Vision System Use Install Endoscope on Camera Head Endoscope Orientation on the Camera Head and Calibration The endoscope has pins in its base that help you to align it easily with the corresponding channels on the camera head sterile adapter.
7-7 Vision System Use Follow these steps to install the scope: 1. Hold the endoscope and camera head with attached sterile adapter firmly in each hand – avoid dropping either part. 3. Push down the scope until it bottoms and turn until it locks into place. You will hear a click when the endoscope is locked into the sterile adapter. Icons on the endoscope base (shown at left) indicate the direction you must turn to lock or unlock the scope over the sterile adapter.
Vision System Use Lamp On/Off Focus In & Out Vision Setup Figure 7.6 Camera head buttons, shown draped on right Invoke Camera / Scope Setup and Navigate Press and hold 1 s to open menu 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Figure 7.6 shows the camera head buttons. As long as no instruments are in following mode, you can open the Camera / Scope Setup menu on the touchscreen by pressing and holding for 1 second the Vision Setup button on the camera head. When you do, the following menu appears.
7-9 Vision System Use Figure 7.8 Auto-calibration in progress (appears in stereo viewer only) To exit the Camera / Scope Setup menu completely, select Exit in the menu (see Figure 7.7 above) or touch the X button on the touchscreen. The surgeon cannot enter following mode until calibration is complete and you exit this menu. Setting the White Balance You must white balance the camera at the start of each procedure and any time a camera head, endoscope, lamp module, or Illuminator is changed.
Vision System Use Note: Do not use gauze. Gauze does not provide an appropriate background for white balancing. Figure 7.10 Camera / Scope Setup on touchscreen via camera head Select Navigate 4. Select White Balance. (Navigate with the Focus In and Out buttons, and press the Vision Setup button to make a selection.) It runs to completion automatically. • Alternatively, you can start white balance by touching the White Balance button on the Camera / Scope Setup screen on the touchscreen or touchpad.
7-11 Vision System Use • If during surgery you change to use a camera head, sterile adapter or endoscope you did not use for calibration before surgery, recalibrate all the endoscope angles you plan to use with the new equipment. Auto 3D Calibration Auto 3D Calibration is driven exclusively by the camera head buttons. Follow these steps to perform Auto 3D Calibration: 1.
Vision System Use Figure 7.14 Verify calibration (appears on touchscreen only) If you select Yes, you return to the previous menu and a check mark appears next to Auto 3D Calibration. Figure 7.
7-13 Vision System Use Manual 3D Calibration 1. Touch 3D Calibration on the touchscreen or touchpad. (If you are not there already, go to Camera / Scope Setup on the Video or Video Settings tab.) The system shifts into calibration mode: both the touchscreen and the Surgeon Console viewer present the left and right eye images in distinct colors, using green and magenta. Figure 7.16 Alignment target and scope tip inserted, target centered on screen 2.
Vision System Use Preoperative and Intraoperative Endoscope Care Intraoperative Endoscope Cleaning As necessary due to fogging or smudging of the tip, remove the endoscope and wipe the tip with moistened sterile gauze. Confirm Live Image in Stereo Viewer Each time you install an endoscope, and after changing view modes or settings during a procedure, look in the stereo viewer to confirm a live image is present and has the desired orientation. Adjust endoscope orientation as necessary.
7-15 Vision System Use The touchscreen monitor provides the ability to adjust vision system functions as described in this section. The following figure illustrates arrangement of overlaid elements in the touchscreen display. Note that many overlaid elements appear only when needed, and others are usually or always present. For a complete list of icons and text messages, please refer to Appendix G: Symbols, Icons and Text Messages Reference.
Vision System Use This area provides masters and instruments status for consoles in use, showing: • The console number at the top, or the user name of the surgeon if logged in • The same status icons as appear elsewhere, and the additional icon showing that the master is clutched (finger clutched) as seen on the right above. For a complete list of icons and text messages, please refer to Appendix G: Symbols, Icons and Text Messages Reference.
7-17 Vision System Use Video Source Tab Figure 7.22 Video Source tab • Endoscope: Touch this camera icon to display the endoscope video image. The touchscreen displays either the left or right eye video, and you can select which eye using the L (left) or R (right) button. This L / R option is useful when something impairs video from one or the other eye. • TilePro 1 or TilePro 2: Touch either to display the video input from the TilePro 1 or TilePro 2 connection on the back of the Core or Surgeon Console.
Vision System Use Figure 7.24 Advanced Video Adjustments Note: The specific adjustment of these settings is a matter of surgeon preference. Like any adjustable video image, you may observe that some settings affect others, with the result that a specific combination of settings may represent a tradeoff, for example, between glare in one part of the image and enhanced visibility in another part. Keep in mind that you can readjust these settings at any time.
