The wait is over. Force Feedback technology in the new Intuitive da Vinci 5 surgical system represents a first-of-its-kind breakthrough. It enables surgeons to sense the push and pull forces exerted on tissue during surgery.
The ability to sense instrument force on tissue has been a promising idea since Intuitive’s inception. The ability to deliver the sense of feeling via the hand controls was in the original da Vinci design proposal, and we’ve never stopped working to find the right approach for surgeons.
Force Feedback technology allows the surgeon to sense push and pull forces, and feel tissue tension and a sense of pressure in common da Vinci tasks—such as dissection, retraction, and suturing. In the da Vinci 5 system, this resulted in up to 43% less force on tissue.* Force Feedback complements the extraordinary precision that da Vinci systems are already known for.
“It’s a brand-new feature” said Todd Tourand, director of Multiport Global Product Management. “Surgeons trust da Vinci precision and control—and we believe Force Feedback will help accelerate their proficiency in learning key da Vinci skills.”
“We sense forces at the tip of an instrument—unlike other robotic systems that claim haptics” said Tourand. “It’s really revolutionary.”
Haptics refers to the use of tactile feedback, such as vibrations or pressure, to simulate the sensation of touch or texture.
Force Feedback technology focuses on the physical forces a surgeon senses when pushing and pulling structures inside the body when operating from the da Vinci 5 surgeon console. This technology is made possible with sensors closest to where forces are exerted on tissue—near the instrument tips. With da Vinci Force Feedback, forces at the instrument tip are transmitted to the controllers so that the surgeon feels forces that match their visual cues and aid in gentler surgery.
Ultimately, force sensing technology wasn’t mature enough to be added to the original system, but the need and desire for it never went away. In the mid-2000s, a group of engineers began to research haptics and made the first prototype. By 2011, they’d expanded their efforts and recognized that haptics was going to require not only a solution with the instruments, but a solution integrated into the entire system. Since then, the project has gone through several iterations to yield the reliable, accurate sensor of today’s Force Feedback architecture—found in the Intuitive da Vinci 5.
Da Vinci 5 includes refined software and newly designed hand controllers in the surgeon console that allow the sensitive force information to be fully realized in the capabilities of Force Feedback instruments.
The short answer: it’s difficult. Incorporating Force Feedback technology in a way that is robust to surgical settings is a very challenging task.
And it was important to create it the right way. Reliably. Repeatably. And to be able to scale it for demand. Force Feedback is not technology for technology’s sake; Intuitive wanted to do it right.
David Robinson, vice president of Design Engineering, was able to ensure the Force Feedback team had the time, space, and creativity to develop the technology.
Robinson knows first-hand, over the course of his 17 years with Intuitive, the challenges of developing Force Feedback for da Vinci. But now, he says, Intuitive has done it right.
“There’s a lot of subtlety in the science of sensing the forces to begin with. And because it’s in such a small package, it’s very challenging not to have crazy little extra forces show up in the sensor signal,” Robinson said.
“With laparoscopic surgery, you get all of the forces associated with every other part of the surgery. There are a ton of forces that you feel in the cannula itself. With da Vinci 5, we are sensing where it matters—we’re sensing the tissue, and we’re taking that feeling and giving it back to the surgeon. They want to know: am I touching the tissue, and how, and with how much force? So we’re doing it right.”
Force Feedback technology is yet another tool in striving to make surgery as minimally invasive as possible.
“Gentle handling is the goal. Your organs aren’t meant to be touched,” Robinson said. “So we are reducing how much force we’re applying on the tissue.”
Lawton Verner is the director of Intuitive’s force sensing project and leads the Force Feedback engineering team.
“I’m in the fortunate position to have seen this project evolve over 14 years,” Verner said. “The company makes very early investments in fundamental technologies, where they think ‘Hey, this might be valuable. We don’t know, but we’re willing to take the risk and invest and see if it pans out.’”
He emphasizes that it took grit and perseverance to develop Force Feedback.
“It’s taken those years of iteration, and input from hundreds of people, to really solve this problem and distill the product down to something that not only meets our customers’ expectations from a performance and a field perspective, but also from a usability and reliability perspective.”
Intuitive values its engineers—investing in them, listening to them, and following their examples of leadership in product development and problem solving.
“We allow and expect folks to stretch. A mechanical engineer can push a software engineer and say, ‘Hey, can’t you do this slightly differently? Can you do it this other way?’ Because we’re all ultimately trying to solve a problem and deliver a product.”
Force Feedback adds to what Intuitive has already delivered in our da Vinci systems.
“We have great precision,” Verner said. “We have great control of the motion. When you sit down on the console without Force Feedback, you get high precision; you’re able to position and control what you’re doing very, very well. But you don’t have the connectivity of feeling what you’re actually doing to the tissue, and you’re having to use your visual cues to do that. Force Feedback takes it to another level.”
Skilled surgeons are extremely adept at using visual cues, and Intuitive is excited to help augment their talents by incorporating additional sensory information.
“When you sit down with the system that allows for Force Feedback, you just naturally get that information—and it’s being conveyed directly to you through the means that you would expect it to be, through your hands, feeling what you feel at the fingertip. And it just heightens your connection with the tissue, because you can understand the forces that you’re applying to it. And it just raises the level.”
The future state of Force Feedback is a place where Intuitive delivers even more fully on the sense of touch.
“The holy grail of sensing in surgery would be to have something like your fingertip on the end of those instruments, so that you get all of the same sensation that you’d have if your fingers were in the patient,” Verner said. “This is one step on that journey to give you the amount of force that you’re applying with the instrument tip. And as we continue to progress, adding more of those haptic sensations will be a natural progression.”
Believing in the impact of this new feature has been inspiring to the engineering teams.
“I’m a firm believer that this is going to help our surgeons have better outcomes and get more comfortable with the system faster. And that’s super motivating for me—to help deliver a product that’s intended to do that.”
Because the engineers are very forward-thinking, they know the arc of the work ahead.
“The next two to three years are already set. We know what we’ll be working on, and it’s not glamorous,” said Robinson.
The next three years will involve scaling the new technology to meet the demand for da Vinci 5.
And the team is confident that surgeons will see—and feel—the value of Intuitive’s breakthrough.
“We think Force Feedback is a fundamental technology that’s going to change the way surgery happens, and is something that can be really impactful for patients,” Verner said. “And we’ll put the work in, we’ll put the time and investment in to see it through and to launch it. And this is one of those stories.”
As always, patients come first—and Intuitive’s engineers have a singular focus when it comes to what they’re creating for surgeons and their patients.
“Surgeons are the heroes,” Robinson said. “This is the tool.”
Important safety information
For risks, contraindications, cautions, and warnings and full prescribing information, refer to the associated da Vinci 5 Surgical System user manual(s), or visit https://manuals.intuitivesurgical.com/market.
For summary of the risks associated with surgery refer to www.intuitive.com/safety.
Contraindication
Use of the force feedback needle driver is contraindicated in hysterectomy and myomectomy due to the risk of vaginal bleeding requiring hospital readmission and/or the need for additional procedures. The use of non-force feedback needle drivers is recommended for suturing in these procedures.
Precaution for Representative Uses
The demonstration of safety and effectiveness for the representative-specific procedures was based on evaluation of the device as a surgical tool and did not include evaluation of outcomes related to the treatment of cancer (overall survival, disease-free survival, local recurrence) or treatment of the patient’s underlying disease or condition. Device usage in all surgical procedures should be guided by the clinical judgment of an adequately trained surgeon.