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All rights reserved. Table of Contents 1 General Information. Operating Room. B Appendix B: Symbols Defined. It is not a reference for surgical techniques. See the da Vinci Xi System User Manual for more information on connecting the instruments to the system. For cleaning, disinfection, and sterilization of reusable instruments, accessories and components, refer to the appropriate da Vinci Xi Reprocessing Instructions.

Caution: Alerts the reader about a potentially hazardous situation which, if not avoided, may result in minor or moderate injury to the user or patient or damage to the equipment or other property. It may also be used to alert against unsafe practices. This includes the special care necessary for the safe and effective use of the device and the care necessary to avoid damage to a device that may occur as a result of use or misuse.

Warning: Alerts the reader about a situation which, if not avoided, could result in death or serious injury. Failure to properly follow all instructions, including instructions supplied with accessory devices like electrosurgical units and the applicable user manuals for the da Vinci Xi System may lead to injury and result in improper functioning of the device. Note: Read Knowing What Applies — Organization of this Manual page 2 to understand what portions of this manual apply to any specific instrument or accessory.

If information specific to an instrument or accessory is not included in this manual, Intuitive Surgical supplies it with that instrument or accessory. Clean and sterilize reusable devices before each use, unless they are not used within the sterile field.

Note: Use standard sterile technique for proper handling and cleaning of components that enter the sterile field. Unless otherwise specified, the information applies to both suites of instruments and accessories.

For specific information on instruments and accessories not covered in this manual, see the user documentation distributed with those products. Intuitive Surgical.

This chapter also provides information specific to EndoWrist and Single-Site instruments. Contact Information For Customer Service and Reporting of Complaints or Adverse Events Use the following information for customer service, including ordering, reporting complaints or adverse events, and general information regarding Intuitive Surgical or our products and services.

In the U. Intuitive Surgical, Inc. For Technical Support If the system requires maintenance or service, call our Technical Support line. In the US, call , where phones are staffed 24 hours a day, seven days a week. If you have questions regarding the use, cleaning, sterilizing, or storing of Intuitive Surgical devices used with the Intuitive Surgical da Vinci Xi System, contact Intuitive Surgical Customer Service at the phone number above.

Such items are specified in the relevant sections. Any other use of Intuitive Surgical instruments or accessories, whether before or after instrument or accessory expiration, including repair, refurbishment, remodeling or reconditioning, is strictly prohibited.

Use care when handling devices during setup and operation. Examine the instrument or accessory, including all of its components, thoroughly before and after each use. If any abnormality is found such as dents , do not use the instrument or accessory. Use the device for its intended purpose only.

Do not expose instruments to X-rays, radioactive rays or strong electromagnetic waves. Otherwise, the instrument may be damaged, making it unrecognizable to the system. Storage Between Uses After removing products from their packaging, store Intuitive Surgical instruments, accessories or components in a clean, dry, dark place. Care must be taken to protect the instrument tips from damage. Disposal When disposing of Intuitive Surgical instruments, accessories, or any of their components, follow all applicable national and local laws and guidelines.

The following sections provide general information such as part numbers and device names, intraoperative information, and troubleshooting. Clean and sterilize reusable Instruments before use.

For details see the da Vinci Xi Reprocessing Instructions. This allows for greater precision when operating in a minimally invasive environment. See the da Vinci Xi Reprocessing Instructions for cleaning and sterilization instructions.

Examples include graspers, cautery hooks, and blades. Release buttons one on each side A. Instrument housing D. Flush ports E. Cautery cord interface. Wrist H. Shaft F. Disks J. Maximum use indicator. Figure 2. Note: The discs can be rotated by hand when not attached to the sterile adapter to verify the cable functionality or align the wrist as applicable for instrument insertion. Refer to the da Vinci Xi System User Manual for more information on connecting the instruments to the system.

Doing so may damage the instrument and make it impossible to remove it from the cannula. For example, do not grasp tissue with clip appliers, which are made to hold and apply plastic ligation clips, or needle drivers, which are made to hold metallic needles. Energizing other endoscopic instruments may cause tissue damage inside or outside the field of view.

