Manual de Skills Simulator

DRAFT/PRE-RELEASE/CONFIDENTIAL
Skills Simulator for the
User Manual
PN 551026-06 Rev. A 2013.10
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Copyrights
© 2013 Intuitive Surgical, Inc. All rights reserved.
MSim™ provided by Mimic Technologies, Inc.
© 2009-2012 Mimic Technologies, Inc. All rights reserved.
PhysX® Technology provided under license from NVIDIA Corporation.
© 2002-2012 NVIDIA Corporation. All rights reserved.
Trademarks and Attribution

Intuitive, Intuitive Surgical, Beyond the Limits of the Human Hand, da Vinci, da Vinci S, da Vinci Si,
EndoWrist, TilePro, InSite, and OnSite are trademarks or registered trademarks of Intuitive
Surgical, Inc.
Mimic is a registered trademark of Mimic Technologies, Inc.

10/29/13
MSim and MScore are trademarks of Mimic Technologies, Inc.

PhysX is a registered trademark of NVIDIA Corporation.
Simbionix is a registered trademark of Simbionix USA and Simbionix, Ltd.

Other parties’ trademarks are the property of their respective owners and should be treated as
such.
Equipment and Software Version

This user manual provides technical information about the use and operation of the da Vinci
Skills Simulator. The equipment described herein is designed to work with the Skills Simulator
software version v8.1 and later.
The da Vinci Skills Simulator is powered by MSim by Mimic Technologies, Inc., which makes use
of PhysX by NVIDIA Corporation.
Skills Simulator for the da Vinci® Si™

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Terms and Conditions of End User Software License Agreement
1 LICENSE. The software (“Software”) embedded within the da Vinci Skills Simulator (“System”) and the accompanying
documentation (“Documentation”) are provided under license and are not sold to buyer. Intuitive Surgical, Inc.
(“Intuitive”) grants to buyer a non-exclusive, non-transferable, fully-paid, restricted license to (a) install and use the
Software solely as incorporated in the System in machine-executable object code form and solely in connection with the
operation of the System as described in the Documentation, and (b) use the Documentation for such Software solely for
the purpose of using the Software in compliance with this license. At no additional cost, Buyer will be entitled to Software
updates when such updates are made generally available without cost to other licensees of the Software. Any software
upgrades or enhancements which are not made generally available at no cost to other licensees will be offered to Buyer at
Intuitive's then current list prices.

2 RESTRICTIONS.
(a) Buyer shall not (i) use, copy, translate, modify, create derivative works of, or transfer, (ii) merge with any other
product, (iii) sublicense, lease, rent, loan, or otherwise transfer, (iv) reverse engineer, decompile, disassemble, attempt to
derive the source code for, or otherwise manipulate, or (v) disclose, permit to be disclosed or publicly display or perform,
the Software, in whole or in part, or any copy thereof. Notwithstanding the foregoing, manipulation of the Software is
permitted if, and then only to the extent that, the foregoing prohibition on manipulation is required to be modified by
applicable law; provided, however, that buyer must first request from Intuitive the information to be sought from the
Software, and Intuitive may, in its discretion, provide such information to buyer under good faith restrictions, and/or
impose reasonable conditions, including but not limited to a reasonable fee, on such use of the Software, to ensure that
Intuitive’s and any third party’s proprietary rights in the Software are protected.
(b) Buyer may make a reasonable number of backup and archival copies of the Software as necessary to support the
use of the Software in connection with the balance of the System, but shall not otherwise copy the Software under any
circumstances. Buyer may not alter, obscure or remove any copyright, trademark, proprietary rights, disclaimer, or
warning notice included on or embedded in any part of the Software (including those of third parties).
1 OWNERSHIP. The Software is licensed, not sold, to buyer. There is no implied license, right or interest granted in any
copyright, patent, trade secret, Trademark, invention or other intellectual property right.
10/29/13
2 TERM. This license will begin on the date the Software is delivered to buyer, and will continue until the end of the useful
life of the System. Notwithstanding the foregoing, this license shall terminate immediately upon written notice to buyer
by Intuitive if buyer materially breach any term or condition of this license. Buyer agrees upon termination to promptly
discontinue all use of and destroy the Software and all copies thereof (whether in tangible form or as installed on buyer
equipment).
3 EXPORT LAW. The Software and related technology are subject to U.S. export control laws and may be subject to export
or import regulations in other countries. Buyer agrees to strictly comply with all such laws and regulations and
acknowledge that buyer have the responsibility to obtain such licenses to export, re-export or import as may be required.
4 U.S. GOVERNMENT BUYERS. The Software is a “commercial item” as that term is defined at 48 C.F.R. 2.101, consisting of
“commercial computer software” and “commercial computer software documentation” as such terms are used in 48 C.F.R.
12.212. Consistent with 48 C.F.R. 12.212 and 48 C.F.R. 227.7202-1 through 227.7202-4, all U.S. Government end users
acquire the Software with only those rights set forth therein.
_________________________________End of section______________________________

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Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1
•1.1 User Manual Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1
•1.2 Skills Simulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2
• Surgeon Console Required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2
• Skills Simulation Software by Mimic, MSim and MScore. . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
• Suture Skills Simulation Software by Simbionix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
•1.3 General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

• Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
• Compliance and Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
• System Label. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4
• Power Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
• Environmental Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5
•1.4 Intended Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6
•1.5 Simulation Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6
• Surgeon Console Performance with Skills Simulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-6
• Persistent Settings on the Surgeon Console . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8
•1.6 General Precautions, Warnings, and Contraindications . . . . . . . . . . . . . . . . . . . . 1-8
• Installation and Service Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
• Laser Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
• Transportation and Storage Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9
• Accessory Equipment Interconnection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10
• Disconnect Skills Simulator During Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10
•1.7 Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-10
• EMC Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-12
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•1.8 Disposal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-15

• Battery Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-15
2 Connections, Startup, and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

•2.1 Mount the Skills Simulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1
•2.2 Connect the Skills Simulator Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4
• Skills Simulator Cable Layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4
• Skills Simulator Short Fiber Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-4
• Skills Simulator Audio Cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6
• AC Power Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6
• Optional Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-6
•2.3 Power On the Skills Simulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-7

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•2.4 Skills Simulator Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9
• Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9
• Default User Log In. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-9
• Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-11
• Navigating Through the Simulator Screens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13
• Exiting an Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-13
• Simulation Screen Instructions and Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-15
• Administrator Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-16
3 Onboard Simulator Administrator and Reports Guide . . . . . 3-1

•3.1 Onboard Simulator Administrator Overview and Log In. . . . . . . . . . . . . . . . . . . . 3-1
• Administrator Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-1
• Administrator Log In . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2
•3.2 Onboard Simulator Administrator Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4
•3.3 Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7
4 Simulation Software by Mimic Technologies. . . . . . . . . . . . . . 4-1

•4.1 Exercise Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1
• Quiz Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1
• Mimic Simulation Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1
•4.2 General Exercise Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
•4.3 Simulation Exercise Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
• Surgeon Console Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2
• Camera and Clutching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3
• Energy and Dissection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7
• Needle Driving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-9
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• EndoWrist Manipulation 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12

• EndoWrist Manipulation 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-14
• Needle Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-16
• Games . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-17
•4.4 Exercise Scoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-20
• MScore™. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-20
• Results per Metric . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-24
•4.5 Simulator Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-25
• Camera Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-25
• Grasp Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-26
• Handoff Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-26
• Energy Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-27
• Pass Targets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-27
• Needle Targets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-28
5 Suturing Skills Simulation Software by Simbionix . . . . . . . . 5-1

•5.1 Suturing Skills Exercise Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-1

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•5.2 General Exercise Tips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-2
• Suturing Constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-3
• Enhanced Suturing Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-4
• General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-5
•5.3 Suturing Skills Exercise Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6
• Suturing Skills. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-6
•5.4 Scoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-10
• Achievement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-10
6 Sleep Mode, Shut Down, Disconnection, Maintenance. . . . . 6-1

•6.1 Sleep Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-1
•6.2 Shut Down. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2
•6.3 Preparation for Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2
• Disconnect Cables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-2
• Remove the Skills Simulator From the Surgeon Console . . . . . . . . . . . . . . . . . . . . . . . . . 6-4
•6.4 Skills Simulator Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-4
• Cleaning the Skills Simulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-5
A Appendix A: da Vinci® OnSite® for Skills Simulator . . . . . . . . A-1

•A.1 General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-1
• Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1
• General Precautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1
• Intended Use – da Vinci OnSite for Skills Simulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-1
• Power Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2
• Network Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2
•A.2 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-2
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• System Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

• Wired Network Connection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-3
• Wireless Connectivity Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5
• Wireless Adapter Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5
• Wireless Network Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-5
• Devices Known to Interfere. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-6
• Addressing Wireless Connectivity Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7
• Disabling Network Connectivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7
• Electromagnetic Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-7
• Wireless Adapter Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-9
•A.3 Remote Skills Simulator Software Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-11
• Disabling Network Connectivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-13
•A.4 IT Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-13
• Internet Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-13
• Proxy Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-13
• Firewall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-13
• Network Topology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A-13

vii
B Appendix B: Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1
•B.1 Setup Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-1
•B.2 Reboot the Skills Simulator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-2
C Appendix C: Specifications, Symbols, Glossary . . . . . . . . . . . C-1

•C.1 Environmental Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-1
•C.2 Box Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-1
•C.3 Symbols Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-2

•C.4 Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-3
_________________________________End of section______________________________
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1-1 Introduction
1 Introduction
1.1 User Manual Organization

This user manual provides information specific to the use of the da Vinci Skills Simulator
(Model: SM3000). The operating instructions and feature descriptions herein are specific to
the software version listed on page ii.
Note: The Skills Simulator is compatible with both the da Vinci Si and Si-e Surgical
Systems. The da Vinci Si-e is an optional configuration for the da Vinci Si System.
Note: This manual addresses the Skills Simulator specifically. For details regarding
the da Vinci Si (or Si-e) Surgical System, its components, instruments or accessories,
refer to the da Vinci Si Surgical System User Manual, PN 550650.
Note: For information specific to Skills Simulator Manager (Sim Manager) software,
see the Skills Simulator Manager User Manual, PN 551116.
Note: Before using the Skills Simulator with Sim Manager, verify that the
Sim Manager software has received the available upgrades to ensure compatibility.
This user manual is organized for quick reference and ease of use. A brief introduction,
overview and connection guide, power on, user interface instructions, and a system software
overview followed by troubleshooting guide, will get you up and running.
The manual consists of the following sections:
• Chapter 1 Introduction (the section you are reading now): Contains regulatory and safety
information that should be read by every user of the Skills Simulator. Includes general
precautions, power information and related information.
• Chapter 2 Connections, Startup, and Use: Explains how to connect power, system cables,
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and optional devices to the Skills Simulator, as well as how to start up and begin using the
system, and how to navigate the user interface.
• Chapter 3 Onboard Simulator Administrator and Reports Guide: Provides information on
the Administrator function and the Simulator reports feature.
• Chapter 4 Simulation Software by Mimic Technologies: Contains software information
including user interface, exercise and scoring information.
• Chapter 5 Suturing Skills Simulation Software by Simbionix: Contains software
information for suture skills exercises including user interface, exercise and scoring
information.
• Chapter 6 Sleep Mode, Shut Down, Disconnection, Maintenance: Explains how to shut
down, store, clean and maintain the Skills Simulator.
• Appendix A: da Vinci® OnSite® for Skills Simulator: Contains information for Simulator
systems that have automatic updates enabled using da Vinci OnSite®.
• Appendix B: Troubleshooting: Provides remedies to setup issues.
• Appendix C: Specifications, Symbols, Glossary: Contains the reference material that is
indicated by its title.
• An Index at the end helps you find the information you want.

Introduction 1-2
1.2 Skills Simulator
The Skills Simulator (Model: SM3000) is the electronic hardware (backpack) that interacts with
the Surgeon Console to provide the virtual platform for surgical skills simulation exercises.
Intuitive Surgical designed the Skills Simulator to enable surgeons to use the Surgeon Console
to practice the basic skills and techniques needed to control the instruments in preparation to
perform surgical procedures with the da Vinci Si Surgical System. Intuitive Surgical and
Mimic Technologies collaboratively designed the simulation exercises using MSim, Mimic’s
proprietary surgical simulation platform that enables realistic training scenarios.
Intuitive Surgical and Simbionix collaboratively designed the suture skills exercise simulation
platform enabling realistic suturing scenarios.
The Skills Simulator mounts on the back of a da Vinci Si Surgeon Console, as shown in Figure
1.1. See section 2.1 Mount the Skills Simulator for mounting instructions.
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Back of Surgeon Console Skills Simulator mounted on back of Surgeon Console
Figure 1.1 Skills Simulator mounted on Surgeon Console
Surgeon Console Required

A da Vinci Si Surgeon Console is required to use the Skills Simulator (Model: SM3000). When
the Skills Simulator is mounted on the back of the Surgeon Console, you can sit at the Surgeon
Console and control the virtual 3D endoscope and virtual EndoWrist® instruments by means of
the master controllers and foot pedals. Refer to the da Vinci Si user manual for information
regarding the Surgeon Console controls you use in the Skills Simulator exercises. Components
of interest may include the master controllers, stereo viewer, left and right-side pods,
touchpad and footswitch panel.
CAUTION: The Skills Simulator is only designed to work with the Surgeon Console,
and it will not work with any other components of the da Vinci Si Surgical System.
Connecting the Skills Simulator to the Vision Cart will trigger the safety system, and
may impact system behavior during surgery, cause delay due to conversion, and
cause excess trauma to the patient from conversion.

1-3 Introduction
Skills Simulation Software by Mimic, MSim and MScore

This manual addresses skills simulation software powered by MSim provided by Mimic
Technologies for use on the Skills Simulator. For skills simulation software features and details
on MSim surgical simulation platform and MScore performance evaluation, refer to Chapter 4
Simulation Software by Mimic Technologies.
Suture Skills Simulation Software by Simbionix

This manual addresses Suturing Skills Simulation software developed by Simbionix for use on
the Skills Simulator. For Suturing Skills simulation software features and performance
evaluation details, refer to Chapter 5 Suturing Skills Simulation Software by Simbionix.
1.3 General Information
Contact Information
For Customer Service and Reporting of Complaints or Adverse Events
Use the following information for ordering, or for reporting complaints or adverse events; and
for general information regarding Intuitive Surgical or our products and services.
Intuitive Surgical, Inc. Intuitive Surgical Sàrl
1266 Kifer Road 1, chemin des Mûriers,
Sunnyvale, CA 94086 USA 1170 Aubonne
Toll free: 1.800.876.1310 Switzerland
Direct: 408.523.2100 Toll free: +800.0821.2020
Fax: 408.523.2377 Direct: +41.21.821.2020
Fax: +41.21.821.2021
Manufacturer
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Intuitive Surgical, Inc. Intuitive Surgical Sàrl

Sunnyvale, CA 94086 USA 1, chemin des Mûriers,
www.intuitivesurgical.com 1170 Aubonne Switzerland
For Technical Support

If the system requires maintenance or service, please call our Technical Support line. In the
U.S., call 1-800-876-1310, where phones are staffed 24 hours a day, seven days a week. In
Europe, call +41.21.821.2020.
Compliance and Classifications

The Skills Simulator is in conformance with the Medical Device Directive, 93/42/EEC.
The Skills Simulator is designed to be in compliance with IEC 60601-1, with the following
mode of operation, and type and degree of protection against electric shock.
• Mode of Operation: Continuous
• Type of Protection: Class I
• Degree of Protection: The Skills Simulator has no patient applied parts.
• Ingress Protection: Ordinary (IPX0).
The Skills Simulator is manufactured in the USA.