7-19 Vision System Use Video Output Enables you to specify the video output format and graphics source for up to three video outputs. (Video Out Aux available by default; Video Out 1 and 2 available as part of optional upgrades.) See the example below. Figure 7.25 Example of video output option selections Note: One video output is standard. Optional upgrades can provide up to two additional video outputs.
Vision System Use Utilities Tab Figure 7.27 Utilities tab • Inventory Management: Provides an overview of the accessories used during the procedure. • Viewing Lamp Hours: To view usage hours of the lamp module, select Inventory Management (on the touchscreen or touchpad). You can also view the lamp hours on the Illuminator by pressing the decrease (–) and increase (+) buttons simultaneously, as described in Appendix C: Illuminator Information.
7-21 Vision System Use Overly Bright Image CAUTION: If the endoscope is working close to tissue, reduce the light source output by adjusting the Illuminator to a lower light output setting. This will prevent tissue damage due to excessive heat. Note that decreasing the light output will result in a more grainy image. Note: Do not use the Illuminator to control image brightness as this may result in increased fogging. Dark Image or Poor Color 1.
Vision System Use 2. If possible, clean the tip of the endoscope with a piece of moistened sterile gauze. Blood or other protein may have accumulated on the tip, diminishing light throughput. Blurry Image 1. Remove endoscope and detach from camera head. Clean both the endoscope tip and the end where it connects to the camera head. If possible, wipe the camera head lenses. a. Check the image quality in the Surgeon Console. If the image is clear, continue with normal use. 2. Focus the image. 3.
7-23 Vision System Use 6. Check the image quality in the Surgeon Console. a. If the image is in focus, continue with normal use. Replacing the Lamp Module If the lamp does not turn on or the illumination seems faint even when illumination is set at 100%, the lamp module may require replacement. For further instructions, see Illuminator Lamp Module Replacement on page 12-2. _________________________________End of section______________________________ 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL b.
Patient Preparation, Port Placement, and Docking Patient Preparation, Port Placement, and Docking This chapter provides instructions for the following: • 8.1 Patient Preparation Guidelines, page 8-1 • 8.2 Port Placement and Cannula Insertion, page 8-1 • 8.3 Docking, page 8-4 8.1 Patient Preparation Guidelines Patient positioning is procedure-specific and is at the discretion of the surgeon.
8-2 Patient Preparation, Port Placement, and Docking The following are generic guidelines for choosing port placement. Anatomical restrictions may necessitate an alternate setup. Determine port placement based on a parallel line pattern: • Insufflate before measuring. • Based on line from target anatomy to camera port, draw parallel lines with 8-10 cm line spacing. • Place da Vinci ports along lines, maintaining 10-20 cm from target anatomy, and 8-10 cm from other da Vinci ports.
Patient Preparation, Port Placement, and Docking The instrument arms and the camera arm on da Vinci Surgical Systems use remote center technology. 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. The remote center is the fulcrum point around which the da Vinci System moves the instrument and camera arms.
8-4 Patient Preparation, Port Placement, and Docking Endoscope Cannula Remote Center Setup Endoscope cannulae used with the da Vinci System do not have a ring or other mark to indicate the remote center. Therefore, it is vital to attach the endoscope cannula correctly in the endoscope cannula mount. • To ensure the remote center of the cannula is properly positioned, the cannula should be attached at a point immediately below the cannula housing (see Figure 8.3 below).
Patient Preparation, Port Placement, and Docking Figure 8.4 “Sweet spot” label 2. Move the Patient Cart towards the patient using the motor drive. See Motor Drive Operation on page 3-3 for details. The Patient Cart should approach the patient with the tower of the Patient Cart lined up in a straight line with the camera cannula and the target anatomy. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 1.
8-6 Patient Preparation, Port Placement, and Docking Camera Arm Docking Figure 8.6 Clutch arms to move into docking position Note: Refer to section 9.2 Moving the Patient Cart Arms on page 9-3 for detailed instructions on instrument arm, camera arm and port clutching. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 1. Once the camera cannula mount is above the camera cannula, use the camera arm port clutch button to bring the cannula mount toward the cannula. 2.
Patient Preparation, Port Placement, and Docking Instrument Arm Docking 1. Use the instrument arm port clutch button to bring the cannula mount to the cannula. 3. Ensure the drape boot is properly aligned with the cannula mount. Connect the cannula mount to the cannula by using the latches located on the cannula mount. Make sure that both latches are closed. 4. Ensure the back end of the instrument arm is rotated away from the camera arm.
