take Instrument arm 3 out of stow-position at any time using its port clutch button to move the arm. As soon as you release the port clutch button in front of the Patient Cart tower, the arm is enabled and the insertion axis extends in preparation for draping.
Draping Draping Draping makes the Patient Cart arms sterile and suitable for surgery. This chapter will outline how to drape the column, instrument arms, the camera arm, the camera head, and, optionally, the touchscreen. It contains the following sections. • 6.1 Draping Guidelines, page 6-2 • 6.2 Column Covering Procedure, page 6-2 • 6.3 Instrument Arm Draping Procedure, page 6-6 • 6.4 Camera Arm Draping Procedure, page 6-12 • 6.5 Camera Head Draping Procedure, page 6-15 • 6.
6-2 Draping 6.1 Draping Guidelines • For speed, sterility and safety, draping should be done by a two-person team: a scrub nurse or surgical assistant and a circulating nurse who can handle non-sterile components. • First drape the column. You should then drape instrument arm 3 (if it will be used). • Using the clutch buttons, the circulating nurse should move each straightened arm to provide plenty of room to maneuver around the arm.
Draping Patient Cart column Figure 6.2 Patient Cart prepared for draping 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 1. Prepare the Patient Cart for draping by exposing the column as shown below. 2. Wrap a three-quarter drape around the Patient Cart column. Use the drape in landscape orientation ( ). Place the drape in the following areas: • Over the setup joint ledge for instrument arms 1, 2, and the camera arm. Setup joint ledge Figure 6.
6-4 Draping • Between instrument arm 3 setup joint and the Patient Cart column. This configuration allows for a mid-procedure third arm deployment if the arm is stowed. Instrument arm 3 (stowed) Figure 6.
Draping 3. Tighten and secure the drape behind the Patient Cart column. Roll the drape ends together to tighten Figure 6.5 Rolling the drape ends together • Secure with a towel clamp. Place the rolled drape (with towel clamp) on the opposite side of the instrument arm 3 setup joint Towel clamp Instrument arm 3 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL • Figure 6.
6-6 Draping 4. After moving any instrument or camera arm setup joint up or down, you should readjust the three-quarter drape. Always ensure the drape remains tight and secure above the setup joint ledge for instrument arms 1, 2, and the camera arm. Setup joint ledge Setup joint ledge (covered) Figure 6.7 Setup joint ledge | Completed Patient Cart with drape 6.3 Instrument Arm Draping Procedure 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 5.
Draping Figure 6.9 Lowering the drape over the insertion axis 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 3. Tent the opening of the drape and grip the outside with your finger and thumb. Hold the top of the drape with the other hand. Lower the drape over the instrument arm insertion axis.
6-8 Draping Press top to click into place Sterile adapter base fits here 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 4. Insert the base of the sterile adapter into the black molded piece into which it fits. Using both thumbs, push the sterile adapter into the instrument arm until it clicks into place (Figure 6.10). If sterile adapter does not engage, remove and re-seat the sterile adapter. Confirm proper engagement using the steps under Sterile Adapter Engagement Verification on page 6-11. Figure 6.
Draping Figure 6.11 Stretching the drape along the arm 7. Seat the cannula mount molding. Make sure the molding snaps over the cannula mount (Figure 6.12). 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 6. Using the cuff of the drape, move it back along the instrument arm toward the Patient Cart tower (Figure 6.11). Incorrect: Molding not over mount tabs on right Correct: Molding envelops mount tabs on both sides Figure 6.
6-10 Draping Straps Figure 6.13 Securing the drape with the drape straps 9. Bend the blue flex-strips to create a clear instrument insertion path along the axis of the instrument arm. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 8. Wrap all white drape straps snugly around the instrument arm, and attach each strap to itself (Figure 6.13). You may wish to confirm that the arm moves without tearing the drapes or straps. Figure 6.
Draping Sterile Adapter Engagement Verification After the Sterile Adapter is attached and the discs rotate back and forth, verify the position of the open notch on each disc. Open Notch Open Notch Location: Top Left disc – 7 o’clock Top right disc – 11 o’clock Bottom right disc – 3 o’clock Bottom left disc – 10 o’clock Clockwise from top left: “7, 11, 3, 10” The discs should be in this alignment after draping and before installation of an instrument.
6-12 Draping 6.4 Camera Arm Draping Procedure Note: Before draping the camera arm, make sure you install the correct endoscope cannula mount based on which endoscope cannula will be used during the procedure. Refer to the Instruments and Accessories User Manual for more information. Note: The blue band on the drape indicates the sterility barrier. If a non-sterile person is assisting in installation of the drape, he/she must not grasp the drape anywhere beyond the blue band.