Introduction 1-4
The system components may have a label as represented in Figure 1.2 and Figure 1.3.
For labels as represented in Figure 1.2 (IEC 2nd Edition) the Skills Simulator is classified with
respect to electric shock, fire and mechanical hazards only in accordance with UL60601-1 and
CAN/CSA C22.2 No.60601-1. Also classified by UL only to IEC publication(s) 60601-1,
60601-1-1.
For labels as represented in Figure 1.3 (IEC 3rd Edition) the Skills Simulator is classified with
respect to electric shock, fire and mechanical hazards only in accordance with ANSI/AAMI
ES60601-1 (2005), CAN/CSA-C22.2 No. 60601-1 (2008), and the references covered under the
above statement.
The Skills Simulator, also referred to as the da Vinci Skills Simulator, is used in conjunction with
the Surgeon Console, Model SS3000.
The Surgeon Console, Model SS3000 also has been evaluated for compliance with standards
referenced above by a Nationally Recognized Test Laboratory (NRTL), Underwriters
Laboratories, Inc. (UL).
System Label
Note: This user manual identifies labels as they appear on systems configured for
destinations in the USA. The languages supplied on labels may vary by the country
or countries for which a system is configured.
Note: The unit identification label includes the serial number and date of
manufacture. It may be necessary for the reader to be as close as 6 in (15 cm) from
the label to read this information.
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Space reserved for unit identifiers

(on all system labels)
Figure 1.2 System Labels: IEC 2nd Edition

1-5 Introduction
Space reserved
for unit identifiers
Figure 1.3 System Labels: IEC 3rd Edition
Power Requirements
The Skills Simulator requires electrical power independent of the Surgeon Console. To ensure
optimum performance, make sure the Skills Simulator is connected to a noise-free and
well-grounded AC power outlet. If the branch circuit supplying the Surgeon Console powers
no other loads, it is acceptable to power the Skills Simulator from the same branch circuit.
The Skills Simulator automatically adapts to 100VAC, 120VAC, or 230VAC. (This is called “Auto
Sense” in table 1-1 below.) Please refer to the electrical rating label on the Skills Simulator.
Table 1-1 Power Requirements
System Component Voltage Rating
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100/120/230V~
Skills Simulator 50/60Hz 500VA Continuous
Auto Sense
Environmental Specifications
Table 1-2 Environmental Specifications
Environmental Conditions: Operating
Temperature: 10 to 30 °C (50 to 86 °F)
Humidity: 10 to 85% non-condensing
The Skills Simulator shall function properly in atmospheric pressures
ranging from 523mm HG (10,000 ft) to 774mm HG (-500 ft). For every
1000 feet above sea level, the 30 ºC operational temperature limit
Atmospheric Pressure:
specified above will be reduced by 1 ºC. (For example, the maximum
operating temperature at 5000 feet will be 25 ºC, and the maximum
operating temperature at 10,000 feet will be 20 ºC.)

Introduction 1-6
Environmental Conditions: Storage and Transport

Temperature: -10 to 55 °C (14 to 131 °F)
5 to 95% non-condensing for transport
Humidity:
10 to 85% non-condensing for storage
Note: Storage and transport of the system are not affected by atmospheric pressure.
1.4 Intended Use

The Skills Simulator is intended to be a practice tool that includes a variety of exercises and
scenarios to give a user the opportunity to improve his or her dexterity with the Surgeon
Console controls. The Skills Simulator is intended to augment, not replace, existing training
programs for the da Vinci Si Surgical System. Successful completion of the exercises is not
intended to convey readiness for surgery nor endorsement by Intuitive Surgical of a user's skill
level.
1.5 Simulation Performance

The Skills Simulator recreates the experience of using the full configuration of a da Vinci Si
System. Although every effort has been made to ensure that the behavior of the virtual
instruments is identical to the behavior of real instruments, some aspects of the simulation,
such as the responsiveness of the instruments, may be different than what a user will
experience on the full configuration of a da Vinci Si System.
Surgeon Console Performance with Skills Simulator

Certain features of the Surgeon Console are not available, or behave differently, when they are
in use with the Skills Simulator.
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• When real instruments and simulated Simbionix instruments reach an end-of-movement

limitation, the master controllers of the Surgeon Console will react with a corresponding
end-of-movement limitation. However, when performing Mimic simulation exercises with
Skills Simulator, the master controllers do not convey this end-of-movement limitation.
• While the full set of system settings in the touchpad controls are available when the
Surgeon Console is connected to the Skills Simulator, settings that affect the
performance of the Patient Cart and the Vision Cart do not perform as they would on the
full configuration of a da Vinci System.
The information in Table 1-3 Touchpad settings identifies whether a Surgeon Console
touchpad feature is supported by the Skills Simulator software.
Table 1-3 Touchpad settings
Touchpad Feature Supported (Yes or No)
Yes* (Console log in is independent from
1. Login
Simulator log in)
2. Video
Brightness adjustment No
2.1 Advanced Video Adjustment
Brightness No
Contrast No

1-7 Introduction
Touchpad Feature Supported (Yes or No)

Red No
Yellow No
Edge enhancement No
Illuminator No
Restore factory settings No
2.2 Camera / Scope Setup
Illuminator on/off No
White balance No
Auto-calibration No
Up/down/left/right arrows (related to
No
calibration)
Scope selection No
2.3 Display Preferences
Digital Zoom No
TilePro No
Viewer mode Yes* (All navigation menus are 2D only)
Telestration eye No
Image depth Yes
3. Audio
Sound level Yes
Mute No
4. Utilities
4.1 Control preferences
Scaling Yes
Finger clutch enable Yes
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TilePro QuickClick No
Haptic zoom No
Master associations No
4.2 Account Management Yes
4.3 Inventory management No
4.4 Event logs Yes
5. Lock Tools Yes

Introduction 1-8
Persistent Settings on the Surgeon Console
If any of the following settings are adjusted on the Surgeon Console while using the Skills
Simulator, they will be stored on the current (or most recent) user’s profile and will persist after
the system is shut down.
Video
• Brightness adjustments
• Advanced Video Adjustments
• Brightness
• Contrast
• Red
• Yellow
• Edge enhancement
• Restore factory settings
• Display Preferences
• Digital zoom
• TilePro
• Viewer mode
• Telestration eye
• Image depth
Audio
• Sound level
• Mute
Utilities
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• Control Preferences
• Scaling
• Finger clutch enable
• TilePro QuickClick
• Haptic zoom
• Account management
1.6 General Precautions, Warnings, and Contraindications

The Skills Simulator is to be used in accordance with this manual. Read all instructions
carefully. Failure to properly follow instructions, notes, cautions, warnings and danger
messages associated with this equipment may lead to serious injury or equipment damage.
While these messages appear throughout the manual, this chapter provides some general
precautions.
WARNING: No modification of this equipment is allowed.
WARNING: To avoid risk of electric shock, this equipment must only be connected to
a supply mains with protective earth.

1-9 Introduction
CAUTION: Equipment is not suitable for use in the presence of a flammable

anesthetics mixture with air, or with oxygen, or nitrous oxide.
Installation and Service Precautions

CAUTION: The Skills Simulator may be serviced only by Intuitive Surgical personnel.
DO NOT attempt to service equipment without Intuitive Surgical personnel. To
reduce risk of electric shock, DO NOT open or remove covers except as instructed in
this user manual.
Laser Safety
Class 1 Laser Product: The Skills Simulator circuit boards may be equipped with optical
communication transmitters, which have been evaluated and found to be in compliance with
requirements found within 21 CFR (FDA-CDRH) and EN 60825-1 for Class 1 laser devices.
CAUTION: While Class 1 laser products are considered to be “eye safe” without the
need for additional protection, when working around the circuit boards, the
following general safety guidelines should be observed to reduce the risk of eye
injury:
• Do not look or stare at optical fiber ports or optical fibers that are connected to a light
source.
• Do not examine with optical instruments optical fiber ports or optical fibers that are
connected to a source. The use of optical instruments (for example, a magnifying glass)
may increase eye hazard.
• Adjustments and settings, maintenance, operational parameters and procedures other
than those specified and allowed herein and on the rating plate of the Skills Simulator
may result in increased eye hazard.
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• Do not attempt to perform any repair or maintenance on optical communications

components. Repairs and maintenance outside that which is allowed herein must be
performed only by an authorized repair facility.
Transportation and Storage Precautions

The Skills Simulator is a portable accessory intended to be mounted on the Surgeon Console
as described in Chapter 2 Connections, Startup, and Use. To move the Surgeon Console,
release both brakes. Always use the handles on the sides of the Surgeon Console to move the
Console.
Note: The Skills Simulator weighs approximately 14 kg (33 lbs). To protect your back,
bend at the knees, and/or get help when picking up, moving, mounting, or
dismounting the Skills Simulator.
Note: Remove the Skills Simulator from the Surgeon Console if the Console is
transported through doorways that are less than 106.7 cm (42”) wide.

Introduction 1-10
Accessory Equipment Interconnection
Accessory equipment connected to the analog and digital interfaces must be certified to the
respective IEC standards (that is, IEC 60950 for data processing equipment and IEC 60601-1 for
medical equipment). All configurations shall comply with the system standard IEC 60601-1-1.
Anyone connecting additional equipment to the signal input part or signal output part
configures a medical system, and is therefore responsible for ensuring that the system
complies with requirements of the system standard IEC 60601-1-1. If you have any questions,
please contact your Intuitive Surgical representative.
CAUTION: Leakage current from interconnected electrical equipment may exceed

safe levels. In order to maintain patient and user safety, it is important to
interconnect only with devices in compliance with IEC 60601-1 requirements. It is
the responsibility of the user to ensure that any interconnected equipment not
supplied by Intuitive Surgical maintains compliance with IEC 60601-1-1
requirements.
Disconnect Skills Simulator During Surgery

CAUTION: The Skills Simulator is not intended to be used while performing surgery
with the da Vinci Si Surgical System, and you must disconnect the blue fiber cable
and the audio cable between the Skills Simulator and the Surgeon Console during
surgery. To minimize power consumption and OR circuit loads, you should also
disconnect the Skills Simulator from the wall outlet during surgery.
Note: It is not necessary to dismount the Skills Simulator from the Surgeon Console
during surgery, only to disconnect it as described above.
Note: Use the power switch to disconnect the Skills Simulator from mains power. To
completely isolate the Skills Simulator from AC mains, disconnect the power cord
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from the AC power outlet.
1.7 Electromagnetic Compatibility

The Skills Simulator has been tested and found to be in compliance with IEC 60601-1-2,
International standard for Medical electrical equipment - Part 1-2: General requirements
for basic safety and essential performance - Collateral standard: Electromagnetic
compatibility - Requirements and tests. It is intended to be used in an operating room
environment, and operation of the Skills Simulator is unaffected when used in the
electromagnetic environment as specified in Tables 2 through 4 below in this section 1.7
Electromagnetic Compatibility. Special precautions and installation information for the Skills
Simulator for electromagnetic compatibility (EMC) are provided in this section.
The performance of the Skills Simulator is unaffected when exposed to full range of
electromagnetic environment as described in the IEC 60601-1-2 standard. There is no
degradation of performance and therefore no risks to the patient or other devices due to
Electromagnetic Interference (EMI) when used in the electromagnetic environment as
specified in Tables 2 – 4 below in this section 1.7 Electromagnetic Compatibility.

1-11 Introduction
Use only Intuitive Surgical-branded interconnection cables and accessories. Performance of

cables or accessories other than those specified by Intuitive Surgical as replacement parts for
internal components cannot be guaranteed. Any resulting damage to the system will not be
covered under warranty.
Equipment in the operating room, including the Skills Simulator and other portable or mobile
communications equipment, can produce Electromagnetic Interference (EMI), which may
affect the function of these devices. Such effects are prevented by use of equipment with EMI
characteristics proven below recognized limits, as identified in the below tables.
In the event of suspected interference from other equipment, which prevents the proper
functioning of the Skills Simulator, contact Intuitive Surgical and/or discontinue use of the
system until the problem can be remedied.
Note: The Skills Simulator is to be used with the provided audio cable to connect to
the da Vinci Si Surgeon Console in order to ensure compliance with EMC
requirements. Use of cables or accessories other than those provided may result in
increased emissions or decreased immunity.
Note: The essential performance of the Skills Simulator during EMC testing was
defined using the following required tests:
• no component failures
• no noise in the image that makes it unusable
• no changes in programmable parameters
• no resets to factory defaults
• no change in operating mode
• no false alarms
• no initiation of any unintended operation
• no cessation or interruption of any intended operation
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Exception: For Voltage Dips and Interrupts, acceptance criteria is no component

failures and is restorable to the pre-test state with operator intervention.
FCC Compliance
Note: This equipment has been tested and found to comply with the limits for a
Class A digital device, pursuant to Part 15 of the FCC Rules. These limits are designed
to provide reasonable protection against harmful interference when the equipment
is operated in a commercial environment. This equipment generates, uses, and can
radiate radio frequency energy, and if not installed and used in accordance with the
instruction manual, may cause harmful interference to radio communications.
Operation of this equipment in a residential area is likely to cause harmful
interference in which case the user will be required to correct the interference at his
own expense.

Introduction 1-12
In regard to grounding reliability and electromagnetic interference, see the label below, which
appears on the Surgeon Console. Its text is repeated below the label image:
GROUNDING RELIABILITY CAN ONLY BE ACHIEVED

WHEN THE EQUIPMENT IS CONNECTED TO AN
EQUIVALENT RECEPTACLE MARKED
“HOSPITAL ONLY” OR “HOSPITAL GRADE”
This device complies with part 15 of the FCC Rules. Operation is
subject to the following two conditions: (1) This device may not cause
harmful interference, and (2) this device must accept any interference
received, including interference that may cause undesired operation.
EMC Tables
The following tables contain the Manufacturer’s declaration and additional information
10/29/13
required by IEC60601-1-2:2007.
Table 1: Manufacturer’s Declaration – Electromagnetic Emissions
The Skills Simulator is intended for use in the electromagnetic environment specified below. The customer or the user of
the Skills Simulator should assure that it is used in such an environment.
Emissions Test Compliance Electromagnetic Environment – Guidance
The Skills Simulator uses RF energy only for its internal
function. Therefore, its RF emissions are very low and
RF emissions CISPR 11 Group 1
are not likely to cause any interference in nearby
electronic environment.
RF emissions CISPR 11 Class A The Skills Simulator is suitable for use in all
Harmonic emissions IEC 61000-3-2 Class A establishments, other than domestic establishments
and those directly connected to the public low-voltage
Voltage fluctuations/ flicker power supply network that supplies buildings used for
Complies
emissions IEC 61000-3-3 domestic purposes.

