Next-generation robotic surgery: insights on Da Vinci 5

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Abstract

INTRODUCTION

The development of robotic-assisted laparoscopic surgery has brought remarkable advancements to the world of minimally invasive surgery [1]. Da Vinci system (Intuitive Surgical, Sunnyvale, CA, USA) has continuously evolved from its first to the fourth generation, enhancing ergonomics and surgical intuitiveness while improving the efficiency of operating room workflows [2]. As robotic-assisted surgery has become more widespread, competitors have accelerated the development of related devices, with several products either released or pending release [3].

At this juncture, Intuitive Surgical has launched its new fifth-generation system, the Da Vinci 5 [4]. After its initial release in the United States in 2024 [5], it was introduced to three institutions in South Korea in December 2024, marking its first deployment outside the USA like the Da Vinci Xi, it is a multi-port device featuring a boom with a gantry shape. While its basic operating mechanism remains similar to the fourth generation, numerous enhancements have been made to perform surgeries more safely, efficiently, and intuitively. This editorial summarizes these changes and their clinical applications based on initial experiences with the Da Vinci 5.

VISION

The Da Vinci 5 offers significantly improved vision compared to its predecessors. In addition to superior image quality, adjustments to color saturation allow clearer identification of fine vascular structures. The system comes equipped with the Intuitive Hub (Intuitive Surgical), enabling surgeons to record surgical footage securely. To protect the privacy of the surgical team and hospital environment, the display automatically blurs when the camera is undocked (Fig. 1). Moreover, the camera's movement feels smoother than in previous models, enhancing surgical precision.

Fig. 1.

Automatic blurring for privacy protection. The left image shows the actual surgical screen, while the right image demonstrates the automatic blur effect applied by the Intuitive Hub (Intuitive Surgical, Sunnyvale, CA, USA) when the camera is undocked.

SMOKE EVACUATION

A newly added auto smoke evacuation feature efficiently removes smoke generated during electrocoagulation. The endoscope tip now includes an integrated heater to reduce lens fogging, significantly improving intraoperative visibility and reducing the need for camera cleaning. This improvement is particularly noticeable in surgeries that rely heavily on electrocoagulation, enhancing efficiency and reducing surgeon stress.

GUIDE TOOL CHANGE

The guide tool change indicator, previously displayed as a linear overlay along the screen edges, has been replaced with circular markers indicating arm numbers. Directional arrows now show the trajectory of instrument entry more intuitively (Fig. 2). The system also retains the memory function for instrument positions, with white lines and circles indicating previous insertion points and tips. This helps confirm safe re-entry positions, minimizing unnecessary tissue damage and assisting surgical staff.

Fig. 2.

Guide tool change interface. The left image displays circular markers indicating arm numbers and directional arrows for intuitive identification of instrument entry points. The right image shows the recorded insertion path of the previously positioned instrument.

ERGONOMIC CONSOLE

While the console retains its recessed design, a major improvement lies in the adjustable head unit. Unlike previous integrated models, the head section is now separable, allowing for individualized adjustments that enhance ergonomic comfort (Fig. 3). This reduces neck and back strain, especially during prolonged procedures.

Fig. 3.

Ergonomic console with adjustable head unit. The head section is now separable, allowing for individualized adjustments to reduce neck and back strain during prolonged procedures.

E-200 GENERATOR

Replacing the Erbe generator (Erbe Elektromedizin GmbH, Tübingen, Germany) used in previous models, the Da Vinci 5 features proprietary E-200 generator of Intuitive Surgical. Building on the improved coagulation speeds seen with the E-100 (Intuitive Surgical), the E-200 offers even faster performance. Unlike the previous five-level intensity settings, the E-200 adopts a watt-based control system, allowing for more precise adjustments and easier comprehension for surgeons accustomed to traditional electrosurgical units.

DIGITAL SWAP

While the traditional pedal clutch for arm swapping remains, the Da Vinci 5 introduces a digital swap feature. By double-clicking the finger clutch, surgeons can swap arms directly on the monitor (Fig. 4). This eliminates awkward wrist angles during swaps and allows for simultaneous switching of both left and right arms, enhancing procedural fluidity without console pad adjustments.

Fig. 4.

Digital swap functionality. Surgeons can swap arms directly on the monitor by double-clicking the finger clutch, improving procedural fluidity without the need for console pad adjustments.

HEAD-IN MENU

Many functions previously controlled via the console pad can now be managed through the head-in menu, activated by a new pedal button (Fig. 5). Surgeons can adjust insufflation, electrical settings, and camera angles without breaking focus, maintaining seamless surgical concentration.

Fig. 5.

Head-in menu for direct control. Many functions previously managed via the console pad can now be accessed through the head-in menu, activated by a new pedal button, enabling seamless surgical adjustments.

FORCE FEEDBACK

One of the most significant advancements in the Da Vinci 5 is the introduction of force feedback. Addressing the long-standing limitation of robotic-assisted surgery -the lack of tactile sensation-this feature reduces tissue trauma by decreasing applied force by 43%. It also records force data for potential research applications. In gynecologic surgery, it aids in identifying fibroids within the deep myometrium, dense fibrosis from endometriosis, and prevents suture breakage due to excessive tension.

CONCLUSION

The Da Vinci 5 boasts a computing power 10,000 times greater than its predecessors. However, current functions utilize only about 10% of its capacity. Future software updates are expected to unlock more features, further enhancing surgical safety and efficiency.

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