Leading the next generation of robotic surgery technology

From the console, Dr. Merritt controls the surgery and the operating room. He calls out what suture materials are needed next over a microphone.

The view through the console shows crisp, sharp visuals of the patient’s anatomy in 3D. The same images are shown on monitors throughout the operating room.

Dr. Merritt’s hands work the controls of the da Vinci 5 and his feet occasionally use the console’s pedals to divide a vessel that will be used to help connect the stomach with the esophagus.

Ohio State leads trials and testing of new surgical robot

The $3 million da Vinci 5 will soon be hitting the open market, and much of the credit goes to 10 Ohio State surgeons who helped usher the machine through clinical trials and FDA approval.

“This is the first robotic update for the system in a decade,” says Michael Meara, MD, MBA, associate professor of surgery in the Department of Surgery and medical director of robotic surgery at the Ohio State Wexner Medical Center. “From an under-the-hood standpoint, it’s a pretty massive leap forward.”

While robotic surgery isn’t new, some of the latest advances will be game-changing for both surgeons and patients.

Benefits of the new robot include:

• Less damage to patients’ tissue during surgery, leading to faster recovery times
• More precise surgical movements and technology
• Sharper surgical imagery
• Dynamic feedback to improve surgeon skills during training simulations
• 10,000 times more computing power
• Ohio State’s da Vinci 5, made by Intuitive, is only one of 10 operational models in the country and the first in the Midwest.

“Ohio State is certainly one of the busiest and highest volume robotic programs in the country,” Dr. Merritt says. “We have multiple surgical service lines that utilize robotic technology.”

Read how robotic surgery benefits lung cancer patients at Ohio State

Clinical trials conducted with patients showed the da Vinci 5 is safe for patients and performed just as well as previous surgical robots.

“We’re proud that the expertise of our clinical and research teams helped us be selected as one of the clinical trial sites for the latest da Vinci model.” Heidi Pieper, program director of Ohio State's Robotic and Minimally Invasive Surgery Program

Ohio State was the first institution to enroll in the trial and had the most patient participants. The first of 22 patients enrolled in December 2022 and the trial lasted for six months.

Cancer patients will continue to be monitored each year for five years to assess long-term outcomes.

“The trial went very well,” Dr. Merritt says. “The results were very good and our efforts in the study were instrumental in the FDA approving the da Vinci 5 robot.”

How the da Vinci 5 improves robotic surgery

During any type of surgery, surgeons handle delicate internal tissue and organs that must be cut or moved. The more tissue damage is reduced, the faster patients heal.

Tissue damage to patients is expected to be reduced by 43% compared to the previous model.

“There’s improved tactile feedback,” Dr. Merritt says.

Part of the latest upgrades include tremor controls for the surgeon, which make it a smoother and more precise system to use.

“The system will alert the surgeon when they’re exerting too much force on tissue, which certainly will result in less tissue damage. It will certainly translate to better patient outcomes,” Dr. Merritt says.

Additional updates could include incorporating advanced imaging, highlighting anatomic structures and even physically identifying cancer.

Better training for surgeons to become skilled at robotic surgery

Surgeons undergo extensive training before they step into their first robotic surgery. The da Vinci 5 can track every movement a surgeon makes while training and stores that information in a database.

It can develop algorithms that show the difference between precise expert surgeons’ movements and those of a novice.

Data show expert surgeons need far fewer movements to complete a surgery while less experienced surgeons tend to make more movements to complete the same surgery.

“One of the biggest barriers to robotic surgical training is training the eyes to learn what tissue tension ‘looks like’ versus how it feels in traditional surgical approaches,” Dr. Meara says. “The tactile feedback integrated into this new technology removes a big barrier for training. It alerts surgeons when there’s too much pressure, resulting in less tissue damage, and that translates to even more precise treatment at the bedside for the patient.”

Based on the surgeon’s technique, a da Vinci 5 simulator will recommend training in the areas the surgeon needs the most to improve.

“We can start drilling down on those particular skills in real time,” says Lori Welsh, robotic surgery education coordinator. “That’s very powerful. That’s data-driven education. They’re just scratching the surface with some of the data that we’re going to be getting.”

More than 100 people, including surgeons and operating room staff, were trained on the da Vinci 5 before the first surgeries.

“If the new robot is more efficient and easier for surgeons to use, then that will certainly translate into faster training, faster learning curves and then a faster simulation of the robotic skill set,” Dr. Merritt says.

A robot with a bigger brain

Many of the advances with the da Vinci 5 are ones that aren’t readily apparent.

“It’s really like jumping from like an iPhone 6 to an iPhone 15,” Dr. Meara says.

The new model has 10,000 times more computing power compared to the last model.

“It’s faster,” he says. “It’s able to perform tasks it could not do previously. It’s also able to grab and interpret information on the fly that maybe we couldn’t previously.”

Ohio State’s history of robotic surgery

That innovation is the latest chapter in the academic medical center’s storied robotics program dating back to 1999.

As of September, Ohio State had completed more than 30,000 robotic surgeries in a range of specialties including gynecology, urology, general surgery, thoracic, and surgical oncology.

This latest robot is one of 15 total robots in Ohio State’s surgical arsenal.

“Ohio State has always had the outlook of, ‘Where can we take this technology?’” Dr. Meara says.

Ohio State’s robotics program has 75 surgeons from over 12 surgical specialties, and is training more than 168 surgical residents and fellows per year.

A week out from surgery, the first da Vinci 5 patients are healing, and even more surgeries are underway.

“The surgeries went well,” Dr. Merritt says. “I think the goal is to use the robot in high-volume robotic centers, collect clinical trial data and then roll out the mass distribution of the robot in early 2025. Ultimately, that all translates to good patient outcomes.”