Intuitive’s da Vinci 5 force feedback cuts surgical errors in pre-clinical studies

Two studies published late last year in Surgical Endoscopy suggest that a new force-sensing feature built into Intuitive Surgical’s latest da Vinci 5 robotic surgery system may help surgeons apply gentler, more controlled movements, regardless of experience level.

The feature, known as force feedback, allows surgeons to feel the amount of pressure being applied at the tips of their robotic instruments -- something not possible in previous generations of robot-assisted surgery systems.

Until now, surgeons have had to rely solely on visual cues to estimate force -- a workaround shown in studies to potentially lead to tissue damage, suture breakage or inconsistent technique.

In the first study, led by Dr. Andrew J. Hung, associate professor of urology and computational biomedicine at Cedars-Sinai Medical Center in Los Angeles, 29 novice surgeons -- each with fewer than 50 robotic procedures performed in the past five years -- were randomized into two groups, with or without force feedback.

The group using the feature applied significantly less force while suturing ex vivo porcine bladder and aorta models -- 1.71 newtons versus 2.40 newtons on bladder tissue (p<0.006), and 1.80 newtons versus 2.53 newtons on aorta (p<0.006).

They also made fewer errors (0.59 vs. 1.76 on bladder, p<0.001; 0.38 vs. 1.14 on aorta, p<0.001), completed tasks more quickly (659 seconds vs. 781 seconds on bladder, p=0.002; 460 vs. 570 seconds on aorta, p=0.001), and scored higher on the Robotic Anastomosis Competence Evaluation, or RACE (3.75 vs. 3.03, p=0.012).

“Suturing can be a unique challenge during robotic surgery because excessive force can break delicate sutures or injure healthy tissue, while insufficient forces might cause slippage or loose sutures,” Dr. Hung said in a March statement. “Force feedback could enhance the performance of surgeons and their suturing proficiency during robotic surgery.”

He added that now that its benefits have been observed in a pre-clinical setting, “we look forward to better understanding the impact on surgical performance and potential patient benefits.”

The second study, led by Dr. Michael M. Awad at Washington University in St. Louis, evaluated 28 surgeons performing three robotic tasks -- retraction, dissection and interrupted suturing -- on inanimate and ex vivo models, with force feedback toggled between off and multiple sensitivity settings.

At the highest sensitivity setting, maximum force was reduced by 36 percent during retraction, 41 percent during dissection and 55 percent during suturing, all statistically significant with p<0.0001. The force reduction was consistent across all experience levels, and the technology also decreased force variability across tasks.

“The lack of a way to measure the forces applied to tissue may result in excessive force exerted, leading to unintentional tissue damage during surgery, which could have a negative clinical impact on patients including pain and recovery time,” Dr. Awad said. He noted that the data suggest force feedback could help enable “gentler robotic surgery,” though more research is needed to understand its effect on real-world outcomes.

“These studies show early, pre-clinical and compelling evidence of the potential impact of force feedback technology across all surgeon experience levels,” added Dr. Myriam Curet, Intuitive’s chief medical officer.

Intuitive Korea introduced the da Vinci 5 in March 2024, making Korea the second country after the United States to adopt the platform following FDA clearance. The system includes the force feedback controller, an upgraded vision system and a redesigned console aimed at improving ergonomics and control.