1-13 Introduction
Table 2: Manufacturer’s Declaration – Electromagnetic Immunity

Electromagnetic
Immunity Test IEC 60601 Test Level Compliance Level
Environment Guidance
Floors should be wood,
concrete or ceramic tile. If
Electrostatic discharge floors are covered with

±6 kV contact ±8 kV air ±6 kV contact ±8 kV air
(ESD) IEC 61000-4-2 synthetic material, the
relative humidity should be
at least 30%.
Mains power quality should
Electrical fast
±2 kV for power supply lines ±2 kV for power supply lines be that of a U.S. commercial
transient/burst IEC
±1 kV for input/ output lines ±1 kV for input/ output lines or hospital environment with
61000-4-4
highly reliable service.
±1 kV differential mode ±2 ±1 kV differential mode ±2 be that of a U.S. commercial
Surge IEC 61000-4-5
kV common mode kV common mode or hospital environment with
highly reliable service.
be that of a U.S. commercial
or hospital environment with
highly reliable service. If the
<5% UT (>95% dip in UT) for <5% UT (>95% dip in UT) for
Voltage dips, short user of the Skills Simulator
0.5 cycle 40% UT (60% dip in 0.5 cycle 40% UT (60% dip in
interruptions and voltage requires continued operation
UT) for 5 cycles 70% UT (30% UT) for 5 cycles 70% UT (30%
variations on power supply during power mains
dip in UT) for 25 cycles <5% dip in UT) for 25 cycles <5%
input lines IEC 61000-4-11 interruptions, it is
UT (>95% dip in UT) for 5 sec. UT (>95% dip in UT) for 5 sec.
recommended that the Skills
Simulator be powered from
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an uninterruptible power
supply.
Power frequency magnetic
fields should be at levels
Power frequency (50/60
characteristic of a typical
Hz) magnetic field IEC 3 A/m 3 A/m
location in a typical
61000-4-8
commercial or hospital
environment.
Note: UT is the AC mains voltage before application of the test level.

Introduction 1-14
Table 3: Manufacturer’s Declaration – Electromagnetic Immunity

IEC 60601 test
Immunity test Compliance level Electromagnetic environment – guidance
level
Portable and mobile RF communications equipment
should be used no closer to any part of the Skills
Simulator, including cables, than the recommended

separation distance calculated from the equation
applicable to the frequency of the transmitter.
Recommended separation distance
d = 1.2 *SQRT(P)
d = 1.2 *SQRT(P) 80 MHz to 800 MHz
d = 1.2 *SQRT(P) 800 MHz to 2.5 GHz
Conducted RF IEC 3 Vrms 150 kHz to where P is the maximum output power rating of the
61000-4-6 80 MHz 3 Vrms transmitter in watts (W) according to the transmitter
Radiated RF IEC 3 V/m 80 MHz to 3V/m manufacturer and d is the recommended separation
61000-4-3 2.5 GHz distance in meters (m). Field strengths from fixed RF
transmitters, as determined by an electromagnetic site
survey,a should be less than the compliance level in
each frequency range.b Interference may occur in the
vicinity of equipment marked with the following
symbol:
Note 1: At 80 MHz and 800 MHz, the higher frequency range applies.
Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and
10/29/13
reflection from structures, objects and people.

a. Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land mobile
radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To
assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be
considered. If the measured field strength in the location in which the Skills Simulator is used exceeds the applicable RF
compliance level above, the Skills Simulator should be observed to verify normal operation. If abnormal performance is
observed, additional measures may be necessary, such as re-orientating or relocating the Skills Simulator.
b. Over the frequency range 150 kHz to 80 MHz, field strengths should be less than 3 V/m.

1-15 Introduction
Table 4: Recommended separation distances between portable and mobile RF

communications equipment and the Skills Simulator
The Skills Simulator is intended for use in an electromagnetic environment in which radiated RF disturbances are
controlled. The customer or the user of the Skills Simulator can help prevent electromagnetic interferences by
maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the
Skills Simulator as recommended below, according to the maximum output power of the communications equipment.
Rated maximum output power
Separation distance according to frequency of transmitter m
of transmitter W
150 kHz to 80 MHz 80 MHz to 800 MHz 800 MHz to 2.5 GHz
d = 1.2 *SQRT(P) d = 1.2 *SQRT(P) d = 1.2 *SQRT(P)
0.01 0.12 0.12 0.23
0.1 0.38 0.38 0.73
1 1.2 1.2 2.3
10 3.8 3.8 7.3
100 12 12 23
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters
(m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output
power rating of the transmitter in watts (W) according to the transmitter manufacturer.
Note 1: At 80 MHz to 800 MHz, the separation distance for the higher frequency range applies.
Note 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and
reflection from structures, objects and people.
1.8 Disposal Information

Dispose of in accordance with local regulations – particularly applies to electronic
components.
Battery Disposal
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The Skills Simulator contains lithium batteries that are not user serviceable. These batteries
must be disposed of in accordance with local regulations. Contact your local Intuitive Surgical
representative for disposal information.
_________________________________End of section______________________________

Connections, Startup, and Use 2-1
2 Connections, Startup, and Use

This chapter covers the following topics:
• 2.1 Mount the Skills Simulator on page 2-1
• 2.2 Connect the Skills Simulator Cables on page 2-4
• 2.3 Power On the Skills Simulator on page 2-7
• 2.4 Skills Simulator Use on page 2-9
2.1 Mount the Skills Simulator

Note: The only supported setup for the Skills Simulator is mounted to the back of
the Surgeon Console. The Skills Simulator is not to be used laying on its back or
free-standing.
1. Make sure a blue fiber cable is not connected to either the Surgeon Console or the Skills
Simulator.
2. Power off the Surgeon Console.
3. Position the Surgeon Console so you can access it from the back. Allow a clear working
space of at least 1 meter (3 ft) on all sides of the Surgeon Console (Figure 2.1).
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Figure 2.1 Clear at least 1 meter of working space

4. Have two AC outlets available, one for the Surgeon Console and one for the Skills
Simulator. If you plan to connect an optional monitor, be sure to have a third outlet
available.
CAUTION: Do not use an extension cord with the Skills Simulator.
Note: The Skills Simulator weighs approximately 14 kg (33 lbs). To protect your back,
bend at the knees and/or get help to pick up, move, mount or dismount the Skills
Simulator.

2-2 Connections, Startup, and Use
5. Carry the Skills Simulator to the back of the Surgeon Console.

Figure 2.2 Carrying the Skills Simulator

6. Place the Skills Simulator on the floor behind the Surgeon Console so that the back of the
Skills Simulator faces the back of the Surgeon Console (Figure 2.3).
7. To protect your back, bend at the knees while you prepare to lift the Skills Simulator by
the side handles (Figure 2.3).
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Figure 2.3 Position the Skills Simulator on the floor behind the Surgeon Console as shown,
then prepare to lift carefully using the side handles.
8. Lift the Skills Simulator to the Surgeon Console. Position it so that the mounting brackets
will slide into the lateral supports on the back of the Surgeon Console (Figure 2.4).

CAUTION: Do not lift the Skills Simulator so high that the mounting brackets will
wrap over the TOP of the lateral supports (Figure 2.4).
Incorrect Placement Correct Placement
Figure 2.4 Mounting the Skills Simulator on the Surgeon Console

9. Slide the Skills Simulator mounting brackets between the lateral supports on the
Surgeon Console.
10. Inspect the mounting brackets to ensure they are firmly in place before proceeding
(Figure 2.5).
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Mounting bracket firmly

in place
Figure 2.5 Ensure that both mounting brackets are secure between the lateral supports

2.2 Connect the Skills Simulator Cables
Skills Simulator Cable Layout

The cables should be arranged so that they are out of the path of foot traffic, including other
equipment, to avoid damaging the cables or creating an obstacle or hazard (Figure 2.6).
Note: You should position the Skills Simulator so that you have easy access to the
power switch and power cord – to facilitate turning the Simulator off or to
disconnect the power cord.
AC power source AC power source
AC outlet
Short blue fiber cable

Short white audio cable
Skills Simulator Black power cord (Surgeon Console)
side panel External monitor (optional)
To back panel
on Surgeon Console
AC outlet
Skills Simulator
Black power cord

(Simulator) USB devices
(optional)
Surgeon Console
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Figure 2.6 Skills Simulator cable layout
Skills Simulator Short Fiber Cable

The short fiber cable is a 1 meter blue fiber cable included with the Skills Simulator that passes
video, audio, and data.
Note: Only the short (1 meter) fiber cable should be used to connect the Skills
Simulator to the Surgeon Console.
Note: You should connect the short fiber cable to the Surgeon Console first, and
then to the Skills Simulator.
For the following instructions, refer to Figure 2.7, Figure 2.8, and Figure 2.9.
1. Remove the protective caps from the short fiber cable, inspect the cable connectors and
system receptacles for debris. The system receptacles have protective covers that you
must open.

2. Connect the short fiber cable to the receptacle on the Surgeon Console. To connect the
short fiber cable, line up the red alignment mark on the short fiber cable connector with
the red alignment mark on the matching receptacle, flip up the receptacle cover and
insert the connector (Figure 2.7).
Red Alignment Mark
2. Flip up receptacle 3. Tug gently to assure

cover & insert connection
1. Observe red marks

and align
Figure 2.7 Connecting the Skills Simulator short fiber cable to the Surgeon Console
3. Connect the other end of the short fiber cable to either of the two receptacles on the
Skills Simulator (Figure 2.8).
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USB ports Audio out connector
Fiber cable receptacles
Power switch
(in OFF position)
Power cord
Figure 2.8 Skills Simulator side panel cable connections
Note: The protective metal caps attached to each short fiber cable should remain
installed on cable ends at all times when not connected to the system.
Note: Once the Skills Simulator is connected and powered on, the short fiber cable
should not be unplugged until the system has completely powered down.

Note: The short fiber cable has a fiber-optic core. Care should be taken to avoid
bending the cable, as kinks can damage the cable and may prevent system
operation. The minimum safe bend radius is 2.54 cm (1 inch).
Skills Simulator Audio Cable

A short (1 meter) audio cable is included with the Skills Simulator. Connect the audio cable
from the Skills Simulator RCA audio out connector (Figure 2.8) to the RCA audio Line In
connector on the Surgeon Console (Figure 2.9).
Audio Line In
connector
Figure 2.9 Audio Line In connector on the Surgeon Console

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AC Power Cord
Connect the power cord from the Skills Simulator (Figure 2.8) to an AC power outlet in the
wall. Make sure adequate power is available at the wall outlet according to Table 2-1. (See the
da Vinci Si user manual for the Surgeon Console power requirements.)
Table 2-1 Power Cord and Power Requirements
System Component Cord Length Power Requirement
500VA Continuous
Skills Simulator 12 ft/3.6 m 4.2A at 115V~
2.1A at 230V~
CAUTION: Do not use an extension cord with the Skills Simulator.
Note: Use the power switch to disconnect the Skills Simulator from mains power. To
completely isolate the Skills Simulator from AC mains, disconnect the power cord
from the AC power outlet.

Optional Connections
USB Devices
If desired, connect the following USB devices to any of the three USB ports on the Skills
Simulator panel (Figure 2.8):
• Mouse
• Keyboard
External Monitor
If desired, connect an external monitor to the Surgeon Console by connecting the monitor
video in (DVI) cable to the Video Out L (left) connector on the back of the Surgeon Console
(Figure 2.10). Make sure the monitor is also plugged into an AC power outlet in the room.
Video Out L
connector
Figure 2.10 Video Out L connector on the Surgeon Console
2.3 Power On the Skills Simulator

1. Make sure all Skills Simulator connections are in place and secure. Refer to section 2.2
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Connect the Skills Simulator Cables on page 2-4.

2. Verify that the Surgeon Console power switch is in the UP position. For more information
on the Surgeon Console power switch, see the da Vinci Si Surgical System user manual.

3. Locate the black power switch on the side panel of the Skills Simulator and set it to the
I (ON) position (Figure 2.11).
Fiber cable LED

illuminated
Power switch
(in ON position)
STATUS LED
illuminated
Figure 2.11 Skills Simulator power switch

Note: Once the power switch on the Skills Simulator is set to the ON position, the
fiber cable LED will illuminate blue on both the Skills Simulator and the Surgeon
Console, and the STATUS LED on the Skills Simulator will flash and illuminate green
(Figure 2.11).
4. Wait until the power button on the top of the Skills Simulator illuminates steady amber
( ) before proceeding (Figure 2.12).
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Power button
illuminated amber
Figure 2.12 Skills Simulator power button

5. Press the power button on top of the Skills Simulator (Figure 2.12). The system boots and
the welcome screen appears in the stereo viewer on the Surgeon Console.
Note: As the software loads, the master controllers will automatically move into a
starting position.
Note: The software may load on the Surgeon Console touchpad before it is finished
loading on the Skills Simulator (the stereo viewer and the optional additional
monitor may be affected by this). During this momentary delay, you may see a blank
screen; this behavior is expected and normal.

2.4 Skills Simulator Use
Getting Started
Once the system is connected and powered on, you can begin practicing the various skills
exercises offered. For detailed software information, see Chapter 4 Simulation Software by
Mimic Technologies. For detailed software information related to Suturing Skills, see Chapter 5
Suturing Skills Simulation Software by Simbionix.
Default User Log In

1. Verify that the Skills Simulator is powered on and the Welcome screen is displayed. Note
the Log In and Overview Video buttons. You should also note the instructions to control
the pointer using the master controllers (Figure 2.13).
How to control the pointer How to click buttons
Figure 2.13 Welcome Screen

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The master controllers are used to control the pointer on the screen. To control the pointer,
first place your head in the stereo viewer on the Surgeon Console. Then lightly grasp the
master controllers as shown on the Welcome screen. To unlock each master controller, close
and release the master controller grip. You may then move either hand to control the pointer.
You will have to repeat this process to take control of the pointer if you remove your head from
the stereo viewer.
Note: To click a button on the screen, use the master controllers to move the pointer
to the button, then close and release either master controller grip to click it.
Note: The master controllers may be clutched during menu navigation, just as they
may be clutched during use of the regular da Vinci Si Surgical System. Applying the
clutch, either with the clutch foot pedal or finger clutches, allows you to move the
master controllers without moving the pointer. Refer to the da Vinci Si Surgical
System user manual for more information on clutching the master controllers.
2. Click Overview Video for a brief introduction to the Skills Simulator software. When the
video ends you will return to the Welcome screen (Figure 2.13).