8-8 Patient Preparation, Port Placement, and Docking Note: If, while operating, you move the masters and no instrument motion occurs, there may be a collision between instruments or instrument arms, or between an arm and the patient. Resolve the collision 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.
Patient Cart Use 9 Patient Cart Use • 9.1 Patient Cart Overview, page 9-1 • 9.2 Moving the Patient Cart Arms, page 9-3 • 9.3 Working with EndoWrist Instruments, page 9-5 • 9.4 Instrument Installation, Insertion, Removal and Intraoperative Care, page 9-7 • 9.5 Working with the Endoscope at the Patient Side, page 9-14 • 9.6 Endoscope Installation, Insertion, Removal and Intraoperative Care, page 9-16 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL This chapter explains the use of the Patient Cart during surgery.
9-2 Patient Cart Use CAUTION: Do not touch any wire harnesses or mechanical cables located on the camera or instrument arms while simultaneously touching the patient or when positioning the arms. LED Status Indicators Indications of the status of the instrument and camera arms are provided by LEDs on the top of the insertion axis of each instrument and camera arm.
Patient Cart Use 9.2 Moving the Patient Cart Arms Arm Clutch and Port Clutch Buttons Arm Clutch Port Clutch Port Clutch Figure 9.3 Arm clutch and port clutch buttons CAUTION: When using setup joint or clutch buttons, keep your fingers clear of the joints located on the camera and instrument arms to avoid injury. Arm Clutch to Move Arms Manually 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Use the arm clutch and port clutch buttons (Figure 9.3) to position the instrument and camera arms.
9-4 Patient Cart Use Port Clutch to Move Setup Joints Manually You can move Patient Cart setup joints manually using the port clutch button. Both instrument and camera arms have two port clutch buttons on the lower part of the arm, one behind the cannula mount and one on the middle of the arm. (See Figure 9.3 above.) When you move the setup joint, it changes the position of the remote center (port position). While you clutch the setup joint, the associated arm LED blinks white, alternating side to side.
Patient Cart Use Figure 9.4 EPO button on rear of Patient Cart The Emergency Power Off (EPO) button is on the back of the Patient Cart. Press this button to completely remove power to the Patient Cart. The system classifies this a non-recoverable fault. The system must be restarted. 9.
9-6 Patient Cart Use 3. Shaft: The rotating “arm” of the instrument 4. Release Levers: The mechanism for removal of the instrument On the bottom of the instrument housing, you'll see a series of discs, which connect to the instrument wrist via cables that run through the instrument shaft. The movement of the master controllers on the Surgeon Console is translated through the pulleys to the EndoWrist instrument wrist.
Patient Cart Use Instrument Sterile Adapter The instrument sterile adapter is part of the instrument arm drape and provides the point of connection between the instrument and the instrument Arm. Note: Follow the instructions in the Instrument and Accessories User Manual to inspect cannulae before use, including use of a gage pin for 8 mm cannulae. 9.4 Instrument Installation, Insertion, Removal and Intraoperative Care Installation 1.
9-8 Patient Cart Use 1. Verify the sterile adapter discs are aligned using the process above before installing an instrument. 2. Do not squeeze the release levers while installing the instrument onto the Sterile Adapter. 3. Do not apply excessive force when installing the instrument. 4. Verify pins on the back of the arm are flush on the arm and not protruding. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Instrument Installation Best Practices Troubleshooting Sequence: 1.
Patient Cart Use Newly released instruments may need to download their new parameters to the da Vinci Si System. This process is only required once for each new type of instrument, and will take up to 15 seconds. During this download period, the arm LED will rapidly flash green and a message is displayed. Progress is shown as a percentage of completion. If an error occurs during plug and play, re-install the instrument.
9-10 Patient Cart Use Guided Tool Change Figure 9.10 Illustration of Guided Tool Change 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Guided Tool Change To provide an efficient and safe method for instrument insertion, the system can assist the patient-side assistant by guiding an instrument into the patient. Guided Tool Change only works when you replace an instrument.
Patient Cart Use Figure 9.11 Blue arm LED indicates successful instrument insertion Note: When certain instruments are installed, the instrument arm provides extra holding force to ensure the instrument does not move during operation. If an outside force is acting on the arm for more than 300 milliseconds, the system will prevent following on that arm and will give error beeps until the force is removed.
9-12 Patient Cart Use In addition, if any blood or other fluid is observed on the inside of the drapes (on the instrument arm), contact Intuitive Surgical Technical Support as soon as possible and before any future use. Intuitive personnel will provide guidance in adequately cleaning the instrument arm. Instrument Removal Before attempting to remove an instrument, make sure the surgeon is ready for it.