Draping Figure 6.16 Lower over insertion axis, install sterile adapter 4. Now install the camera arm sterile adapter into the carriage on the camera arm. Using the side of one hand as shown above, make a trough in the drape through the carriage to create room for the endoscope to pass through. Then firmly push the camera arm sterile adapter into place (Figure 6.16). To check if it is properly seated, pull up on the camera arm sterile adapter, which should remain attached to the camera arm.
6-14 Draping 6. Use your hands inside the drape cuff to engage the opposing Velcro strips near the center column. Figure 6.18 Seating the cannula mount molding 8. Wrap the white drape straps snugly all the way around the camera arm and tape each strap’s end to itself. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 7. Seat the cannula mount molding. Make sure the molding snaps over the cannula mount (see Figure 6.18 below and Figure 6.12 on page 6-9). Straps Figure 6.
Draping Figure 6.20 Bend the blue flex-strips around the insertion axis 6.5 Camera Head Draping Procedure Note: Before draping the camera head, wipe the lenses to remove any debris or smudges. Since the Vision Cart and cables are not sterile, a non-sterile person (circulating nurse below) must assist a sterile person (scrub nurse below) with draping and connecting the camera head. (The camera head itself is not sterile and must not be autoclaved.) 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 9.
6-16 Draping 4. Scrub nurse: Invert the drape over the camera head. Figure 6.22 Invert drape over camera head, pull along cables 5. Circulating nurse: Pull the drape along the cables. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 3. Circulating nurse: Attach the camera head to the camera head sterile adapter. You must align the pins in the camera head with the channels in the sterile adapter, push down and turn until the camera head locks into place. You will hear a click once it locks into place.
Draping Figure 6.23 Unfold monitor drape and remove paper 3. Place one hand in the bottom opening of the drape and hold the top of the drape with the other hand. Lower the drape over the monitor with the label facing towards you. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 2. Scrub Nurse: Place the drape on a sterile table with the label facing up. Remove and discard the paper insert. Figure 6.
6-18 Draping Figure 6.25 Push drape back with cuff 5. Secure the tape around the arm and then tighten the drawstring around the base of the monitor arm, using the fastener to keep it secure (Figure 6.26). Tuck any extra drawstring inside the pouch located near the cuff of the drape (Figure 6.26). Pull 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 4. Use the cuff of the drape to move the drape all the way down to the base of the monitor arm. Tape Open Tuck Done Figure 6.
Draping Figure 6.27 Smoothing the drape on the monitor 7. Secure the Velcro straps on the sides and rear of the monitor. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 6. Align the drape window to the monitor. Press the drape so that it clings smoothly to the monitor surface. Figure 6.28 Secure Velcro straps on sides and rear When you finish draping, tuck the arms against the column and stow the Patient Cart for surgery.
7-1 Vision System Use 7 Vision System Use • 7.1 Vision System Overview, page 7-1 • 7.2 Setting Up the Vision System, page 7-5 • 7.3 Working with the Illuminator Controls, page 7-14 • 7.4 Working with the Touchscreen Vision Controls, page 7-15 • 7.5 Adjusting the Touchscreen Monitor, page 7-20 • 7.6 Troubleshooting Image Quality, page 7-20 7.
Vision System Use The Illuminator provides lighting for the surgical field. The Illuminator monitors the life left on the lamp module and notifies you when replacement is recommended. For replacement instructions, see Illuminator Lamp Module Replacement on page 12-2. For additional, general information and specifications regarding the Illuminator, see Appendix C: Illuminator Information. Endoscopes CAUTION: Do not autoclave the endoscope.
7-3 Vision System Use Endoscope Information Intuitive Surgical endoscopes (see list below) are made by Schoelly Fiberoptic and distributed by Intuitive Surgical. Schoelly Fiberoptic GmbH Robert-Koch-Str. 1-3 79211 Denzlingen GERMANY Distributed by: Intuitive Surgical 1266 Kifer Road, Sunnyvale, California 94086 • USA Intuitive Surgical Sàrl 1, chemin des Mûriers, 1170 Aubonne Switzerland Customer Service from USA 1.800.876.1310 Customer Service from Europe +800.0821.2020 Manufactured in Germany.
Vision System Use CAUTION: Handle the camera head carefully. Dropping the camera head may result in damage and loss of camera functionality. CAUTION: Handle the light guide cable carefully. If the cable is bent sharply or kinked, it can damage the fiber optic material enclosed in the light guide cable. Such damage can substantially reduce the amount of light transmitted through the light guide cable (Figure 7.4). Figure 7.
7-5 Vision System Use 7.2 Setting Up the Vision System CAUTION: Failure to adhere to approved operating practices may result in damage to the endoscope. Examples of improper practices include: dropping of equipment, collisions, and improper cleaning and sterilization techniques. A damaged endoscope may result in fragments falling into the patient.