3. Click Log In. The User Log In screen appears (Figure 2.14).
User drop-down list

Figure 2.14 User Log In

Note: For information on the administrator log in, refer to Administrator Log In (page
3-2).
Note: To return to the Welcome screen, click Log Out.
4. In the user drop-down list, select Default User.
5. Enter the default user pin: 1234
Note: The default user pin is 1234.
6. Click OK. The Main Menu screen appears (Figure 2.15).
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Figure 2.15 Main Menu

Main Menu

1. On the Main Menu screen, click a skills category. The exercises on the Skills Simulator are
grouped into categories according to the primary skill practiced in each exercise.
Note: An exercise screen exists for every exercise on the Skills Simulator. It allows
you to choose to either watch video instructions that describe the exercise, or run
the exercise. After watching video instructions, you return to the exercise screen.
Note: To navigate to a previous menu screen, click the desired link from the
navigation list in the upper left corner of any menu screen (Figure 2.17).
Navigation list
Click an exercise button

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Figure 2.17 Skills category screen

2. On the selected skills category screen, click any exercise button to select it. The selected
exercise screen appears (Figure 2.18).
Figure 2.18 Sample exercise

3. Click Video Instruction to view a brief instructional video of the exercise. Otherwise,
proceed to step 4. After the video plays, the system automatically returns to the selected
exercise screen. Click Stop at any time to stop the video and return to the exercise screen.
• For certain exercises, you can select whether to launch them as Left Handed or Right
Handed. (Figure 2.19).
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Figure 2.19 Left handed or right handed option

4. Click Launch Exercise to load the selected exercise.
Note: As the exercise loads, the master controllers will automatically move into a
starting position. If you are holding the master controllers, be sure to relax your
hands and allow the master controllers to move.
When the masters have moved to their starting positions and the simulated instruments, or
multiple choice questions, appear on the screen, you may begin the exercise. See Chapter 4
Simulation Software by Mimic Technologies for an overview of simulation exercises. See
Chapter 5 Suturing Skills Simulation Software by Simbionix for an overview of Suturing Skills
simulation exercises.

Note: To take control of the instruments for an exercise, the user must first match
grips. Matching grips requires two steps, first, partially open and close the master
controllers (or rotate slightly). Second, match the master grip angle to the virtual
instrument grip angle. When you have successfully matched grips, you can control
the instrument. If the orientation of the grips does not match the orientation of the
instrument, you will see a message instructing you to relax your grip on the master
controllers.
Note: See the da Vinci Si Surgical System user manual for further information on
matching grips.
Navigating Through the Simulator Screens

The Simulator provides a navigation list to show you the location of the current page within
the software. These lists are meant to help you keep track of your location. To navigate to a
previous menu screen, click the desired link from the navigation list.
Figure 2.20 Navigation aid
Exiting an Exercise
After Completing Exercise
The Skills Simulator will automatically exit an exercise once you have completed it. At the
completion of an exercise, the Performance Evaluation screen appears with metric results of
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the exercise you just completed. This screen will also appear if you exit an exercise
prematurely.
Figure 2.21 Performance evaluation

Click Exit to return to the exercise screen. For detailed information regarding performance
assessment metrics, see Chapter 4 Simulation Software by Mimic Technologies. For detailed
information regarding Suturing Skills performance assessment metrics, see Chapter 5
Suturing Skills Simulation Software by Simbionix.

Before Completing Exercise

To exit or restart an exercise before completing it:
• To exit a quiz exercise, select the Quit button on the upper right corner of the screen.
• To restart a Suturing Skills exercise, press the restart button ( ).
• To exit a simulation exercise, briefly pull down and release (or flick) the foot pedal
ergonomic switch (Figure 2.22).
Foot pedal ergonomic

switch
Figure 2.22 Briefly flick switch downward to exit a virtual exercise
Note: It is important that you briefly flick the left-side pod ergonomic switch if you
chose to exit a simulation exercise. Hold the switch down if you want to adjust the
Surgeon Console ergonomic settings.
Note: Exiting an exercise before it is complete will result in an incomplete score.
Note: Restarting (by pressing the blue restart button ) a Suturing Skills exercise
before it is complete will result in a lower score.
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Simulation Screen Instructions and Elements
The simulation screen is where the exercises are run. You will view simulated instruments in
3D and practice a variety of skills exercises. While performing a task on the Skills Simulator,
instructions and tips may appear in green text at the top of the screen (Figure 2.23).
Note: The Skills Simulator uses the same energy pedal mapping and user interface
as the Surgeon Console to which it is connected. If you are using a different Surgeon
Console for surgery than was used for Simulator practice, be aware that energy
pedal mapping and user interface differences can exist.
Text
Virtual EndoWrist
instruments Virtual objects
Figure 2.23 Simulation instructions and elements

• Virtual EndoWrist instruments: Simulate the look and behavior of EndoWrist
instruments in response to manipulation of the masters.
• Virtual objects: Three-dimensional simulated objects you can manipulate within Skills
Simulator exercises.
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• Text: Instructions and tips guide you through an exercise.

For more information about the software and exercises, see Chapter 4 Simulation Software by
Mimic Technologies and Chapter 5 Suturing Skills Simulation Software by Simbionix.

Administrator Main Menu

As an Administrator you have the rights to create new users, edit user settings, change the
administrator Personal Identification Number (PIN), and save user reports. See Chapter 3
Onboard Simulator Administrator and Reports Guide for more information.
Figure 2.24 Administrator Menu

________________________________End of section______________________________
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Onboard Simulator Administrator and Reports Guide 3-1
3 Onboard Simulator Administrator and

Reports Guide
This chapter provides information on the various onboard administrator features. This chapter
also provides information on the various user reports that the Simulator can generate. The
following topics are covered:
• 3.1 Onboard Simulator Administrator Overview and Log In, on page 3-1
• 3.2 Onboard Simulator Administrator Menu, on page 3-4
• 3.3 Reports, on page 3-7
3.1 Onboard Simulator Administrator Overview and Log In

Note: If you lose the administrator PIN number, contact Intuitive Surgical Technical
Support. In the U.S., call 1-800-876-1310, where phones are staffed 24 hours a day,
seven days a week.
Administrator Overview
Use the administrator feature to manage user accounts, change the administrator PIN, and
generate and save user reports that include exercise results.
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3-2 Onboard Simulator Administrator and Reports Guide
Administrator Log In
1. Verify that the Skills Simulator is powered on and the main Welcome screen is displayed
(Figure 3.2).
Figure 3.2 Welcome Screen

2. Click Log In. The User Log In screen appears (Figure 3.3).
User drop-down list

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Figure 3.3 User Log In

Note: To return to the welcome screen, click Log Out.

3. Click Administrator. The Administrator log in screen appears (Figure 3.4).
Figure 3.4 Administrator Log In

4. Enter the default administrator pin: 8888
Note: The default administrator pin is 8888. Intuitive Surgical recommends that you
change the default administrator pin immediately after logging in.
5. Click OK. The Administrator Menu screen appears (Figure 3.5).
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3.2 Onboard Simulator Administrator Menu


Create New User
1. Click Create New User. The Create New User screen appears.
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Figure 3.7 Create New User

2. Enter the new user’s first and last name. Enter the new user’s PIN.
3. Click Add. The create new user confirmation screen appears.
Figure 3.8 Add user confirmation

4. Click OK.

Edit Users
You have two options when creating and modifying user accounts:
1. Onboard Simulator Administrator
2. Simulator Manager
These software applications act autonomously. The users you create using the Onboard
Simulator Administrator can only be modified using the Onboard Administrator. Likewise, if
you create user accounts using the Simulator Manager, those accounts can only be modified
using the Sim Manager. Refer to the Skills Simulator Manager User Manual (PN 551116) for
more information on the Simulator Manager.
1. Click Edit Users. The Edit Users screen appears.
Figure 3.9 Edit Users

2. Click a user name. The Edit User’s Information screen appears.
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Figure 3.10 Edit User’s Information

3. From this screen you can edit or delete the user.

• Edit the user. Edit the first name, last name, or PIN and then click Update. The update
user confirmation screen appears. Click OK.
Figure 3.11 Update confirmation

• Delete the user. Click Delete User. The first confirmation screen appears.
Figure 3.12 Delete confirmation

4. Click Delete. The second confirmation screen appears.
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Figure 3.13 Delete user confirmation

5. Click OK.
Change Administrator PIN

1. Click Change Administrator PIN. The Change Administrator PIN screen appears.
Figure 3.14 Change Administrator PIN

2. Enter the old PIN. Enter and re-enter the new PIN. Click OK. The PIN confirmation screen
appears.
Figure 3.15 Change PIN confirmation

3. Click OK.
3.3 Reports
The Simulator provides you with two ways to generate reports. The Administrator Menu lets
you save and view reports for all Simulator users (see Save User Reports – Administrator
Menu). The Main Menu lets you generate a single completion report – your own (see Save
Report – Main Menu).
Save User Reports – Administrator Menu

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Figure 3.16 Save User Reports feature

1. Click Save User Reports. The Skills Simulator Report Generator screen appears.
Figure 3.17 Skills Simulator Report Generator

2. Insert a USB memory stick into any of the USB ports on the Skills Simulator panel. The
Simulator saves the reports to the USB memory stick. Existing data on the memory stick
will not be erased.

3. Click Done.
4. Use your computer’s operating system to find and open the USB drive. You will find the
reports, which can be opened by any HTML-compatible browser.
5. Open the appropriate Reports folder.
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Report – Save User Reports
The Save User Reports feature provides the following reports:
• Completion Report. This report is user specific and displays the highest score for each
exercise and how many attempts have been made.
Figure 3.19 Completion Report

• Total Simulator Usage Report. These reports are sorted by total Simulator usage time.
Figure 3.20 Total Simulator Usage Report

Save Report – Main Menu
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Figure 3.21 Save Report feature

1. Click Save Report. The Skills Simulator Report Generator screen appears.

2. Insert a USB memory stick into any of the USB ports on the Skills Simulator panel. The
Simulator saves the report to the USB memory stick. Existing data on the memory stick
will not be erased.

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3. Click Done.
4. Use your computer’s operating system to find and open the USB drive. You will find the
reports, which can be opened by any HTML-compatible browser.
5. Open the appropriate Reports folder.

Report – Save Report
The Save Report feature generates a single completion report for the person logged in to the
system. E.g., The Default User can view his/her report (Figure 3.24). This report is user specific
and displays the highest score for each exercise and how many attempts have been made.
Figure 3.24 User Report

_______________________________End of section______________________________
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4-1 Simulation Software by Mimic Technologies
4 Simulation Software by Mimic

Technologies
This chapter includes an overview of the various simulation exercise types, tips, scoring, and
metrics. Exercises are implemented utilizing MSim, Mimic’s proprietary surgical simulation
platform. Please visit www.mimicsimulation.com for more information.
Note: The metrics provided in this chapter are estimates, and as such Intuitive
Surgical does not intend for these metrics to reflect expected performance in an
actual surgical setting. Metrics are provided by Mimic Technologies with the intent of
mastering a particular simulated exercise, and should not be used to determine
proficiency for surgical operation.
See the da Vinci Si Surgical System user manual for information regarding the
Surgeon Console or other system components. This chapter covers the following topics:
• 4.1 Exercise Types, on page 4-1
• 4.2 General Exercise Tips, on page 4-2
• 4.3 Simulation Exercise Overview, on page 4-2
• 4.4 Exercise Scoring, on page 4-20
• 4.5 Simulator Targets, on page 4-25
4.1 Exercise Types

The Mimic Technologies simulation software provides a variety of scenarios designed for
practice using the Intuitive Surgical da Vinci Surgical System. In each exercise you will complete
tasks or answer questions. Once an exercise is complete, you will see metrics that assess your
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performance. The Skills Simulator Mimic simulation software includes two types of practice:
1. quiz exercises, 2. simulation exercises.
Quiz Exercises
On the Main Menu, click Surgeon Console Overview to review and take quiz exercises.
These quiz exercises present multiple choice questions. For each question, you will study the
text and images and select the correct option from the choices provided. See Surgeon
Console Overview on page 4-2 for more information.
Mimic Simulation Exercises

Mimic simulation exercises present computer-generated 3D views of simulated scenarios. You
operate the virtual robot in the same manner the real robot is operated, and the virtual
instruments simulate the behavior of actual instruments.
Most Mimic simulation exercises present a variety of targets that act as guides through each
task. For a detailed description of each target type, see Simulator Targets on page 4-25.

Simulation Software by Mimic Technologies 4-2
4.2 General Exercise Tips
Follow these general tips when using Mimic simulation software on the Skills Simulator:
• Keep instruments in view at all times.
• Avoid instrument collisions with the floor, cavity wall, or other objects on the screen.
Collisions resulting in too much stress applied cause the instruments to turn red (see
Excessive Force below).
• Do not cross or collide instruments with each other; this will help avoid unnecessary
stress on the instruments. Stress is indicated by the instruments turning red (see
Excessive Force below).
• Approach from above and rotate the instrument wrists when picking up or guiding
objects.
• To avoid losing sight of one or both instruments, do not use camera zoom in large
increments.
There are tips associated with some exercises that may not pertain to all. These additional tips
are listed in each individual exercise summary under the Tips heading.
Excessive Force
Excessive force is defined as too much stress (or force) applied to an instrument, or to a target.
This excessive force can be caused when instruments collide with each other, or when
instruments collide with other objects in the scene. Pay special attention during tasks such as
tissue retraction, driving a needle, etc. Excessive force on the instruments is indicated by the
instrument shaft turning red (Figure 4.1).
Shaft turns red

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Figure 4.1 Excessive force
4.3 Simulation Exercise Overview

This section provides an overview of the Skills Simulator simulation exercises. To select an
exercise or log in to the Skills Simulator, see section 2.4 Skills Simulator Use.
Surgeon Console Overview

You can take any of the quizzes shown in Figure 4.2. After completing a quiz exercise, you
receive an assessment based on the percentage of correct answers.

