From Visual Haptics to Force-Controlled Robotic Surgery: Preliminary Clinical Experience Using the da Vinci 5 System in Colorectal Surgery-Case Series Study.

BACKGROUND

The absence of haptic feedback has been a fundamental limitation of robotic surgery. The da Vinci 5 (dV5) system is the first da Vinci platform to incorporate true force feedback (FFB), enabling real-time transmission of instrument-tip forces to the surgeon. However, the quantitative impact of FFB sensitivity settings remains unclear. This study represents the first Japanese clinical evaluation of dV5 FFB in colorectal surgery.

METHODS

We conducted a case-series analysis of 10 consecutive robotic colorectal cancer resections performed using the daV5 system by a single Japan Society for Endoscopic Surgery-certified surgeon. Instrument-tip force data (Newtons) from the first arm were extracted from system logs. Average forces were analyzed according to FFB sensitivity settings. Analyses were descriptive given the small sample size.

RESULTS

Under the medium sensitivity setting, the overall mean instrument-tip force was 1.68 N. Mean forces increased stepwise as sensitivity decreased: high 1.40 N, medium 1.68 N, low 2.60 N, and off 2.70 N, demonstrating a clear dose-dependent relationship (off/low > medium > high). Left-sided and rectal procedures tended to require slightly higher forces than right-sided colectomy. Transient force peaks were mainly attributable to instrument interference. No tissue injury was identified on video review.

CONCLUSIONS

FFB in the dV5 system may enable quantitative, sensitivity-dependent modulation of instrument-tip force during colorectal surgery. FFB reduced applied forces in a dose-dependent manner, supporting its role as a force-control mechanism rather than merely a sensory adjunct. However, its impact on tissue handling and clinical outcomes remains unclear, given the absence of grasping force evaluation.