The evolution of da Vinci systems

It’s important to get one thing straight from the beginning: single-port robotic-assisted surgery is not a replacement for multi-port robotic-assisted surgery. They complement one another. This story is about how Intuitive evolved the da Vinci surgical system from four arms to one for narrow and alternative access surgery with da Vinci SP.

From its earliest days, Intuitive has worked closely with hospital leaders, surgeons, and care teams. The company cares deeply about what impacts customers inside and outside of the operating room and aims to help drive better outcomes for hospitals’ patients. Re-envisioning the da Vinci system to enable a single-port option was no different.

In 2006, just six years after launching their first multi-port da Vinci system, Intuitive began working on what would become the da Vinci SP surgical system. The challenge was to provide a single-port solution for alternative access, narrow access, and extraction site surgeries without sacrificing the vision, precision, and control surgeons had come to trust from the da Vinci multi-port system. The solution? A versatile, high-performance, single-port robotic-assisted surgical system that makes new approaches for minimally invasive procedures possible across a range of complexity.

In the early 2000s, some surgeons performed minimally invasive surgery through single-incision laparoscopy. It was technically and physically challenging for patients and surgeons alike. Straight laparoscopic instruments lack the wrists and elbows featured in da Vinci products, and don’t triangulate easily through a single incision. With the lack of flexibility came larger incisions, an increased chance of patient trauma, and discomfort for surgeons who had to hover and bend over their patients for long periods of time.

These challenges became an opportunity for Intuitive to bring the innovations from da Vinci’s multi-port system into a single-port solution that helps give surgeons greater access, especially in narrow parts of the anatomy. How could Intuitive introduce robotic-assisted capabilities through a single incision? Could a single arm support simultaneous use of instruments and an endoscope? The SP exploration began in 2006.

Intuitive set the bar high with its da Vinci multi-port system—surgeons were already experiencing new capabilities in the operating room. The task for Intuitive engineers was to take their current knowledge and technology and minimize invasiveness and surgical variability even further. The addition of elbows allowed for smaller incisions but added a higher level of complexity in the design and engineering. The difficulty didn’t double—it squared.

The challenge faced was architectural, and everything needed to be reimagined. Surgeons want as much room as possible to work safely within a patient, but at a certain point that extra space goes against the idea of being minimally invasive.

After two years of work, the engineers invited surgeons to an Intuitive lab to try out a prototype. Testing took place over several years while the team continued to address technical specifics and identify the right materials at a cost the market could withstand. Then, in 2010, the first human testing took place in Lille, France with prostatectomies, partial nephrectomies, and total nephrectomies. 

Following testing in Lille, the team began to evolve the design and received 510(k) clearance for da Vinci SP on Intuitive’s third generation platform, da Vinci Si in 2014. And then, another tough choice. With Intuitive’s fourth generation system, da Vinci Xi, gaining clearance in 2014, the decision was made to wait to release da Vinci SP alongside the new platform. The single-port robotic solution is more advanced, so debuting it on the older platform simply didn’t make sense. Instead, the team spun the design for the fourth-generation platform. It took more time—it was the right thing to do.

There were surgeons who believed in the vision for single-port robotic surgery from the beginning. Dr. Moses Kim, chair of urology at Hoag Memorial Hospital, noted, “When I first saw Intuitive’s da Vinci SP system, I thought, ‘This is the holy grail for single-port surgery.’” It’s the belief from within the company, and from early adopters, that kept the team pushing on through every technical challenge and roadblock.

Da Vinci SP provides 360 degrees of anatomical access with a single arm that eliminates the possibility of external collisions. Anatomy can be reached in all four quadrants of the abdomen without redocking. With a 3DHD fully articulating endoscope, anatomy can be seen clearly, and tissue planes can be visualized in a way never made possible before. Designed with wrists and elbows, SP instruments provide greater range of motion than the human hand to achieve triangulation inside the body.

With the addition of da Vinci SP to Intuitive’s portfolio, surgeons have yet another tool in their box. This further empowers surgeons to tailor the procedure to the patient and their disease, rather than taking a one-size-fits-all approach.

Taking on yearslong challenges requires a certain level of grit, tenacity, and perseverance—something that is lived and breathed within Intuitive’s culture. It requires inherent belief, dedication to the cause, and the ability to celebrate small wins while continuing to learn and make progress.

Since the launch of da Vinci SP, additional indications have been cleared in the United States including simple prostatectomy and transoral otolaryngology. And yet, the company remains in a stage of discovery and imagining what’s possible next. Every bit of progress unlocks a new opportunity. The work has just begun.