Note: The quiz exercises will test you on material covered in the da Vinci Si Surgical
System user manual. The exercise screen will direct you to the appropriate section
of the manual to review the content.
Figure 4.2 Surgeon Console Overview
Camera and Clutching

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Figure 4.3 Camera and Clutching

Camera Targeting
Figure 4.4 Camera Targeting
Table 4-1 Camera Targeting Summary

Exercise Purpose Objective(s)
• Learn to accurately position the
camera while working in a large
• Manipulate the camera to position
workspace.
light blue sphere camera targets in
Camera Targeting 1 • Practice keeping instruments in
the center of your screen's dark
view during large camera
blue crosshairs.
movements.
• Develop stereo depth acuity.
• Same as Camera Targeting 1, and:
• Improve basic camera targeting • Pick up and carry various size
Camera Targeting 2
skills. stones and place them in
designated baskets.
Tips
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• While holding down the camera pedal, move both master controllers to manipulate the
camera view.
• If the arrow on the crosshairs disappears, or the crosshairs themselves disappear, it is
likely the camera target is behind your camera. To reacquire the camera target, simply
zoom out until the camera target reappears.
• Use multiple small camera sweeps when navigating to each blue camera target.
• Avoid instrument collisions with the cavity wall.

Scaling
Figure 4.5 Scaling
Table 4-2 Scaling Summary

• Use the touchpad to select
different magnitudes of
scaling.
• To experience and understand the
• Use camera and clutch to assist
Scaling difference between the three scaling
in touching the targets.
modes.
• Experience how scaling effects
range of motion and accuracy
of EndoWrist manipulation.
Tips
• This exercise requires the user to change the instrument scaling setting on the Touchpad.
This change will remain in effect after the exercise is completed.
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• To activate the third instrument, tap the arm swap (left kick-plate) located on the left-side
of the footswitch panel.
• It may be necessary to use the clutch and camera in order to move the instruments
between targets while also keeping the grips in the center of the master workspace.
• Under lower scaling ratios, such as Quick, move the instruments slowly and deliberately
when near the targets in order to accurately hit them.
• Under higher scaling ratios, such as Fine, actively use the clutch and camera to keep your
grips in the center of the workspace while moving the instruments between targets.

Ring Walk
Figure 4.6 Ring Walk
Table 4-3 Ring Walk Summary

• Develop accuracy in positioning the
Ring Walk 1 camera while working in a large
• Alternate between guiding a ring
workspace.
along a curvy vessel and moving
• Learn to effectively switch between camera
the camera to position crosshairs
control and dexterous EndoWrist
Ring Walk 2 over camera targets.
manipulation while keeping your
instruments within the scene.
• Alternate between walking a ring
along a curvy vessel and moving
• Same as above, and:
the camera with precision.
Ring Walk 3 • Practice retracting obstacles using a third
• Retract obstacles along the way
instrument.
that impede movement of the
ring.
Tips
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Ring Walk 1, Ring Walk 2:

To move the scope in, pull the image toward you by pulling both masters toward your eyes. To
rotate the scope clockwise, rotate both masters clockwise, like a steering wheel.
Ring Walk 3:
Same as above, and:
• To activate the third instrument, tap the arm swap (left kick-plate) located on the left-side
of the footswitch panel.
• Move all three instruments together so that they stay in view. Clutch when necessary to
keep your master grips ergonomically centered in your workspace.

Energy and Dissection

Figure 4.7 Energy and Dissection

Energy Switching
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Figure 4.8 Energy Switching

Table 4-4 Energy Switching Summary
• Learn to identify the energy
• Make contact with targets
state icons and develop
using appropriate
Energy Switching 1 competency switching
instrument and apply correct
between the mono coag and
energy source.
bipolar energy sources.
• Develop competency when • Make contact with targets on
switching between rigid vessels using the
Energy Switching 2 instruments and energy appropriate instrument and
sources – mono coag, mono applying the correct energy
cut and bipolar. source.

Tips
Energy Switching 1, Energy Switching 2:
• The footswitch map displays the available primary and secondary energy modes.
• Observe the icons and their behavior when fired. See your da Vinci Si manual for more
information.
Energy Switching 1:
• If a red circle appears around a target, you are either not correctly touching or grasping
the target sphere, or you are applying the wrong energy source.
Energy Switching 2:
• If a red circle appears around a target, you are either not correctly touching or grasping
the target sphere, or you are applying the wrong energy source.
Energy Dissection
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Figure 4.9 Energy Dissection

Table 4-5 Energy Dissection Summary
• To isolate a large blood vessel by
• Learn to use cautery and
cauterizing and cutting small
Energy Dissection 1 coagulation as part of
branching blood vessels that
dissection.
anchor the vessel.
• Same as Energy Dissection 1,
• Learn to use cautery and
and:
coagulation as part of
Energy Dissection 2 • Quickly locate and stop any
dissection while
bleeding vessels that appear
managing bleeding.
during dissection.
• Same as Energy Dissection 1,2
• Same as Energy
and:
Energy Dissection 3 Dissection 1 and Energy
• Control the instrument with
Dissection 2.
either the left or the right master.
Tips
• Inadequate cauterization may result in bleeding once the vessel has been cut.
• Address bleeding vessels as soon as possible to minimize blood loss.

• Avoid excessive stretching, which will cause branching vessels to break.

• The footswitch map displays the available primary and secondary energy modes.
• When firing energy instruments observe the icons and their behavior. See your da Vinci Si
manual for more information.
Needle Driving
Figure 4.10 Needle Driving

Suture Sponge
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Figure 4.11 Suture Sponge

Table 4-6 Suture Sponge Summary
• Learn to control a needle when
passing it between
instruments.
Suture Sponge 1 • Insert and extract the needle
through several pairs of
targets on the edge of a
sponge.
• Same as Suture Sponge 1, and:

• To improve dexterity and • Insert and extract the needle
accuracy when driving a through several pairs of
Suture Sponge 2
needle through a targets on the edge of a
deformable object. sponge with random
variations in their positions.
• Same as Suture Sponge 1, and:
• Insert and extract the needle
through several pairs of
Suture Sponge 3 targets on the edge of a
sponge with random
variations in their positions
and bite sizes.
Tips
• Hand the needle off between instruments to prepare the needle for insertion through the
targets.
• Plan the needle throw so that the needle rotates into the center of the yellow insertion
target and out through the black extraction target in one smooth rotation.
• Rotate your instrument wrists to facilitate driving the needles through both the yellow
and black targets.
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Dots and Needles
Figure 4.12 Dots and Needles

Table 4-7 Dots and Needles Summary

• Develop skill and technique when • Learn to pass a needle from one
Dots and
driving a needle through a soft instrument to another.
Needles 1
deformable object. • Accurately insert and drive a
needle through several pairs of
Dots and • Execute difficult needle throws targets that have various spatial
Needles 2 through a soft deformable object. distances and positions.
Tips
• Plan the needle throw so that the needle will rotate into the center of the yellow insertion
• Use the left or right instrument for driving the needle to practice ambidextrous control.
Note: When an instrument is flashing yellow, it must be used to insert the needle
into the target.
Tubes
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Figure 4.13 Tubes
Table 4-8 Tubes Summary

• To practice tissue manipulation • Use both instruments to
and needle driving that will be manipulate two vessels in
Tubes
encountered as part of an order to facilitate needle
anastomosis. driving.
Tips
• Manipulate the vessel as needed to provide easier access to the insertion target. If
necessary, hand off the needle between instruments to orient it relative to the yellow
insertion side of the target.
• Plan the needle throw so that the needle rotates into the center of the yellow insertion

EndoWrist Manipulation 1
Figure 4.14 EndoWrist Manipulation 1

Pick and Place
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Figure 4.15 Pick and Place
Table 4-9 Pick and Place Summary

• Introduction to using stereo
vision and EndoWrist • Place colored objects in
Pick and Place
instruments for picking up and matching colored containers.
placing objects.

Peg Board
Figure 4.16 Peg Board
Table 4-10 Peg Board Summary

• Improve EndoWrist dexterity
and coordinated two-handed
motion by handing off objects
Peg Board 1 between instruments. • Pick up and transfer rings
• Learn to avoid unwanted sequentially from the peg
collisions of instruments with board to a single peg on the
the surrounding environment. floor.
• Same as Peg Board 1, and:
Peg Board 2 • Develop camera control skills in
the context of a Peg Board task.
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Tips
• Rotate the instrument wrists to transfer the rings and place the rings onto the floor peg.
• Do not pull on a ring if it is still hooked on a peg.
• Avoid instrument collisions with the pegs and the floor.
• Always grasp the flashing ring on the peg board with the flashing instrument.

EndoWrist Manipulation 2
Figure 4.17 EndoWrist Manipulation 2

Match Board
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Figure 4.18 Match Board
Table 4-11 Match Board Summary

• Improve EndoWrist dexterity for • Pick up objects and place
Match Board 1 positioning and orienting them into their
objects. corresponding spaces.
• Same as Match Board 1, and:
• Learn to retract objects while
Match Board 2
avoiding excessive instrument
strain. • Lift panel doors, pick up
objects, and place the
• Same as Match Board 1, and: objects in their
• Practice switching between corresponding spaces.
Match Board 3 three instruments.
• Learn to retract multiple objects
simultaneously.

Tips
Match Board 1:
• When picking up objects, approach them from above and rotate the instrument wrists.
• Use the instrument closest to each character to pick it up.
Match Board 2:
Same as Match Board 1, and:
• Observe the graphic images on the door panels that serve as guides to open them.
Match Board 3:
Same as Match Board 1, and:
• Observe the graphic images on the door panels and slider panels that serve as guides for
opening them.
Ring and Rail
Figure 4.19 Ring and Rail

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Table 4-12 Ring and Rail Summary

• Coordinate control of an object's position
• Pick up a ring and guide the
Ring and Rail 1 and orientation along a trajectory using
ring along a curving rail.
EndoWrist instruments.
• Coordinate two-handed control of an
object's position and orientation along a
trajectory using EndoWrist instruments. • Pick up three colored rings
• Learn to manipulate objects under individually and guide them
Ring and Rail 2
motion constraints. along their matching colored
• Build on camera control skills when rails.
performing a task across a large
workspace.
Tip
• Alternate instruments as needed to navigate the curves of the rail.

Needle Control
Figure 4.20 Needle Control

Needle Targeting
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Figure 4.21 Needle Targeting
Table 4-13 Needle Targeting Summary

• Remove needles from a rack
• Learn to accurately
and accurately insert needles
Needle Targeting manipulate and insert
through a pair of matching
needles.
colored targets.
Tips
• Plan your needle insertion so that you can rotate the needle through the center of the
large target and into its associated small target in one smooth rotation.
• If a target turns red as you are inserting the needle, you are not inserting the needle into
the center of the target.
• Dropped needles fall to the bottom of the cavity.
• Avoid excessive stress on the instruments when inserting the needle.

Thread the Rings

Figure 4.22 Thread the Rings
Table 4-14 Thread the Rings Summary

• Practice two-handed needle
manipulation with hand-offs
• Pass a needle and suture
Thread the Rings between instruments.
through a number of eyelets.
• Develop accuracy when
driving a needle.
Tips
Hand off the needle between instruments to correctly orient it so that you can pass it through
the flashing eyelet.
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Games
Figure 4.23 Games

Playground
Figure 4.24 Playground
Table 4-15 Playground Summary

• Practice manipulating a
• Improve dexterity when variety of objects and
Playground
using EndoWrist instruments. swapping between three
instruments.
Stacking Challenge
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Figure 4.25 Stacking Challenge
Table 4-16 Stacking Challenge Summary

• Improve EndoWrist dexterity
and develop camera control • Stack boxes and dominoes to
skills. build the tallest tower
Stacking Challenge
• Learn to precisely possible within a two minute
manipulate multiple objects period.
under a time constraint.

Tips
• Plan a strategy for stacking the boxes and dominoes before you enter following mode,
which will start the timer.
• Keep track of your time as indicated in the lower left of your screen.
Falling Dominoes
Figure 4.26 Falling Dominoes
Table 4-17 Falling Dominoes Summary

• Improve dexterity when • Practice manipulating a
Falling Dominoes
using EndoWrist instruments. variety of objects.
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4.4 Exercise Scoring
MScore™
MScore is a performance evaluation tool developed by Mimic Technologies that provides
assessment based on a wide variety of metrics that measure robotic surgery skills. In addition
to viewing exercise reports in detail, users can keep track of their progress over time.
MScore launches automatically when you complete or quit an exercise.
Figure 4.27 MScore default view

Users see the MScore default view. The user can toggle between Exercise Report, Exercise
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History and Metric History tabs. The Exercise Report tab is displayed by default. You can exit
MScore any time by clicking the Exit button.
Exercise Report tab

The Exercise Report tab summarizes performance in a specific exercise. By default, the report
of the most recent exercise is displayed.

Exercise Report
Tab
Figure 4.28 Exercise Report Tab

Metric based evaluation
Each exercise score is based on a set of metrics, and each metric compares the user’s
performance to baseline values (developed by Mimic Technologies) that represent a low range
(i.e. 0%) and a high range (i.e. 100%). At a glance, the evaluation icons give the user a general
idea on how well he or she performed on each metric. A green check mark corresponds to an
“excellent” score, a yellow warning sign corresponds to a score that “could be better,” and a red
cross corresponds to a score that “needs more work.” Also, while a completely filled progress
bar represents achievement in the high range or better for a metric, a completely empty
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progress bar represents a score in the low range or less. Any metric with a 0% score is
considered to be a critical error. These metrics should not be used to determine proficiency for
surgical operation.
Detailed information can be viewed by clicking on the box of the desired metric. This view
includes the definition of the metric, text-based feedback, raw value, percentage score,
baseline values used for calculating the percentage score, and the weight of the metric on the
overall score. The color of the text corresponds to the color of the evaluation icon displayed in
the metric box.
Overall score
The Overall Score box displays the overall score calculated based on individual metrics. Raw
values, percentage scores, base line values and weights of each individual metric are listed in a
tabulated format to explain how each metric score is calculated, and how much each
contributes to the calculation of the exercise score.
Detailed report
Click Overall Score to view the Detailed Exercise Report. Click Close to exit.

