Exploring the Da Vinci Surgical Robot: Is Healthcare Entering a New Era of Minimally Invasive Surgery?

Many people likely still remember a viral video from last year, which showed a grape undergoing surgery inside a small glass vial. The entire procedure was performed by the “da Vinci” surgical robot. Owing to the speed and precision of the operation, the grape’s “skin” was successfully sutured, drawing widespread acclaim for the da Vinci system. However, within the medical community, this technology is no longer considered novel.

As early as 2006, the first da Vinci surgical robot was introduced to the Chinese PLA General Hospital (301 Hospital). After ten years of development, more than 40 hospitals in China are now equipped with 57 da Vinci surgical robots, having performed a total of nearly 30,000 surgeries.

The system is named the "da Vinci Robot" because its developers believed that Leonardo da Vinci designed a humanoid machine in 1495, earning him recognition as the inventor of the world’s first robot. However, contrary to common perception, the da Vinci Robot does not possess humanoid features or artificial intelligence capabilities such as deep learning. Strictly speaking, it is an advanced robotic platform composed of three components: the surgeon console, the patient-side manipulator system, and the imaging system.

From a medical perspective, the da Vinci Surgical System is an advanced laparoscopic system.During surgical procedures, it also requires the robotic arms to pass through the chest and abdominal wall. Its design philosophy is to perform complex surgeries using minimally invasive techniques.

Ms. Pan Zhongying, President of Beijing United Family Hospital, directly defined the da Vinci Surgical System as a surgical tool with robotic characteristics.

As the first private medical institution in China to be equipped with the da Vinci Surgical System, United Family Healthcare has performed 100 major and minor surgeries using the system (hereinafter referred to as the “da Vinci robot”), demonstrating profound understanding and extensive practical experience in robotic-assisted surgery.

Pan Zhongying stated that the da Vinci Surgical System primarily serves as an assistive tool for physicians, enabling minimally invasive surgeons to perform procedures with greater precision and fewer errors.For instance, a highly skilled surgeon may encounter complex cases where the use of traditional medical instruments is limited during procedures; in such scenarios, the advantages of the da Vinci Surgical System become particularly evident.

In addition to reaching areas inaccessible to the surgeon’s hands during procedures, the da Vinci Surgical System enables highly precise operations with minimal incisions and reduced blood loss, thanks to its fine instruments measured in centimeters. This significantly accelerates patient recovery.

I. What are the advantages and disadvantages of surgical robots?

Zhu Gang, Chief Physician of the Department of Urology at United Family Hospital, was among the first cohort of surgeons trained to operate the da Vinci Surgical System. To date, he has performed 11 robot-assisted surgeries. According to Dr. Zhu, the da Vinci system is currently primarily used in urological, thyroid, gynecologic oncology, gastrointestinal, and pediatric surgical procedures. This is because conditions in these areas either involve sensitive nerves or are located deep within the body, requiring high-precision manipulation. Taking prostate surgery as an example, the prostate gland is situated deep at the junction of the urethra and bladder. Traditional open surgery requires a large incision, whereas robot-assisted surgery only needs several small ports approximately 1 cm in size, resulting in significantly less blood loss. In fact, over 90% of radical prostatectomies for prostate cancer in the United States are performed with robotic assistance.

Director Zhu Gang sat at the console of the da Vinci Surgical System.

Before the surgery began, Director Zhu Gang and his colleagues were adjusting the robotic arms.

As a frontline “surgeon” in robotic surgery, Zhu Gang believes that the medical community has entered a new era of minimally invasive procedures.

In traditional surgery, surgeons must manually hold instruments and operate beside the patient, remaining in a state of constant tension that easily leads to fatigue. With the advent of the da Vinci Surgical System, the operating surgeon can step away from the operating table and complete the entire surgical procedure by controlling the robotic arms from a console.