This damage could occur at points near the tip or at the port site cannula of the energized instrument. As with any endoscopic procedure, the surgeon should rely on visual cues to enhance force feedback. Ensure there is adequate room for instruments to move inside the patient and for the arms outside the patient to move without contacting the patient during the procedure.

Avoid mechanical shock or stress that can cause damage to the instruments. System compatibility with non-approved instrumentation cannot be guaranteed. This may result in damage to the instruments or other unintended consequences, such as disconnection of the instrument tip. ProGrasp from the cannula, release all tissues and approved third-party devices from the grips to avoid jamming between the device and cannula. Removing an instrument while grasping objects could cause jamming and make it impossible to remove the instrument from the cannula.

It is recommended to visualize the instrument tip under endoscopic view for removal. Avoid contact between instruments intraoperatively and do not use one instrument to apply force to another instrument inside the patient.

Do not allow debris to dry on or inside the instrument intraoperatively before instrument processing. In order to keep the instrument from drying when soiled, keep the instrument in water or an enzymatic bath between the surgical procedure and instrument processing. The instrument may also be flushed through the main flush port with sterile water during use to minimize buildup of internal deposits of bio-material.

Training provided by Intuitive Surgical is limited to the use of the da Vinci Xi System and does not replace the necessary medical training and experience required to perform surgery. Do not use an instrument if it is damaged. Before use, all instruments should be visually inspected for damage or irregularities.

Do not use the instrument if damage or abnormalities are observed. WARNING: Do not remove the cannula assembly and instrument from the body simultaneously as this may damage the surrounding tissues and the instrument. To clean an instrument intraoperatively, remove the instrument from the system and wipe the instrument tip with moist sterile gauze. This may damage the instruments or injure tissue inside or outside the field of view.

Note: If instruments cannot be manipulated in a precise and controlled manner, or if instrument motion appears to be non-intuitive, carefully remove the instrument and return the instrument to Intuitive Surgical. Contact Intuitive Surgical Technical Support immediately. Note: If, while operating, you move the hand controls and no instrument motion occurs, there may be an interference between instruments or instrument arms, or between an arm and the patient.

Resolve the interference before proceeding with the surgery. Note: In order to minimize residual soil on the instrument, keep the tips and wrist moist during intraoperative use.

Note: For further details and instructions on instrument installation, insertion, and removal, see the da Vinci Xi System User Manual. For details on intraoperative use of Single-Site instruments and accessories, see Chapter 3, Overview of Single-Site Surgery, section 3.

For details on intraoperative use of cannulae, see Chapter 9, Cannulae, Obturators, Reducer, and Cannula Seals, section 9. The instrument may not be immediately visible when being moved from the cannula into the patient. CAUTION: During instrument insertion using Single-Site instruments, including during Guided Tool Change, avoid excessive force as the tip could move beyond the intended position or the instrument could be damaged due to flexibility of the shaft.

Note: When using Guided Tool Change with Single-Site instruments, there could be a small lateral offset in the tip position of the newly inserted instrument due to the flexibility of the instrument shaft. For information on the 8 mm Instrument Introducer for use with EndoWrist instruments , see 8 mm Instrument Introducer in this chapter.

Before installing the instrument onto the sterile adapter and into a cannula, make sure the wrist is straight and close the tips if applicable. This will ensure easy insertion into the cannula and prevent damage to the instrument.

Do not fully close the Clip Applier, as this would prematurely lock the clip. Insert the instrument tip straight down into the cannula and press the instrument housing into the sterile adapter. Use caution and view the instrument tip with the endoscope when manually inserting an instrument into the patient.

Use care when inserting the instrument into the cannula to avoid catching the tip on the seal or cannula bowl, bending the shaft excessively or puncturing the arm drape with the instrument tip. Use the integrated flex strips to provide clearance for the instrument during insertion. Note: When Single-Site instruments are placed through a curved cannula, it is not necessary to use the built-in, 5 mm cap on the 5 - 10 mm Single-Site Cannula Seal PN to maintain insufflation.

Use of the cap can lead to increased friction. Any lateral pressure on the instrument during removal may damage, break or disconnect the tip or bend the shaft.