Overall score chart
The Overall Score chart on the upper right corner of the window provides feedback on
progress history. The length of each bar is proportional to the score received on its
corresponding attempt. A clear bar covering the entire score scale represents an incomplete
attempt. The bar associated with the most recent attempt is highlighted. The green and
yellow lines are the baseline values defining the range of score regions.
Exercise report of a past attempt
The exercise report of a past attempt can be viewed by clicking on the score bar in the Overall
Score chart or by selecting an attempt number from the Attempt drop-down menu. Report of
an incomplete attempt displays “Incomplete” in the Overall Score box (and incomplete marks
in metric boxes).
Report for a specific attempt of a specific exercise
To view the reports of any attempt, select the desired exercise from the Exercise drop-down
menu, and then select the desired attempt from the Attempt drop-down menu, or click the
score bar of the desired attempt in the Overall Score chart.
Exercise History tab

The Exercise History tab displays the exercise score history.
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Figure 4.29 Exercise History Tab

The Overall Score chart is a line graph of all attempts and metrics, and the charts on the lower
half of the window represent overall scores for individual metrics. The green and yellow lines
are the baseline values defining the score ranges.
Figure 4.30 Individual Metric

To view history of any exercise, select the desired exercise from the Exercise drop-down
menu.
Metric History tab

To display the Metric History tab, click any chart in the Exercise History tab, or click the Metric
History button.
Figure 4.31 Metric History Tab

The Metric History tab includes progress history of a selected metric of overall exercises
performed. While the chart on the upper right corner defines field names, the charts below
are line graphs of metrics over all attempts of an individual exercise. History of any metric is
viewed by selecting the desired metric from the Metric drop-down menu.
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Results per Metric
When an exercise is complete you receive an assessment based on several metrics. To view
detailed information about a metric, click the individual metric score box on the Performance
Evaluation screen (Figure 4.32). Note that not all metrics are evaluated for every exercise.
Figure 4.32 Performance Evaluation

The information below, provided by Mimic, describes each metric:
Time to Complete Exercise
The total time from when the user enters following or camera control until the final target is
completed or the exercise is exited before completion.
Economy of Motion
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The total distance traveled by all instruments during an exercise.

Instrument Collisions
The total time that two or more instruments come into firm contact during a simulation.
Excessive Instrument Force
The total time that excessive force is applied to either instrument.
Instruments Out of View
The total distance traveled by instruments outside the user's field of view. Users should never
move an instrument when it is not directly visible with the scene.
Master Workspace Range
Reports the larger of the two radii of the working volume traversed by each master controller.
Drops
A record of each time an object (such as a ring or a needle) is dropped in an inappropriate area
of the scene.

Blood Loss Volume

Some exercises feature vessels or tissue that can bleed if cut without cauterizing. The
simulated amount of blood loss is recorded and presented as Blood Loss Volume in the
post-exercise assessment. Minimize bleeding by using energy tools to cauterize bleeding
vessels.
Broken Vessels
A record of the number of broken vessels.
Incorrect Answers
The number of incorrect answers in a Quiz Exercise.

Misapplied Energy
The total time an incorrect energy is applied to a target or energy is enabled while not
touching a target.
Score
Certain exercises will report points, such as height achieved in the Stacking Challenge.
Missed Targets
Each missed needle target is recorded.
4.5 Simulator Targets

This section summarizes the most common targets that a user may encounter. View the
instructional video accompanying each exercise on the Skills Simulator for more information.
Camera Targets
A light blue sphere appears somewhere in the scene. The focal point of the endoscope is
indicated by a dark blue circle in center of the screen.
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Figure 4.33 Camera Targets

Camera targets require moving the focal point of the endoscope to the sphere, so that the
dark blue circle matches the edges of the light blue sphere. This may require moving the
endoscope in three dimensions, including zooming in and out. A small arrow will appear in
the circle indicating the direction to the next sphere target.

Grasp Targets
Indicated by a flashing instrument and a corresponding flashing object. Use the flashing
instrument to grasp the flashing object.
Figure 4.34 Grasp Targets
Handoff Targets
Grasp targets may link to form a handoff target. This requires the user to grasp the object with
the indicated instrument and pass it to a second instrument, while maintaining control of the
object.
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Figure 4.35 Handoff Targets

Energy Targets
Small spheres of different colors that require applied energy. Each color represents an energy
type.
Figure 4.36 Energy Targets

For monopolar energy, the tool must be in contact with the target while energy is applied. For
bipolar energy, the tool must grasp the object (contacting with both jaws of the tool) while
energy is applied. During energy application, a green progress circle surrounds the sphere.
On-screen prompts let the user know which energy to apply to each target. Use the
appropriate Surgeon Console foot pedals to apply monopolar and bipolar energy.
Pass Targets
Require the user to move an object past a given location. The object and target location flash
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yellow.
Figure 4.37 Pass Targets

Needle Targets
Require the needle to pass through a precise location. Below are two examples of needle
targets:
Needle Pass Targets

Require the user to pass the needle through a single location. The location appears as a
semi-transparent yellow and black sphere. Insert the needle through the yellow side of the
sphere and then through the black side, which turns green upon correct insertion or red upon
incorrect insertion. The target is complete after the needle is inserted through and completely
extracted from the target sphere.
Figure 4.38 Needle Pass Targets

Needle Pass Pair Targets
Require the user to pass the needle through both an insertion and an extraction point. The
insertion point initially appears in yellow and the extraction point is dark grey. The target is
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complete after the needle is passed completely through the insertion and extraction points,
and both points have turned green.
Figure 4.39 Needle Pass Targets

_______________________________End of section______________________________

5-1 Suturing Skills Simulation Software by Simbionix
5 Suturing Skills Simulation Software by

Simbionix
This chapter includes an overview of the Simbionix Suturing Skills simulation exercises and
metrics. These exercises are implemented utilizing Simbionix proprietary surgical simulation
platform.
The Simbionix simulation software provides skills scenarios designed for practice using the
Intuitive Surgical da Vinci Si Surgical System. In this set of exercises you will practice tying
suture knots over various anatomical representations. You can complete tasks in categories
that range in order of complexity: Vertical Defect Suturing, Horizontal Defect Suturing,
Continuous Suturing, and Interrupted Suturing. The graded Suturing Skills scenarios record
metrics that assess performance based on individual improvement only; they do not assess
surgical proficiency.
Note: The metrics provided are estimates, and as such Intuitive Surgical does not
intend for these metrics to reflect expected performance in an actual surgical
setting. Metrics are provided with the intent of mastering a particular simulated
exercise, and should not be used to determine proficiency for surgical operation.
See the da Vinci Si Surgical System user manual for information regarding the Surgeon
Console or other system components. This chapter covers the following topics:
• 5.1 Suturing Skills Exercise Instructions, on page 5-1
• 5.2 General Exercise Tips, on page 5-2
• 5.3 Suturing Skills Exercise Overview, on page 5-6
• 5.4 Scoring, on page 5-10
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5.1 Suturing Skills Exercise Instructions

1. Log in to the Skills Simulator and navigate to the Main Menu (refer to the instructions in
section 2.4 Skills Simulator Use, page 2-9).

Suturing Skills Simulation Software by Simbionix 5-2
2. Click Suturing Skills. The Suturing Skills screen appears. Select an exercise.
Figure 5.2 Suturing Skills

Handedness
To practice ambidextrous control, you can change your handedness setting to use your left or
right hand for driving the needle.
3. Click the Left Handed or Right Handed option button to select your dominant hand.
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Figure 5.3 Continuous Suturing

Note: The hand you select will apply to every exercise you practice unless you return
to the exercise screen and select the other hand.
4. Click Video Instruction to view an overview video, or click Launch Exercise.
5.2 General Exercise Tips

Follow these general tips when using Simbionix simulation software on the Skills Simulator.

Suturing Constraints
Suturing Breakage Under Tension
The suture may break when placed under too much tension; or, when there is too much
tension when tightening a knot.
Figure 5.4 Suture breaks under tension | suture breaks when tightening knot
Collision Detection
The Simulator provides enhanced collision detection and feedback for when instruments
collide; or when instruments collide with the needle.
Figure 5.5 Instrument to instrument collision | instrument to needle collision

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Enhanced Suturing Information
Knot Type
The Simulator provides information and guidance on the type of knot and wrap formed.
Figure 5.6 Half knot formed – one wrap
Figure 5.7 Half knot formed – double wrap

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Figure 5.8 Square knot
Figure 5.9 Granny Knot

Figure 5.10 Surgeon Knot
General Information
Restart Button
Move an instrument to touch the restart button ( ) at the upper corner of the screen to
receive a new suture at any time.
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Figure 5.11 Restart button

Note: Restarting (by pressing restart ) a Suturing Skills exercise before it is
complete will result in a lower score.
For further details on scoring parameters, see 5.4 Scoring on page 5-10.

5.3 Suturing Skills Exercise Overview
Suturing Skills exercises are categorized in order of difficulty. To select an exercise or log in to
the Skills Simulator, see the procedures outlined in the 2.4 Skills Simulator Use section.

In certain modules, specific on-screen messages and guides direct you to the target
completion goal. In other modules, you have the freedom to practice different techniques to
complete the task. Or, you can select Suturing Practice to try each technique without
impacting your score. This section covers the following exercises:
• Vertical Defect Suturing
• Horizontal Defect Suturing
• Continuous Suturing
• Interrupted Suturing
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• Suturing Practice
Suturing Skills

Vertical Defect Suturing

A module that guides you through the steps to complete a two-handed square knot, and
practice techniques involved with a vertical running suture.
Figure 5.14 Vertical Defect Suturing
Table 5-1 Vertical Defect Suturing Summary

Purpose Objective(s)
• Demonstrate basic techniques for • Tie two knots at the indicated locations,
knot tying across a vertical defect. follow the on-screen icons for guidance.
Horizontal Defect Suturing

A module that guides you through the step to complete a one-handed square knot and
practice techniques involved with a horizontal running suture.
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Figure 5.15 Horizontal Defect Suturing
Table 5-2 Horizontal Defect Suturing Summary

• Demonstrate basic techniques for
• Tie two knots at the indicated locations,
knot tying across a horizontal
follow the on-screen icons for guidance.
defect.

Continuous Suturing
A module that presents an environment to practice techniques involved with a continuous or
running suture.
Figure 5.16 Continuous Suturing

Table 5-3 Continuous Suturing Summary
• Tie a knot at the first position as an anchor
for your suture.
• Practice techniques to complete a
• Approximate the simulated tissue using a
continuous or running suture.
continuous, or running, suture through the
indicated targets.
Interrupted Suturing
A module that presents an environment to practice techniques involved with an interrupted
running suture.
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Note: If you are unable to complete the three surgeon’s knots with a single piece of
suture, touch the Additional Suture button ( ) to request additional suture.
Figure 5.17 Interrupted Suturing

Table 5-4 Interrupted Suturing Summary

• Tie a knot at each position
• Practice techniques to complete an • Approximate the simulated tissue using an
interrupted suture. interrupted suture through the indicated
targets.
Suturing Practice
Represents an environment to practice Vertical Defect Suturing, Horizontal Defect Suturing,
Continuous Suturing, and Interrupted Suturing.

Note: The Suturing Practice exercise does not end on its own. To exit, remove your
left hand from the master controller and briefly pull down and release (or flick) the
foot pedal ergonomic switch on the left-side pod of the Surgeon Console.
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Figure 5.18 Suturing Practice

Table 5-5 Suturing Practice Summary
• This is a free-range exercise. There are no
• Practice basic knot tying skills in an requirements and there is no scoring.
unmonitored environment. • Use the simulated environment to practice
suturing skills as needed.

5.4 Scoring
The Simbionix Suturing Skills exercises have a different metric system than the Mimic skills
exercises. The Simbionix metric system does not have an overall score. Instead, each user’s
performance is compared to the previous attempts made on the exercise by the same user.
Each metric is evaluated as to whether the performance is below the previous average score
(red circle), is above the previous average but can still improve (green circle), or is the highest
score for the user thus far (gold star). See Figure 5.19.
The Suturing Skills metrics are grouped into three categories: Knot-Tying, Needle Handling,
and Time Efficiency. To see the details for each metric, click the category grouping, then click
the specific metric to see how the performance was determined (Figure 5.19).
Figure 5.19 Example of Simbionix metric score display
Achievement
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Remember that Simbionix Suturing Skills exercises are based on improvement. To set a
benchmark, the exercise must be performed at least once. Please see the table below for a
detailed description of Suturing Skills exercise metrics. You should adhere to the
recommendations listed in the table to practice towards a passing score.
Below Benchmark/ Below Benchmark/ Below Benchmark/
Metric Description
Above Average at Average Below Average
Time to Complete Total time to complete task. N/A N/A N/A
Off-screen Needle Number of times a grasped You improved your average Keep your instruments in Keep your instruments in
Carries needle is outside the field of score and can still do better. view when grasping the view when grasping the
view. Continue to watch that you needle. needle.
don't carry your needle
off-screen.
Exercise Restarts Number of times the You improved your average You restarted the exercise You restarted the exercise
exercise is restarted via the score and can still do better. too many times. too many times.
blue restart button. Try to complete the exercise
without restarting.
Needle Passages The total number of times You improved your average Try to complete each Try to complete each
the needle passes score and can still do better. needle target with a single needle target with a single
completely through tissue Try to complete each pass without pulling the pass without pulling the
(inserted in one point and needle target with a single suture through. suture through.
extracted through another pass without pulling the
point). suture through.

Below Benchmark/ Below Benchmark/ Below Benchmark/

Metric Description
Above Average at Average Below Average
Target Accuracy The number of needle You improved your average Accuracy is based on Accuracy is based on
passage points in which the score and can still do better. proximity to the center of proximity to the center of
needle accurately passed Continue to work on the needle targets. Be the needle targets. Be
through its corresponding passing your needle mindful of needle position mindful of needle position
entrance and exit targets, through the center of all before driving. before driving.
divided by the total number targets.
of points through which the
needle has passed.

Unnecessary The total number of times You improved your average Precision is encouraged in Precision is encouraged in
Needle Pierces the needle is extracted back score and can still do better. this exercise. Needles this exercise. Needles
towards the respective Be careful that your needle should only be thrown should only be thrown
entrance point in order to does not pierce the tissue deliberately through deliberately through
correct a piercing. unless you are completing a targets. Unnecessary targets. Unnecessary
Unnecessary pierces include pass. piercing is penalized. piercing is penalized.
both needle entrance and
exit points.
Remaining Suture The sum of the absolute You improved your average Create a short tail prior to Create a short tail prior to
Tail deviation of all knot tail score and can still do better. completing first half knot. completing first half knot.
lengths, from a predefined Create a short tail prior to Maintain short tail length Maintain short tail length
suggested knot tail length of completing first half knot. throughout. throughout.
1.5 cm Maintain short tail length
throughout.
Suture Strain The number of times a You improved your average If too much force is applied If too much force is applied
Count suture was strained beyond score and can still do better. to a suture, it can break. In to a suture, it can break. In
a predefined value, which is Try to avoid letting the the simulation, the suture the simulation, the suture
simulated as a suture suture turn red. will turn red to indicate too will turn red to indicate too
breakage threshold. much force. Do not let the much force. Do not let the
suture turn red. suture turn red.
Granny Knots The number of granny knots You improved your average Alternate wraps to prevent Alternate wraps to prevent
completed versus square score and can still do better. the formation of granny the formation of granny
knots. Alternate wraps to prevent knots. knots.
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the formation of granny

knots.
_________________________________End of section________________________________

Sleep Mode, Shut Down, Disconnection, Maintenance 6-1
6 Sleep Mode, Shut Down, Disconnection,

Maintenance
This chapter describes how to enable sleep mode, shut down, disconnect and maintain the
Skills Simulator.
6.1 Sleep Mode

1. Press the power button on the Skills Simulator or on the Surgeon Console to send the
system into sleep mode.
2. When the power button on the Skills Simulator is lit steady amber ( ), the system is in
sleep mode (Figure 6.1).
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Figure 6.1 Skills Simulator power button

6-2 Sleep Mode, Shut Down, Disconnection, Maintenance
6.2 Shut Down

1. Press the power button on the Skills Simulator or on the Surgeon Console and wait until
the power button on the top of the Skills Simulator is lit steady amber ( ) before
proceeding.
2. Set the power switch on the side panel of the Skills Simulator to the O (OFF) position
(Figure 6.2).
USB ports
Audio out cable
Fiber cable
Power switch
(in OFF position)
Figure 6.2 Skills Simulator side panel cable connections

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6.3 Preparation for Storage
Disconnect Cables
Once the Skills Simulator is shut down, proceed as follows:
1. Disconnect the optional keyboard and mouse, if present, from the Skills Simulator side
panel USB ports (Figure 6.2).
2. Disconnect the optional monitor DVI cable, if present, from the Video Out L connector
on the back of the Surgeon Console (Figure 6.3).