Patient Cart Use Grip Release For additional information regarding the Emergency Stop button, see Right-Side Pod – Power and Emergency Stop, on page 10-4 (Chapter 10, Surgeon Console Use). WARNING: Rotating the grip release tool too far and/or in the incorrect direction can cause unintended instrument motion or damage to the grip release mechanism. Note: Whenever possible, use Surgeon Console control to release the instrument grips.
9-14 Patient Cart Use Intraoperative Instrument Care Please follow these recommendations to ensure the EndoWrist instruments are kept at their highest level of functionality: • Clean the tips of instruments between instrument exchanges Instrument Usage EndoWrist instruments are valid for a predetermined number of uses. We designed this feature to help ensure reliable and consistent performance throughout the EndoWrist instrument life.
Patient Cart Use Figure 9.14 Endoscope assembly The endoscope interface of the camera arm consists of four parts: • Insertion Axis: Delivers the endoscope to the surgical site. • Camera Arm Sterile Adapter: Provides the point of connection for the endoscope to the camera arm. • Cannula Mount: Designed to hold the cannula securely in place • Cannula: Provides the port through the body wall of the patient, through which the endoscope is inserted.
9-16 Patient Cart Use 9.6 Endoscope Installation, Insertion, Removal and Intraoperative Care Before use, ensure the endoscope tip is adequately heated to minimize fogging when entering the surgical site. To heat the endoscope tip, dip it in a canister of heated sterile water. Place a piece of sterile gauze at the bottom of the canister to prevent damage to the delicate endoscope tip. Installation When the endoscope is ready to install on the camera arm, follow these steps: 1.
Patient Cart Use 3. Connect the yellow portion of the camera cable to the strain relief support on the camera arm. Strain relief support Figure 9.17 Camera cable in strain relief support shown without sterile drapes Note: Leave the cable attached to the strain relief support when working with the camera head or endoscope assembly.
9-18 Patient Cart Use Note: Intuitive recommends you wipe clean the tip of the endoscope immediately after removing it, to prevent hardening of deposits that may be present. WARNING: The connection point between the camera head and the endoscope can become hot. Exercise caution when handling the endoscope. The endoscope may be changed during a procedure. To change the endoscope, perform the following steps: 1. Remove the endoscope from the camera arm as instructed above. 2.
Surgeon Console Use 10Surgeon Console Use • 10.1 Surgeon Console Overview, page 10-1 • 10.2 Setting up the Surgeon Console, page 10-5 • 10.3 Touchpad Controls, page 10-11 • 10.4 Surgical Controls, page 10-22 • 10.5 Dual Console Surgery, page 10-39 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL This chapter explains use of the da Vinci Si Surgeon Console during surgery. The following subjects are covered: Figure 10.1 Surgeon Console 10.
10-2 Surgeon Console Use Master Controllers • The orientation platform (Figure 10.2) rotates the instrument tips and opens and closes the grips of the instruments. • The positioning arm (Figure 10.2) moves the instrument in the surgical environment. Positioning movements can be scaled to a 3:1 (Fine), 2:1 (Normal), or 1.5:1 (Quick) ratio.
Surgeon Console Use Figure 10.3 Stereo viewer Touchpad The touchpad is the main control interface of the Surgeon Console. Functional descriptions of the specific controls are provided in the following section. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Patient Cart operator by a microphone located under the viewport and a pair of speakers located in the head rest. See Video (page 10-12) and Audio (page 10-17) for more information on use and adjustment of the stereo viewer. Figure 10.
10-4 Surgeon Console Use Left-Side Pod – Ergonomic Controls Stereo viewer tilt Stereo viewer height Armrest height Footswitch panel depth Figure 10.5 Left-side pod – ergonomic controls For more detail on ergonomic adjustments, see Ergonomic Setup on page 10-10. Right-Side Pod – Power and Emergency Stop The right-side pod on the Surgeon Console provides Power and Emergency Stop buttons (Figure 10.6).
Surgeon Console Use 10-5 Footswitch Panel The footswitch panel allows the surgeon to control the camera, instruments, and ESU without removing his or her head from the stereo viewer Secondary energy (yellow) above Camera Control and Focus Primary energy (blue) below Arm Swap Foot sensors Figure 10.7 Footswitch panel For instructions to use the footswitch panel, see Footswitch Panel Use on page 10-24. 10.2 Setting up the Surgeon Console This section explains how to set up the Surgeon Console for use.