The da Vinci surgical system does more than just free surgeons’ hands; in certain complex clinical scenarios, it can even surpass human capabilities. For instance, suturing and knot-tying are the most challenging aspects of conventional laparoscopic surgery, yet the da Vinci robot performs these tasks with greater precision than humans, enabling even surgeons previously untrained in laparoscopy to operate effectively. Standing before the robotic arms, Director Zhu Gang noted that the instruments directly interacting with the human body during surgery are highly refined, with dimensions measured in centimeters.

However, Zhu Gang also admitted that compared with traditional surgery, the lack of haptic feedback during the operation is a major drawback of the da Vinci Surgical System, and doctors are not accustomed to it when they first start using it.However, as the number of surgeries increases and practical experience accumulates, haptic feedback is no longer the primary obstacle. This is largely due to the intelligent error-correction capabilities of the da Vinci Surgical System, which can real-time control and correct tremors caused by excessive assistant movements from surgeons, thereby reducing operational errors.

Zhu Gang also opened up, saying that the pressure of sitting at the robot console was no less than that of performing surgery with his own hands.

II. Strict Requirements for Both Patients and Physicians

In addition to physicians being highly proficient in operating the da Vinci Surgical System, appropriate patient selection for robotic surgery is also critical. Although some patients request the use of the da Vinci system after learning about its significant benefits, United Family Hospital convenes a multidisciplinary team of experts to evaluate each patient’s condition before every procedure to determine whether they meet the criteria for robotic-assisted surgery.

Not only are patients carefully selected, but the Da Vinci robotic system also imposes stringent requirements on the operating surgeons, nurses, and assistants. Personnel must undergo training, pass examinations, and obtain certification to be qualified to operate the robot; furthermore, they must have extensive prior clinical experience. Currently, a single robotic surgery involves multiple certifications, including those for the lead surgeon, assistant, and nursing staff.

“Surgeons must have a thorough understanding of the hardware and software systems of robotic surgical platforms. Only after completing a series of requirements—including online training, hands-on animal laboratory sessions, and passing certification examinations—are they qualified to perform clinical surgeries.”,” said Zhu Gang.

However, such certifications are not national standards but are issued by robot manufacturers.

Regarding the cost of da Vinci robotic-assisted surgery, Zhu Gang stated that it generally requires an additional RMB 30,000 on top of traditional surgical fees. This amount includes the system activation fee and the actual cost of consumables used during the procedure, forming the basic pricing structure for da Vinci surgeries.

III. This is a market monopolized by foreign manufacturers with exorbitant profits.

In his conversation with Zhu Gang, he also revealed a rather helpless reality. Although the practical application of robotic surgical systems in China has already become quite mature, rapid widespread adoption remains fraught with challenges.

On the one hand, the da Vinci Surgical System is classified as a Class A large-scale medical device. Any hospital in China seeking to introduce this equipment must obtain direct approval from the National Health and Family Planning Commission. There are clear standards governing which hospitals are eligible for allocation and how many units they may configure; procurement is not solely determined by a hospital’s financial capacity.

On the other hand, the technology and market for the da Vinci Surgical System are monopolized by foreign manufacturers. Consequently, its price is significantly higher than that of other medical devices. Furthermore, the robotic arms of the da Vinci system are classified as high-value consumables; they are temporarily attached to the robot prior to use and must be discarded after ten uses. Each robotic arm costs tens of thousands of RMB.

Prices remain stubbornly high. The Da Vinci Surgical System’s monopoly over the surgical robotics market did not emerge overnight; other surgical robots existed prior to its advent. However, as with any new technology or product attempting to penetrate an emerging field, the process and outcomes are often fraught with uncertainty, and surgical robotics is no exception.

As early as 1985, American researchers attempted to use the Puma 560 industrial robot to assist in brain tissue biopsy, marking the initial prototype and exploration of surgical robots.

In the late 1980s and early 1990s, surgical robots specifically designed for surgical procedures also emerged, with RoboDoc being a representative example.