Video Out L
Audio in
cable
Figure 6.3 Audio and video connectors on the Surgeon Console

3. Unplug the monitor power cord, if present, from the wall AC power outlet.
4. Disconnect the Skills Simulator AC power cord from the wall AC outlet.
5. Disconnect the audio cable from both the Skills Simulator (Figure 6.2) and the Surgeon
Console (Figure 6.3).
6. Disconnect the short (1 meter) blue fiber cable from both the Skills Simulator (Figure 6.2)
and the Surgeon Console (Figure 6.5). Be sure to place the cap on the end of the fiber
cable once it is removed (Figure 6.4).
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Figure 6.4 Fiber cable protective end cap

6-4 Sleep Mode, Shut Down, Disconnection, Maintenance
Fiber cable
Figure 6.5 Fiber cable connection on the Surgeon Console
Remove the Skills Simulator From the Surgeon Console

Note: It is not necessary to dismount the Skills Simulator from the Surgeon Console
during surgery, only to disconnect it as described on page 1-9, Transportation and
Storage Precautions.
1. Standing close to the Skills Simulator, grasp the side handles.
2. Lift the Skills Simulator so the mounting brackets slide up from the Surgeon Console
lateral supports.
3. Moving backwards, slowly pull the Skills Simulator away from the Surgeon Console and
lower it gently to the floor (Figure 6.6).
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Figure 6.6 Lowering the Skills Simulator to the floor
6.4 Skills Simulator Maintenance

Preventative Maintenance is not required for the Skills Simulator; however, if maintenance
becomes necessary it must be performed by an authorized Intuitive Surgical Service
Representative. There are no user-serviceable parts on the Skills Simulator.
WARNING: No modification of this equipment is allowed.

For Technical Support
If the Skills Simulator requires maintenance or service, please call our Technical Support line.
In the U.S., call 1-800-876-1310, where phones are staffed 24 hours a day, seven days a week. In
Europe, call +41.21.821.2020.
Cleaning the Skills Simulator

Dampen a soft, lint-free cloth with a mild anti-bacterial soap and water solution, and wipe the
exterior surfaces of the Skills Simulator and cabling as necessary. Allow components to dry
before use.
Note: The system cables and their receptacles contain fiber-optics. Only when
requested by Intuitive Surgical personnel, clean both cable and receptacles by
blowing the fiber ends with a generic dry and oil-free canned air duster.
_________________________________End of section______________________________
10/29/13

A-1 Appendix A: da Vinci® OnSite® for Skills Simulator
A Appendix A: da Vinci® OnSite® for Skills

Simulator
A.1 General Information
The following appendix is applicable only if your da Vinci Skills Simulator System has
da Vinci OnSite for Skills Simulator enabled.
Purpose
The purpose of this appendix is to provide the user with an overview and use instructions for
the da Vinci OnSite for Skills Simulator system networking solution. da Vinci OnSite provides
these basic capabilities and benefits:
1. Automated software update retrieval, where the Skills Simulator downloads scheduled
updates from an ISI server.
2. Install new updates to Skills Simulator training exercises.
3. Install updates to firmware.
General Precautions
da Vinci OnSite for Skills Simulator must be used in accordance with this manual, and only by
personnel who have been trained in its use by an authorized Intuitive Surgical, Inc. (ISI)
representative. Read all instructions carefully. For information specific to da Vinci OnSite for Si,
and networking infrastructure details, see the da Vinci Si Surgical System User Manual
(PN 550650).
Note: Ethernet networks (both wired and wireless) are subject to losses of
10/29/13
connectivity that could disrupt use of applications that employ network

connectivity, like OnSite, or make data unreliable when it is received at a remote
location. Such disruptions, if they occur, have no effect on the performance or
functionality of the Skills Simulator or the da Vinci Si System.
CAUTION: da Vinci OnSite for Skills Simulator components may be installed and
serviced only by Intuitive Surgical personnel. Do not attempt to install or service
equipment without Intuitive Surgical personnel.
CAUTION: Leakage current from interconnected electrical equipment may exceed

safe levels. To maintain the safety of patients and users, interconnect only with
devices in compliance with IEC 60601-1-1. It is the user’s responsibility to ensure
that any interconnected equipment not supplied by Intuitive Surgical maintains
compliance with IEC 60601-1-1.
Intended Use – da Vinci OnSite for Skills Simulator

da Vinci OnSite for Skills Simulator (also referred to as OnSite for Simulator) is an accessory to
the da Vinci Si Surgical System and is intended for use by trained Intuitive Surgical Customer
Service personnel for the purpose of installing software updates.

Appendix A: da Vinci® OnSite® for Skills Simulator A-2
Power Requirements
To ensure optimum performance, make sure the Skills Simulator and Si Surgeon Console are
connected to a dedicated, noise-free and well-grounded AC power outlet.
WARNING: To avoid risk of electric shock, this equipment must only be connected to
a supply mains with protective earth.
Network Connections
OnSite for Simulator requires a wired RJ45 Ethernet 10bT/100bT/1000bT and/or wireless
802.11 network connection with Internet access in the OR where the Skills Simulator is to be
used.
A.2 Introduction
When Intuitive Surgical field service personnel install and configure system software and
hardware to enable OnSite functionality, the Skills Simulator can connect to the ISI dVMS
Server and download all software updates.
OnSite is a proprietary Intuitive Surgical product leveraging the existing Intuitive Surgical Field
Service staff and applications.
An OnSite-equipped Skills Simulator sends and retrieves software status and updates
regardless of system state and mode.
System Overview
OnSite for Simulator consists of three major components, that is the Skills Simulator backpack
networking components, the dVMS Server Infrastructure, and the remote user
(Intuitive Surgical Field Service personnel).
To implement remote capabilities, the Skills Simulator must have access to the Internet. OnSite
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is designed to accomplish this using existing hospital networks. It therefore conforms to most
hospital IT policies and security standards.

Wired Network Connection

Connect the Skills Simulator Ethernet connection to the hospital network (wall plate) using a
CAT5e network cable (Figure A.1).
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Figure A.1 Network cable connections

Note: To take advantage of the full potential of OnSite, the system must remain
connected to the network. If desired to disconnect the system from the network, see
the instructions for Disabling Network Connectivity on page A-13.

An icon on the Welcome screen indicates the status of the network connection (Figure A.2).
da Vinci Network Online
da Vinci Network Offline
Figure A.2 Network Connection Status

10/29/13
Note: Once the Ethernet cable is connected, it can take up to two minutes to detect
the da Vinci network and update the status on the Welcome screen.

Wireless Connectivity Option

Wireless Overview
A wireless USB adapter is connected to a USB port on the Skills Simulator in order to enable
the Wireless Connectivity Option. A hospital-supplied Wireless Access Point (WAP) with
Internet access is required to establish wireless connectivity.
Figure A.3 Wireless adapter and USB ports on Skills Simulator

Note: It is important to note that if the wireless network is modified or updated after
the Wireless Connectivity Option is installed, its suitability to support the wireless
applications should be re-assessed. In particular, contact Technical Support if any of
the following changes are planned or have occurred.
Wireless Adapter Transmitter

10/29/13
The wireless adapter contains the following Transmitter Module: FCC ID: XU8TEW648UBM.
Wireless Network Requirements

Intuitive Surgical field service personnel will install and configure the Wireless Connectivity
Option. Below are the details of a suitable wireless network to support da Vinci wireless
applications.
Specifications
• The Wireless Connectivity Option utilizes the IEEE 802.11 wireless standard using either
802.11b or 802.11g at 2.4 GHz Industrial, Scientific, and Medical (ISM) band.
• The Wireless Access Point must be located within 75 feet of the Skills Simulator.
Security
• Wireless Network Infrastructure
• Intuitive has tested the Wireless Connectivity Option in WPA2 pre-shared key mode
with AES encryption, and recommends that the Wireless Connectivity Option is
integrated into the hospital network using this security configuration.
• da Vinci OnSite Software Application
• The OnSite software application uses a Secure Socket Layer (SSL) session based on
unique certificates on the Skills Simulator and the server.

• Data being transmitted from the Skills Simulator to the server is 128-bit encrypted.
Once successfully installed and configured, Intuitive Surgical field service personnel conduct
an end-to-end functional test to ensure that OnSite functions as expected.
It is possible that the wireless network conditions might degrade over time or experience
periods of disturbance; da Vinci applications have been designed to be robust to typical
network disturbances, but if an issue persists, contact Technical Support for assistance to
resolve the issue.
Note: It is important to note that if the wireless network is modified or updated after
the Wireless Connectivity Option is installed, its suitability to support the wireless
applications should be re-assessed. In particular, contact Technical Support if any of
the following changes are planned or have occurred.
• If the Wireless Access Point or Skills Simulator is moved from the location where it resided
during installation.
• If the Wireless Access Point is replaced with a new make or model.
Devices Known to Interfere

Microwave Oven
Testing conducted by Intuitive Surgical determined that microwave ovens can disrupt wireless
communication in certain configurations:
• Intuitive Surgical recommends keeping microwave ovens (1000 Watt) at least 25 feet from
the wireless adapter or Wireless Access Point, especially if it is located in the signal path.
Higher wattage microwaves should be placed at larger distances.
7.6 meters
or 25 feet
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7.6 meters
or 25 feet
Signal
Path
Wireless Access Point
Wireless Adapter
• If a microwave oven causes interference, use the wired backup to correct the problem.
RFID Reader (2.4 GHz)

Testing conducted by Intuitive Surgical determined that RFID readers operating in frequency
hopping mode, or configured to operate at a frequency that overlaps the channel being used
by the wireless adapter and the Wireless Access Point, will cause minor network disturbances.
To eliminate the interference, Intuitive Surgical recommends the following:

• The RFID reader not operate in frequency hopping mode if it is being used in the same
room as the Wireless Connectivity Option.
• A separation of a least 4 MHz exists between the frequency range of the channel being
used by the wireless adapter/WAP and the operating frequency of the RFID reader. For
example, a wireless adapter/WAP operating on channel 10 spans 2.446 – 2.468 GHz;
therefore, to avoid disturbances from the RFID reader, its operating frequency should be
less than or equal to 2.442 GHz or greater than or equal to 2.472 GHz.
Valid RFID Reader Valid RFID Reader
Operating Frequencies 4 MHz 4 MHz Operating Frequencies

Wireless Connectivity
Option Frequency Range
2.442 2.446 2.468 2.472

GHz GHz GHz GHz
Figure A.4 Valid RFID Reader Operating Frequencies

Intuitive Surgical recommends that performance is tested with the RFID device active before
use.
Addressing Wireless Connectivity Problems

If you encounter connectivity problems while using the Wireless Connectivity Option,
Intuitive Surgical recommends you do the following:
• Determine if a device transmitting in the 2.4 GHz range is in the room, and if so, disable
the device and see if it resolves the connectivity problems.
• If you experience several disconnections, and the above step did not resolve the issue,
then establish the wired connection as described in the Skills Simulator User Manual.
Disabling Network Connectivity

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If there is a need to disable all network connectivity for the Skills Simulator, disconnect the
150 Mbps Micro Wireless N USB Adapter.
Note: To re-establish network connectivity, you must re-connect the indicated
150 Mbps Micro Wireless N USB Adapter.
Electromagnetic Compatibility
The essential performance for Skills Simulator wireless connectivity during EMC testing was
defined as follows during any of the required tests:
• No component failures
• Video quality exceeded pre-defined metric demonstrating that the video quality was not
impacted
• Audio script test passed demonstrating that the audio link was not impacted
• No changes in programmable parameters
• No resets to factory defaults
• No change in operating mode
• No false alarms
• No initiation of any unintended operation

• No cessation or interruption of any intended operation
Exception: For Voltage Dips and Interrupts, acceptance criteria is no component failures and
is restorable to the pre-test state with operator intervention. For Radiated Immunity in the
band 2.0 - 2.5 GHz, acceptance criteria is no component failures and is restorable to the
pre-test state with operator intervention, and restorable during test with a hard-wired
connection.
Compliance Information
CAN/CSA-C22.2 No 60950-1-03
Network Router:
ANSI/UL Std No 60950-1 1st Ed.
Wireless Adapter: * 2.412-2.484 GHz
802.11b: up to 11 Mbps
Wireless Data Rate
802.11g: up to 54 Mbps
* See Wireless Adapter Data on page A-9 for more information

10/29/13

Wireless Adapter Data
wireless
150Mbps Micro Wireless N USB Adapter

TEW-648UBM (V1.0R)
The 150Mbps Micro Wireless N USB Adapter (model TEW-648UBM) quickly
connects a laptop or desktop computer to a high speed wireless n network.
Enjoy proven wireless n speed and reliability, in a micro design that extends
less than three eighths of an inch (9mm) from the edge of a computer.
Connecting to a network is made easy with the external one-touch Wi-Fi
Protected Setup (WPS) button. Advanced wireless encryption protects your
valuable data. Wi-Fi Multimedia (WMM) Quality of Service (QoS) prioritizes
important video, audio, and gaming traffic. Seamlessly stream video,
download files, and play games with this ultra compact wireless n adapter.
Features • 1 x USB 2.0 connector

• Ultra compact form factor
• Wi-Fi compliant with IEEE 802.11n standard
10/29/13
• One-touch wireless connection with external Wi-Fi Protected Setup (WPS) button
• Backwards compatible with IEEE 802.11g and IEEE 802.11b devices
• Maximum reliability, throughput, and connectivity with automatic data rate switching
• Supports 64/128-bit WEP, WPA/WPA2-RADIUS, and WPA-PSK/WPA2-PSK
• Wi-Fi Multimedia (WMM) Quality of Service (QoS) data prioritization
• Easy user setup and intuitive diagnostic utility
• Coverage of up to 30 meters indoor (98feet) and 50 meters outdoor (164 feet) *
• 3-year limited warranty
*Maximum wireless signal rates are referenced from IEEE 802.11 theoretical specifications. Actual data throughput and coverage will vary depending on
interference, network traffic, building materials and other conditions.
TEW-648UBM
rev:09.30.2010