10-6 Surgeon Console Use Table 10-1 Settings Saved to the User Profile Change affects other console when made in dual console modea Video Edge Enhancement (0-100) Yes, affects other consolea Digital Zoom (Wide/Full/2x/4x) TilePro (Off/2D/3D, and TilePro window sizing slider) Telestration Eye (L/R) No, local effect only No, local effect only Image Depth (Normal/Far) Image Enhancement (On/Off ) Finger Clutch (On/Off ) TilePro QuickClick (On/Off ) Haptic Zoom (On/Off ) Motion Scaling (from masters to in
Surgeon Console Use Follow these steps to log in: Figure 10.8 Login screen When you select the user name, the touchpad notifies you by the following screen that the ergonomic adjustment axes of the Surgeon Console will move: 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Repeat User If you already have a user name, touch it to log in. Scroll using the arrow keys if necessary. Figure 10.
Surgeon Console Use Make sure persons and objects are clear of the Surgeon Console and, as the button says, Press and Hold to Restore Settings. A blue bar indicates progress as the Surgeon Console applies the last ergonomic settings for this user. If you press and hold the Reverse button, the Surgeon Console reverses its movement, and the progress bar backs up. If you release either button, movement stops, as does the progress bar.
Surgeon Console Use 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Now the system walks you through ergonomic setup. This is required only one time, when creating a new account. The following New User screens appear in order. Step 2: Adjust chair height Step 3: Adjust armrest height Step 4: Adjust viewer height Step 5: Adjust viewer tilt Step 6: Adjust foot switch panel depth Figure 10.
10-10 Surgeon Console Use Manage Users Touch Manage Users to access the Manage Users screen, where you can delete users. Ergonomic Setup CAUTION: Before adjusting ergonomic controls on the Surgeon Console, make sure there is adequate room for the components to move. Once logged in, the system saves to your profile any changes you make to the system configuration, like ergonomic settings, and then applies your profile automatically each time you log in again.
Surgeon Console Use 10.3 Touchpad Controls The touchpad home screen provides system status, including instrument arms, camera arm, and energy controls. In dual console mode, it also enables you to give or take control of instrument arms (see Dual Console Surgery on page 10-39). Arm 2 status Scope status, angle, zoom Arm 1 status Arm 3 status Motion scaling setting Login/Logout 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Overview Function tabs Figure 10.
10-12 Surgeon Console Use Unlock Touchpad Figure 10.14 Touchpad locked Touch Unlock to access the touchpad again. Video The Video tab provides quick access to the brightness adjustment as well as Advanced Video Adjustments, Camera/Scope Setup and Display Preferences. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL When the surgeon takes instruments into following mode, the touchpad automatically locks, to prevent inadvertent actions. Figure 10.
Surgeon Console Use Figure 10.16 Advanced Video Adjustments Note: The specific adjustment of these settings is a matter of surgeon preference. Like any adjustable video image, you may observe that some settings affect others, with the result that a specific combination of settings may represent a tradeoff, for example, between glare in one part of the image and enhanced visibility in another part. Keep in mind that you can readjust these settings at any time.
10-14 Surgeon Console Use Figure 10.17 Camera / Scope Setup • Scope Angle: You can specify the scope angle by touching the corresponding button: 0 (degrees, for straight endoscopes), 30 (degrees up) or 30 (degrees down) for angled endoscopes. Note: When a new scope angle is selected, the system realigns the master controllers to match the instrument tip orientation and position.
Surgeon Console Use Figure 10.18 Display Preferences • Zoom: Also known as digital zoom, this allows you to zoom in on the image without changing the position of the endoscope tip. Zoom has four settings (Wide, Full, 2x, 4x). The current setting appears below the scope status icon on the touchpad. When you change the Zoom setting, a navigation window appears in the bottom right corner of the Surgeon Console image. The navigation window represents the widescreen (16:9) image.
Surgeon Console Use Figure 10.19 Sample TilePro layout in stereo viewer Note: TilePro is disabled unless the system senses auxiliary video input(s). • Viewer Mode: Toggles the stereo viewer between 2D and 3D mode. • Telestration Eye: Toggles display of telestration overlay between the left-eye (L) and right-eye (R) image. • Image Depth: Optimizes the surgeon’s ability to see a fused 3D image at Normal or Far distances. The system defaults to Normal. • Image Enhancement: Default is On.
Surgeon Console Use Audio The Audio tab enables volume adjustments and microphone mute. Figure 10.20 Audio tab • Volume: Drag the slider to adjust volume in the Surgeon Console speakers; volume increases left to right. • Mute: Touch to mute the Surgeon Console microphone. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Note: If you experience difficulty in communicating with the patient side assistant, check the audio settings.
10-18 Surgeon Console Use Utilities Account Management Provides access to user account information. Users may change information regarding their profile or delete their account. Figure 10.21 Account Management 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The Utilities tab provides access to Account Management, Inventory Management, Event Logs and Control Preferences. Inventory Management Reports usage status for instruments used during the procedure.
