Surgical robots: da Vinci, Hugo, Versius and single-port systems
The surgeon sits at a console and moves wristed instruments through keyhole ports while a 3D camera shows the inside of the body magnified. Intuitive's da Vinci has dominated for two decades; Medtronic's Hugo and CMR's Versius are the first serious rivals, and single-port robots work through one incision.
Overview
Intuitive Surgical's da Vinci was cleared in 2000 and grew into the standard for robotic prostatectomy, hysterectomy, partial nephrectomy, colorectal, lung and increasingly pancreatic and gastric cancer surgery. The current Xi and da Vinci 5 systems add force feedback, integrated table motion and firefly fluorescence imaging; the SP model passes a camera and three instruments through a single 2.5 centimetre port, used in transoral and urological surgery. Medtronic's Hugo RAS, CE marked in 2021, uses separate modular arm carts and an open console; CMR Surgical's Versius, from Cambridge, is a compact modular system with small arms that received US authorisation in 2024; Johnson & Johnson's Ottava is in clinical trials, and Chinese systems from MicroPort MedBot and Edge Medical are entering their home market. Bronchoscopy robots (Intuitive Ion, Johnson & Johnson Monarch) are a separate family covered under robotic bronchoscopy.
Across cancer surgery the robot gives shorter stays, less blood loss and fewer conversions than laparoscopy in difficult pelvises, with cancer outcomes generally equivalent to open surgery, the LACC trial in early cervical cancer being the important exception. Costs are high, haptic feedback is only now arriving, and competition is expected to lower prices more than to change what the machines can do.
- Patient-side cart
- Wristed instrument arms
- Target through 8 mm ports
How it works
Tele-manipulated wristed instruments and a stereoscopic endoscope pass through ports; the console scales and filters the surgeon's hand movements so complex minimally invasive resections can be performed with magnified 3D vision.
- Precision and 3D vision in confined spaces
- Shorter stay and less blood loss than open surgery
- Competition from Hugo, Versius and single-port designs
- Capital and per-case cost
- Limited haptic feedback on most systems
- Not superior for every indication, worse in early cervical cancer
Latest papers
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