The da Vinci Code: The Robot Edition

The Stitch

By: Lindsey Joyce, MSN, RN, CNOR-CARD

Published: 12/11/2025

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Leonardo da Vinci is known for his works of art, including those of the human body. He even authored a book with drawings of the human body that were used during early medical training. However, I'm sure he never thought that hundreds of years later, a robotic surgical system would be named after him. The first da Vinci surgical system was launched in 2000,¹ with five generations subsequently released between 2000 and 2024. As of the end of 2024, more than 9,900 da Vinci systems have been used in 72 countries and in more than 16 million surgeries.²

What It Is

The da Vinci surgical system is a robotic device that is known for its enhanced precision during minimally invasive procedures; it is an extension of the surgeon who is surrounded by a team of skilled surgical professionals. It is used in many surgical specialties, including cardiac surgery, colorectal surgery, general surgery, gynecologic surgery, head and neck surgery, thoracic surgery, and urologic surgery.³The da Vinci system comprises a console (ie, the control center), the patient cart, and the vision cart. It is approximately a $2 million dollar investment, and individual instruments can cost from $1500 to $3000 each.⁴

Console

The surgeon sits at the console during the robotic portion of the procedure. It has joystick-type controls to allow the surgeon to control the robotic arms, which manipulate the endoscopic instruments. A display provides the surgeon with a three-dimensional (3D) view of the surgical site.

Patient Cart

The robotic instruments (eg, clamps, scissors, dissectors, the endoscope with camera) attach to the patient cart via three or four articulated mechanical arms. The RN circulator moves the patient cart close to the sterile field before the instruments are attached to the mechanical arms. A guide screen shows the proper patient cart placement for the procedure. Instruments can be changed during the procedure by the scrub person or assistant (eg, physician assistant, resident, RN first assistant).

Vision Cart

The vision cart (ie, video tower) is equipped with high-definition technology that includes the 3D endoscope and image processing equipment to provide true-to-life images of the patient's anatomy. It also contains supporting hardware and software components for the robot, such as the electrosurgical unit, suction and irrigating devices, insufflator, and light source for the endoscope. It has a secondary video display so that all perioperative team members can view the same image that the surgeon sees in the console.

Benefits

Robotic systems allow surgeons to perform procedures in tight spaces (eg, pelvis) that have little room to maneuver instruments by manual methods. Because of the smaller incisions, patients may experience fewer postoperative side effects, shorter recovery times, and less blood loss and tissue trauma when compared to open procedures. In addition, robotic systems can promote ergonomics for surgeons.

Tips for Success

So, you're going to be in the robotic room! There is a lot to learn to be successful during these procedures. To start, there are many education courses designed for perioperative personnel who work in the robotic room. Talk with your educator to see if it is possible to get access to these learning materials.

Generally, each perioperative service line (including robotics) has a coordinator who is an expert in that surgical specialty. Get to know the robotics coordinator at your hospital. They can teach you how to operate all the equipment in the room, troubleshoot any anomalies, position patients for various procedures, and prepare for robotic procedures. The robotics coordinator can be instrumental to your success, so ask questions and learn what you can from them.

In addition to the robotics coordinator, robotic industry technical support is available for staff members to contact with questions, issues, or troubleshooting needs. In fact, contact information is readily available on many devices. Local industry representatives also may be available for additional support.

Although positioning a patient is very crucial in any surgery, it is especially important for robotic procedures. Each position (eg, supine, lithotomy, lateral) has its own concerns. For example, for the lithotomy position, when lithotomy stirrups are used for an extended period of time, the patient's heels should be in the boot of the stirrup and the calf properly padded behind it to prevent nerve damage. The knees and shoulders should also be lined up evenly. In the supine or lithotomy position, patients may be at risk for sliding on the OR bed, especially when the Trendelenburg position also is involved⁵; therefore, devices, such as an anti-slip mat coupled with one or more safety straps, should be used to prevent sliding. Approved bed attachments (eg, footboard) also should be used when applicable. However, shoulder braces can cause nerve injury and should not be used.⁵

Robotic procedures also provide their own set of anesthesia concerns.⁶ The robotic patient cart is not small and thus could prevent access to the patient's airway. The perioperative team should work together to ensure that the anesthesia professional always has airway access. A steep Trendelenburg position can cause abdominal contents to move toward the head and push on the diaphragm,⁵ which can affect breathing patterns or displace the endotracheal tube. In addition, using the Trendelenburg position for a prolonged period can lead to increased intraocular pressure and edema.⁵ To address these concerns, nurses should collaborate with the anesthesia professional. Using just enough insufflation gas (eg, carbon dioxide) for abdominal pressure, ensuring the face is visible to everyone, limiting time spent in Trendelenburg, and protecting the patient's eyes are some ways to prevent negative events.⁵

The da Vinci robot requires specialized instruments that are connected to the robotic arms. The type of instrument depends on the procedure, surgeon's preference, and function. The instruments are very delicate and expensive and require special care, cleaning, decontamination, and sterilization processes after use. The manufacturer specifies how many times the instruments can be reprocessed. The robotic coordinator and team members should be able to show you how to properly care for these instruments to maximize their use.

Similar to any laparoscopic procedure, you should be ready to convert to an open procedure. An example of one situation requiring such a conversion is the failure of the robot. Robotic team members should know how to perform emergency undocking. Some facilities use simulation to practice preparing for an emergency situation. Instruments for conversion to an open procedure should be readily available. You may need extra supplies, such as laparotomy sponges, suture, or towels, among others. Although you may not know exactly what to do, you may be asked to open these supplies, move equipment, or help the anesthesia professional.

The Future

It's important to note that robotic surgery, including procedures involving the da Vinci system, continues to evolve. Surgeons are gaining more experience, and updated versions of the system are being developed with improved features.

Editor's notes:

AORN does not endorse any commercial company's products or services. Inclusion or exclusion of products in this article does not constitute an endorsement or review (implied or otherwise) by AORN of the quality or value of such products, or of the claims made by its manufacturer.

References

  1. Intuitive history. Intuitive. Accessed October 1, 2025.
  2. About us. Intuitive. Accessed October 1, 2025.
  3. Intuitive for surgeons. Intuitive. Accessed October 1, 2025.
  4. Taylor A. Advances in abdominal surgery robots. Outpatient Surgery. April 9, 2021. Accessed October 26, 2025.
  5. Guideline for positioning the patient. In: Guidelines for Perioperative Practice. AORN Inc; 2022. Accessed October 1, 2025.
  6. Tameze Y, Low YH. Outpatient robotic sugery: considerations for the aenesthesiologist. Adv Anesthesia. 2022;40(1):15-32

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