Surgeon Console Use Figure 10.23 Event Logs Troubleshooting Displays the system name and system software version, and provides L (left) and R (right) buttons to display the color bar test pattern in the left or right video channel independently. The functionality is the same as found on the touchscreen Troubleshooting screen. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Event Logs Provides access to system event logs, including error logs.
10-20 Surgeon Console Use Figure 10.25 Control Preferences • Scaling: Scales master controller positioning movements to Quick (1.5:1), Normal (2:1) and Fine (3:1) ratios. The system defaults to Fine. • Finger Clutch: Turn finger clutching on or off. The finger clutch buttons on the masters are on by default, when no one is logged in to the Surgeon Console. However, note that finger clutch on or off is saved to a user’s profile.
Surgeon Console Use Figure 10.26 Master Associations • You can press Auto to apply master associations automatically, or use the arrow buttons to manually switch masters association by instrument arm. When instruments are reassigned, the system takes the instruments out of following, notifies and prompts you with the icon and associated message below: Your instruments have been reassigned. Tap ‘Arm Swap’ pedal to acknowledge and continue.
10-22 Surgeon Console Use The system does not allow you to associate all 3 arms with one master, and notifies you if you attempt it: “Maximum of two arms per side.” Figure 10.28 Maximum of two arms per side 10.4 Surgical Controls This section describes the interface for controlling the instruments, camera and stereo viewer display via the masters and footswitch panel.
Surgeon Console Use Note: Clip appliers must match grips and be open more than 90% before they will be allowed to close. Note: To ensure patient safety, the Patient Cart operator's actions take precedence over Surgeon Console control. Any movement of the arms by the Patient Cart operator takes all instruments out of following.
10-24 Surgeon Console Use The footswitch panel features two groups of footswitches. The three switches on the left control system functions (camera control, master clutch, and arm swap). The four pedals on the right side of the footswitch panel control energy activation for devices connected to the Energy connectors on the Core (for example, electrosurgical units or ESUs). The energy control pedals are arranged as a left pair of pedals and a right pair of pedals.
Surgeon Console Use Primary (Blue) and Secondary (Yellow) Pedals Each pair has a blue pedal below for primary activation, and a yellow pedal above for secondary activation. • Secondary Pedal (yellow): Activates the secondary function of a pedal-linked instrument (for example, Cut for monopolar instruments). For information about the user interface associated with pedal activation, see Footswitch Panel Use on page 10-24.
10-26 Surgeon Console Use If your system is configured with SmartPedal technology, follow the instructions immediately below. If your system is configured without SmartPedal technology, follow the instructions starting on page10-32 with the section Non-SmartPedal: Energy Control Pedals. The high resolution stereo viewer displays the surgical site and provides extended system information via icons and text messages.
Surgeon Console Use • Background colors on instrument names, arm numbers: The background colors on instrument names and arm numbers, which extend around the screen border on that side, have the following meanings: • Blue: Foot detected over an enabled pedal pair • Orange: Instrument activated • Camera Indicators: At top center of stereo viewer display, they include: • Camera Angle: Displays 0º, 30º or 30º .
10-28 Surgeon Console Use Figure 10.34 SmartPedal Technology touchpad message: Pedal to instrument associations 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL SmartPedal Technology: Left Controls Left, Right Controls Right SmartPedal Technology expresses a simple association of pedals with instruments: The left pair of pedals activate the instrument associated with the left master; likewise, the right pair of pedals activate the instrument associated with the right master.
Surgeon Console Use • When no pedal function is available, the pedal is disabled and its icon is gray and lacks accompanying text that would list an available function. When a disabled pedal is pressed, its outline is highlighted orange, though it is not activated. SmartPedal Technology: Stereo Viewer Border Colors The activation status colors in the stereo viewer extend around the screen border for the instrument on that side.
10-30 Surgeon Console Use SmartPedal Technology: Activation Status Indicators in Surgeon’s View • Black border • Gray pedals with no function listed • Pedals turn light gray when the surgeon’s foot is held over a pedal Instrument Function Available • Color pedals with associated function Foot Held Over an Enabled Pedal • Blue border • Color pedals with associated function 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL Instrument Function Not Available Activating Instrument Function • Orange border • Activa
Surgeon Console Use • In single and dual console mode, pressing the camera control pedal stops all energy firing (and instrument motion). SmartPedal Technology – Troubleshooting: Activation Not Available Activation is disabled in any of the following situations: • The associated generator is not connected to the da Vinci System, or not powered on. • Two generators with the same energy type are connected to the system, for example, two monopolar ESUs.