Until 1994, the AESOP endoscope-holding robot, developed by Computer Motion in the United States, achieved more precise and consistent camera movements than human operators, marking a critical step in the development of robotic minimally invasive surgical systems. However, it could not independently execute instructions to perform surgical procedures; it served merely as an electromechanical arm for holding the endoscope. In 1996, Computer Motion introduced the ZEUS Robotic Surgical System, attempting its application in minimally invasive surgery.

However, with the advent of the da Vinci Surgical System, all aforementioned robots became obsolete. On January 9, 1999, Intuitive Surgical, Inc., a U.S. company, launched the da Vinci Surgical System. In 2000, it received formal clearance from the U.S. Food and Drug Administration (FDA) for clinical use, becoming the world’s first robotic surgical system approved for laparoscopic procedures.

Since then, the da Vinci Surgical System has gained unstoppable momentum, rapidly expanding to hospitals worldwide and achieving near-monopoly status in the global surgical robotics market—a dominance that persists to this day.

The advent of the da Vinci system was also driven by medical needs, with endoscopic technology serving as a typical example. In the past, surgeons relied on conventional thoracoscopic instruments, which made precise manipulation difficult during procedures and resulted in poor ergonomic comfort. Consequently, true intracardiac operations still required auxiliary incisions through the chest wall. To overcome the limitations of endoscopic techniques and pursue minimally invasive surgeries with improved operational experience, robotic-assisted minimally invasive surgical systems emerged accordingly.

IV. How is liability apportioned in the event of a robotic incident?

In fact, with the widespread adoption of the da Vinci Surgical System, most patients remain concerned about safety issues. After all, it involves a cold, mechanical device directly entering the body to perform procedures; should an accident occur, who would bear the liability?

Just a few days ago, Intuitive Surgical issued a safety notice to customers, advising physicians to exercise caution when using cardiac cryoprobes in robotic surgery.

Intuitive Surgical stated that it had received five postoperative reports concerning mitral valve repair procedures performed using the da Vinci Surgical System, which indicated an increase in metallic particles within the body. Among these five case reports, two patients experienced transient neurological symptoms. Although a direct causal link between these symptoms and the robotic surgery could not be definitively established, the company issued a safety notification.

In this regard, Pan Zhongying, President of Beijing United Family Hospital, believes that robotic surgery is not foolproof, nor is high technology a panacea. In the event of an incident, it is crucial to trace the root cause and determine how the error occurred.

“This is also why preoperative patient screening is so critical. As administrators, we must strive to collaborate with manufacturers to elevate safety concerns to a top priority, implement systematic preventive measures in advance, and minimize the probability of errors,” she said.

In the face of unexpected incidents, pessimists remain skeptical of, or even outright reject, surgical robots. For optimists, however, they represent an inevitable trend. As robotic systems and technologies advance—particularly with the integration of artificial intelligence—will robots be able to autonomously perform surgeries on patients, and potentially even replace doctors?

Pan Zhongying’s answer is that surgical robots will bring about certain changes for physicians, but a surgery requires better synergy between the surgeon and the anesthesiologist. Robotic surgery will not replace doctors; instead, it places higher demands on surgeons’ teamwork capabilities, making the role of physicians increasingly important.

She further illustrated this point by noting that in the past, professional typists used typewriters to input text; with the widespread adoption of computers, dedicated typing roles have disappeared. However, expectations for typesetting and design have grown more demanding. This demonstrates that overall technological advancements and standards are progressively elevated—an inevitable evolutionary process as humanity explores new technologies and frontiers.

In line with Pan Zhongying’s vision, she hopes that surgical robots will eventually enable true remote operation, allowing surgeons to perform procedures from distant locations and thereby enabling patients to benefit from global medical expertise. For ordinary patients, however, faced with the introduction of surgical robots and their high procedural costs, would they be willing to be among the first to adopt this technology?

Article edited and reposted from TMTPost, Author: Song Changle