10-32 Surgeon Console Use Non-SmartPedal: Energy Control Pedals Left pair Right pair Primary energy (blue) below Foot sensors Right Pair Controls Monopolar, Harmonic, Vessel Sealer and Stapler Instruments The right pair of pedals controls energy activation for monopolar, harmonic, Vessel Sealer and Stapler energy instruments.
Surgeon Console Use The high resolution stereo viewer displays the surgical site and provides extended system information via icons and text messages. The following figure illustrates arrangement of overlaid elements displayed in the stereo viewer monitor. Note that many overlaid elements appear only when needed, and others are usually or always present. For a complete list of icons and text messages, please refer to Appendix G: Symbols, Icons and Text Messages Reference.
10-34 Surgeon Console Use • Black, partially transparent (default): Foot sensors detect nothing • Gray: Foot detected over a disabled pedal pair • Blue: Foot detected over an enabled pedal pair • Orange: Energy firing • Camera Indicators: At top center of stereo viewer display, they include: • Camera Angle: Displays 0º, 30º or 30º . • Camera Rotation: Provides information regarding the rotation of the endoscope relative to ground.
Surgeon Console Use Non-SmartPedal: Footswitch Map (Stereo Viewer) Energy type, right pair, when mapped Border color: gray = energy disabled blue = energy enabled orange = energy firing Pedal area background color: blue = foot over enabled pedal pair gray = foot over disabled pedal pair Available energy modes Figure 10.
10-36 Surgeon Console Use gray border = energy disabled blue border = energy enabled orange border = energy firing Figure 10.41 Pedal Area Background Colors Besides the default black, the pedal area background color turns blue when a foot is over (close to or touching) a pedal pair ready to fire, or gray when over a pedal pair not ready to fire. When a pedal is pressed, its outline is highlighted orange, whether energy is actually firing or not.
Surgeon Console Use indicates a disallowed configuration in different ways, depending on the source of ambiguity. In all cases, the system grays out the energized indicator and does not map a pedal whose function would be ambiguous. • In dual console mode, if each surgeon controls an energy instrument, the first press of an energy pedal activates the associated instrument, and other presses are locked out until the first is ended.
10-38 Surgeon Console Use Figure 10.44 Example of pedal conflict In Figure 10.44, the PK Dissecting Forceps is installed and active on instrument arm 1, and the Maryland Bipolar Forceps is installed and active on instrument arm 2. Since the system would map both instruments to the left pair of energy pedals, the system does not allow either instrument to fire, because which instrument should fire on a left energy pedal press is ambiguous.
Surgeon Console Use 10.5 Dual Console Surgery Dual Console Connection and Startup To operate in dual console mode (using a second Surgeon Console), simply plug the second console’s system cable in one of the available Fiber ports on the back of the Core. No other connection is necessary, except of course to plug in the Surgeon Console to a dedicated AC power outlet. The second Surgeon Console behaves just as the first with respect to power operations, as described in Chapter 5 Startup.
10-40 Surgeon Console Use Master Associations The system gives both surgeons the ability to reassign instruments to different masters, and this feature continues to operate in dual console mode. The new instrument assignment applies on both consoles and persists when instruments are swapped. For details, see Master Associations on page 10-21. Instrument Control When the system detects two Surgeon Consoles in use, the Give/Take and Swap All buttons on the touchpad home screen appear.
Surgeon Console Use Swap All affects all 3 instrument arms (not the endoscope). However, if Surgeon A controls no arms before the swap, Surgeon A can control only up to two arms when he matches grips after the swap. He or she must first match grip on the two instruments that were in following with the other surgeon before the swap; the third arm will remain out of following as it was. To take control of the third instrument, he or she must press the arm swap pedal (left kick-plate) as usual.
10-42 Surgeon Console Use The virtual pointer is a software tool designed as an instructional aid, typically for use during dual console surgery. The pointer is a three-dimensional (3D) graphical object, light blue and conical in shape, which appears overlaid on the live video image when activated. It enables a surgeon to point and refer to specific anatomical features on the live video image intraoperatively.
Surgeon Console Use Note: It is possible to activate the pointer when using a single Surgeon Console if the third arm is stowed. For example, if arm 3 is stowed and you associate arms 1 and 2 with the left master, the right master can be used to activate the pointer. The virtual pointer has the following use characteristics: • By closing the grips of an unassociated master, the surgeon activates a virtual pointer.
11-1 System Shutdown and Storage 11System Shutdown and Storage This chapter explains the following: • 11.2 Inventory Management, page 11-2 • 11.3 Shutting Down the da Vinci Si System, page 11-3 • 11.4 Storing the System, page 11-4 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL • 11.1 Preparing the System for Shutdown, page11-1 Figure 11.1 Patient Cart in stow position, ready for storage 11.1 Preparing the System for Shutdown 1. Remove the instruments and endoscope from the Patient Cart. 2.
System Shutdown and Storage Figure 11.2 System accessories For instructions on cleaning system components, see 12.2 System Cleaning on page 12-1. 6. Remove and properly dispose of all drapes. Note: Users will find it easier to separate the camera head from the sterile adapter by first cutting off the camera head drape, as indicated by the label on the drape itself, shown here. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 5. Remove all sterile system accessories for cleaning. Figure 11.
11-3 System Shutdown and Storage 11.2 Inventory Management Serial Number Description Uses Left Figure 11.4 Usage Summary For instruments that expire after a certain number of procedures, the system displays the number of uses or activations left out of uses allowed in the right column. See Instrument Usage on page 9-14 for details on how the system tracks usage. 11.3 Shutting Down the da Vinci Si System 1.
System Shutdown and Storage 2. Press any system Power button. The system will begin the ten second shutdown process and displays the following message: Preparing to shutdown. Note: If the system is not restarted within ten minutes after power down, the system will view any restart as a new procedure and instrument uses will be decremented accordingly. Note: Cooling fans on the Patient Cart and the Core (Vision Cart) run continually when either is plugged into AC. This is part of normal operation.
12-1 Cleaning and Maintenance 12Cleaning and Maintenance This chapter covers the following subjects: • 12.2 System Cleaning, page 12-1 • 12.3 Illuminator Lamp Module Replacement, page 12-2 • 12.4 CCU Fuse Replacement, page 12-6 12.1 System Maintenance Preventive maintenance is required and must be performed by an authorized Intuitive Surgical Service Representative. There are no user-serviceable parts on the main system components, with the exception of the Illuminator.
Cleaning and Maintenance Follow your hospital protocol for the handling of blood and body fluids. Clean the display with a diluted mixture of mild detergent and water. Use a soft towel or swab. Use of certain cleaning agents may cause degradation to the labels and plastic components of the product. Consult cleanser manufacturer to see if agent is compatible with it. Do not allow liquid to enter the display.
12-3 Cleaning and Maintenance Figure 12.1 Cermax VQ Xenon Lamp Module The module is designed for simple and quick changing, but should be performed by qualified personnel. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL When the lamp requires changing, you must replace the complete lamp module. The lamp and heat sinks are installed as a complete unit as shown below.
Cleaning and Maintenance 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL The following image shows the label affixed to the lamp module itself, and explains pictorially the steps to replace the lamp module. Figure 12.2 Lamp module replacement label—on lamp module To remove the old lamp module: 1. Turn the Illuminator off by pressing the Lamp On/Off button. CAUTION: Hot. Wait 10 minutes while system is cooling with internal fan operation.
12-5 Cleaning and Maintenance Push in to release Released Pull out drawer Figure 12.3 Open the access drawer 3. Grasp the handle and pull the entire lamp module out as shown. 10/9/14 DRAFT/PRE-RELEASE/CONFIDENTIAL 2. Push inward to open the access drawer on the left side (front) of the Illuminator. Handle Figure 12.
Cleaning and Maintenance To insert new lamp module: 2. Carefully align the sides of the module and place in the receiver channel (see Figure 12.5). To ensure proper connection, firmly push the module as far as it will insert. The edge of the module will be flush with the sides of the drawer once connected. Connectors Receiver channel Figure 12.5 Installing new lamp module 3. Close the drawer firmly so it is fully engaged. For assistance replacing the lamp, call our Technical Support line.
12-7 Cleaning and Maintenance CCU Fuse Replacement Instructions To replace the fuse on the Camera Control Unit, follow these steps: b. Unplug the Vision Cart and other main system components from their AC wall outlets. c. Switch off the CCU power switch next to the power cord inlet. 2. Remove the CCU power cord from the power inlet next to the CCU power switch and fuse housing.
Appendix A: Error Handling Intuitive Surgical is committed to safety. Every effort has been made to ensure the system will not only be reliable, but in the event an error occurs, the system will handle the error in the safest and most efficient manner possible. This appendix explains the following: • Obtaining Technical Support, page A-1 • Error Handling, page A-1 • Conversion to Open Surgery, page A-5 A.
A-2 Appendix A: Error Handling • Displays a text message on the monitors to describe the error. • If the fault is arm-specific, the system displays an error icon and lights the arm LED yellow or red. If the fault is not arm-specific, all arm LEDs light yellow or red. Figure A.2 Arm LEDs in fault states Recoverable Faults If the fault is recoverable, you can override it by touching Recover on the touchpad or touchscreen, which enables the system to continue.