150Mbps Micro Wireless N USB Adapter

TEW-648UBM (V1.0R)
SPECIFICATIONS
Hardware
Interface • USB 2.0
Standards • IEEE 802.11b, IEEE 802.11g, and IEEE 802.11n (draft 2.0)
Button • WPS button: enables quick wireless connection with WPS function
Power Consumption • Receive mode: 100mA (max.) • Transmit mode : 210mA (max)
Supported OS • Windows 7 (32/64-bit), Vista (32/64-bit), XP(32/64-bit)
Dimensions (LxWxH) • 20 x 15 x 7 mm (0.8 x 0.6 x 0.3 in.)
Weight • 1 g (0.03 oz)
Temperature • Operating: 0° ~ 40° C (32° ~ 104° F) • Storage: -10° ~ 70° C (14° ~ 158° F)
Humidity • Max. 95% (non-condensing)
Certifications • CE, FCC
Wireless
Modulation • OFDM, DSSS
Antenna • Built-in on board antenna
Frequency • 2.412 ~ 2.484 GHz
Data Rate (auto fallback) • 802.11b: up to 11Mbps • 802.11g: up to 54Mbps • 802.11n: up to 150Mbps
Output Power • 802.11b: 14dBm (typical) • 802.11g: 11dBm (typical) • 802.11n: 10dBm (typical)
Receiving Sensitivity • 802.11b: -84dBm (typical) at 11mpbs • 802.11g: -69dBm (typical) at 54Mbps • 802.11n: -66dBm (typical) at 150Mbps
Encryption • 64/128-bit WEP, WPA/WPA2-RADIUS, WPA-PSK/WPA2-PSK
Channels • 1~11 (FCC), 1~13 (ETSI)
NETWORKING SOLUTIONS PACKAGE CONTENTS

• TEW-648UBM
10/29/13
• CD-ROM (Utility and Driver)

• Multi-Language Quick Installation Guide
RELATED PRODUCTS
TEW-651BR 150Mbps Wireless N Home Router
TEW-650AP 150Mbps Wireless N Access Point
TEW-647GA Wireless N Gaming Adapter
CONTACT INFORMATION
20675 Manhattan Place,Torrance, CA 90501 USA

Tel: 1-310-961-5500
Fax: 1-310-961-5511
Web: www.trendnet.com
Email: sales@trendnet.com
1-888-326-6061
TRENDnet is a registered trademark. Other Brands and product names are trademarks of their respective holders. Information provided in this document pertain to TRENDnet
products and is subject to change at any time, without notice. For the most recent product information please visit http://www.trendnet.com.
Copyright © TRENDnet. All Rights Reserved.

A.3 Remote Skills Simulator Software Update

The system can receive new software update alerts while powered on (power button lit blue)
or in sleep mode (power button lit amber). Once the updates are available, a message will
appear in the upper corner of the Welcome Screen that notifies the user of a pending update.
The message will provide instructions on when to leave the Simulator powered on (Figure
A.5).
Figure A.5 Software update available

To install updates:
1. Leave the Skills Simulator in sleep mode overnight. For instructions on enabling sleep
mode, see Sleep Mode on page 6-1.
Note: If the system is powered on and the power button is lit blue (not in sleep
mode) the update will only happen if the Skills Simulator is on the Welcome Screen.
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This is a feature to ensure that a user’s session is not interrupted, should he or she
happen to be completing exercises on the Skills Simulator at the planned time of
download.
2. At the time specified on the Welcome screen, and when the Skills Simulator is in sleep
mode and not in use, the system will automatically start the installation process.
• The Skills Simulator backpack does not need to be connected to the Surgeon Console
for the updates to take place.
Before starting the update, the system will check for the following parameters:
• No dual console connected
• No patient cart connected
• No vision cart connected

While updating, the power button is lit blue. When the update is complete, the power button
is lit amber (sleep mode). The status indicator LED on the side of the Skills Simulator backpack
also indicates when the system is updating (lit blue and blinking) and when the update is
complete (lit green and blinking). See Figure A.6.
Power button Status indicator

(Lit amber) (Lit green and blinking)
Figure A.6 Power button | Status indicator (shown when update is complete)
Note: During the update, the system components may power-up and power-down,
and the stereo viewer screen may flicker. This is expected and normal.
Note: While an update is in process, the backpack can be removed from the Surgeon
Console by disconnecting the blue fiber cable from the Skills Simulator and
connecting the Surgeon Console fiber cable to the Vision Cart. The Skills Simulator
will continue to update and the Surgeon Console can be used for surgery.
Note: The Skills Simulator must remain powered during the update process. Do not
unplug the power cord or turn off the black power switch during an update.
3. Press the power button on top of the Skills Simulator (Figure A.6). The system starts and
the welcome screen appears in the stereo viewer on the Surgeon Console. At log in, the
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screen displays the software version and date of last upgrade (Figure A.7).
Figure A.7 Software version and install date

If the update is unsuccessful, a message appears on the Welcome screen (Figure A.8).
Figure A.8 Update unsuccessful
Disabling Network Connectivity

To disable the Skills Simulator from the network, disconnect the Ethernet cable from the
Ethernet port on the backpack, or unplug the USB wireless adapter, if present.
A.4 IT Requirements
Internet Access
The wireless adapter device that will be integrated into the Skills Simulator requires Internet
access to contact servers at Intuitive Surgical.
ISI requires a wired RJ45 Ethernet 10bT/100bT/1000bT and/or wireless 802.11 network
10/29/13
connection with Internet access in the OR where the Skills Simulator is to be used. If your Skills
Simulator is used in multiple locations, then ISI requests that network access be made
available in each location.
da Vinci OnSite is compatible with both DHCP and Static networking addresses.
Proxy Server
All IP proxy servers are compatible with OnSite for Simulator.
Firewall
OnSite for Simulator requires outbound port 443 open.
Network Topology
OnSite for Simulator requires a minimum amount of bandwidth to post log files (generally less
than 1 MB per day).
________________________________End of section______________________________

Appendix B: Troubleshooting B-1
B Appendix B: Troubleshooting
This appendix provides information to help troubleshoot setup problems.
B.1 Setup Troubleshooting

See Table B-1 for an overview of setup symptoms, possible problems, and remedies. For most
issues, you should perform a reboot of the system, see section B.2 Reboot the Skills Simulator.
If symptoms persist after following the suggested remedies and/or rebooting the system,
please contact Intuitive Surgical For Technical Support. In the U.S., call 1-800-876-1310, where
phones are staffed 24 hours a day, seven days a week. In Europe, call +41.21.821.2020.
Advanced Exchange Program

If your Skills Simulator needs repair, Intuitive Surgical offers an Advance Exchange (AEX)
program. This is an effort to eliminate down-time while your Skills Simulator is repaired. By
filling out the AEX form, you authorize Intuitive Surgical to immediately send a replacement
Skills Simulator to your site. To protect your data, the replacement Skills Simulator arrives with
a memory stick you can use to transfer your files to the replacement Simulator. You may then
use the packaging provided to send the faulty Simulator back to Intuitive Surgical for repair.
Please contact Intuitive Surgical Technical Support for more information and to request the
AEX form.
Table B-1 Troubleshooting

Symptom Possible Problems Remedy
• Disconnect the Skills Simulator
from the Surgeon Console, and
reconnect the Skills Simulator to
Error message: “31016“and The Skills Simulator may be attached to the original Surgeon Console that
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nonrecoverable fault red triangle a Surgeon Console with a different has compatible software.
appears on-screen. software version. • To update a Surgeon Console with
compatible software, contact
Intuitive Surgical Technical
Support.
• Turn Skills Simulator off, verify all
Nonrecoverable Fault: Red triangle Short blue fiber cable became
connections, and reboot the
appears on-screen. disconnected during use.
system.
• Turn the Skills Simulator off, verify
Recoverable Fault: Yellow triangle
all connections, and reboot the
appears on-screen.
Blue fiber cable is loose, or it may be system.
dirty. • Follow maintenance instructions
Error Message: “Fiber cable connectors
on page 6-5: Cleaning the Skills
require cleaning”.
Simulator.
Audio problems: Video has no sound; • Turn Skills Simulator off, verify all
The audio cable is not hooked up
other features (such as energy connections, and reboot the
correctly.
instruments) have no sound. system.
• Turn Skills Simulator off, verify all
Video problems: Skills Simulator and
Blue fiber cable is unattached. connections, and reboot the
Surgeon Console will not connect.
system.

B-2 Appendix B: Troubleshooting
B.2 Reboot the Skills Simulator

1. Press the power button on the Skills Simulator or the Surgeon Console to get the system
into standby mode. Wait until the power buttons illuminate steady amber ( ).
2. Verify all connections between the Skills Simulator and the Surgeon Console are correct.
For example, check that the fiber cable blue LED is illuminated for both the Skills
Simulator and the Surgeon Console, and that the green LED is flashing on the Skills
Simulator. Disconnect any monitor DVI cables, if present.
3. Set the Skills Simulator power switch to the OFF position. All LED will turn off at this point.
4. Set the power switch on the Simulator back to ON. Wait until the power buttons on the
Skills Simulator and the Surgeon Console illuminate steady amber.
5. Press the power button on the Skills Simulator or the Surgeon Console. The system
reboot is complete once the power buttons illuminate steady blue.
Note: The Skills Simulator may be moved from one Surgeon Console to another; but,
the software version of the Skills Simulator must be compatible with the software
version of the Surgeon Console it is connected to.
Note: The software may load on the Surgeon Console touchpad before it is finished
loading on the Skills Simulator (the stereo viewer and optional additional monitor
may be affected by this). During this momentary delay, you may see a blank screen;
this is expected and normal.
________________________________End of section______________________________
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Appendix C: Specifications, Symbols, Glossary C-1
C Appendix C: Specifications, Symbols,

Glossary
This appendix provides supporting information for the Skills Simulator, including
specifications and reference tables for symbols and glossary. See the da Vinci Si Surgical
System user manual for similar information regarding the Surgeon Console or other system
components.
C.1 Environmental Specifications

Table C-1 Environmental Specifications: Operating
Environmental Conditions: Operating
Temperature: 10 to 30 °C (50 to 86 °F)
Humidity: 10 to 85% non-condensing
The Skills Simulator shall function properly in atmospheric pressures
ranging from 523mm HG (10,000 ft) to 774mm HG (-500 ft). For every
1000 feet above sea level, the 30 ºC operational temperature limit
Atmospheric Pressure:
specified above will be reduced by 1 ºC. (For example, the maximum
operating temperature at 5000 feet will be 25 ºC, and the maximum
operating temperature at 10,000 feet will be 20 ºC.)
Table C-2 Environmental Specifications: Storage and Transport

Environmental Conditions: Storage and Transport
Temperature: -10 to 55 °C (14 to 131 °F)
5 to 95% non-condensing for transport
Humidity:
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10 to 85% non-condensing for storage
Note: Storage and transport of the system are not affected by atmospheric pressure.
C.2 Box Dimensions

Table C-3 Box Dimensions
HxWxD Weight
63.5cm x 58.4cm x 17.8cm 14 kg
Skills Simulator
(25” x 23” x 7”) (33 lbs)

C-2 Appendix C: Specifications, Symbols, Glossary
C.3 Symbols Reference

The following table provides a reference for symbols you may see on the Skills Simulator
hardware, Surgeon Console hardware, or user documentation.
Table C-4 Symbols Reference
Symbol or Icon Meaning Where Found
Attention: Consult accompanying

Several places on the da Vinci Si System
documents.
Inside Surgeon Console service panel

Ethernet Connection and the side panel of the Simulator
backpack.
On product labels containing rating
Alternating Current information on rear of Surgeon
Console
Standby – found on Power button of

Simulator, lit amber when in standby Power buttons of Skills Simulator and
mode (connected to mains but not Surgeon Console
powered on), blue when powered on.
Off (power: disconnection from mains Side panel of Skills Simulator
On (power: connection to mains) Side panel of Skills Simulator

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Blue cover of fiber cable receptacle on

Caution: Laser hazard
Skills Simulator and Surgeon Console
Audio Out connector Side panel of Skills Simulator
Blue fiber cable (system cable)

Skills Simulator and Surgeon Console
receptacle
Skills Simulator main label or system

or Read the operating instructions.
component labels.
USB Port Side panel of Skills Simulator
Nonrecoverable fault Skills Simulator software

Appendix C: Specifications, Symbols, Glossary C-3
Table C-4 Symbols Reference
Symbol or Icon Meaning Where Found
Recoverable fault Skills Simulator software
da Vinci Network Online Skills Simulator Welcom screen

da Vinci Network Offline Skills Simulator Welcome screen
C.4 Glossary of Terms
Table C-5 Glossary

Term Meaning
3D Three-dimensional.
The three-dimensional image created by two cameras. The stereo viewer on

3D Display
the Surgeon Console provides such an image.
Alternating Current, also represented by the AC symbol: ~. “AC” or “AC power”

AC refers to electrical power provided via a wall outlet, as opposed to battery
power.
The informal term applied to the Skills Simulator, which resembles a backpack
Backpack
when mounted to the Surgeon Console.
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CAUTION An important level of concern.
Console See Surgeon Console.
The Default User, included with the Simulator, can run all of the exercises on
Default user
the Simulator with no restrictions.
An instrument used for the examination of the interior of a canal or a hollow

Endoscope space; also called a “scope.” This exists only in a virtual sense on the Skills
Simulator.
A task or series of tasks offered by the Skills Simulator, using sophisticated

Exercise 3D virtual reality software, that are designed to practice the skills required to
use the da Vinci Si Surgical System on live patients.
Detailed descriptions of the exercises offered by the Skills Simulator in video

Exercise instructions
format.
Any one of several tools used to effect the procedure in the patient once
attached to an instrument arm and inserted into the patient. Instruments
Instrument
include, for example, Large Needle Drivers, DeBakey Forceps and Round Tip
Scissors. Instruments exist only in a virtual sense on the Skills Simulator.

C-4 Appendix C: Specifications, Symbols, Glossary
Table C-5 Glossary

Term Meaning
Metrics Measures of user performance that are generated and saved by the Simulator.
Measures of user performance that rate the level of performance (specified by

Metric history
color) for a specific exercise.
Note User information to emphasize an important point.

A software application developed by Mimic Technologies that allows users to

MScore™
view metrics-based performance reports after completing an exercise.
A proprietary surgical simulation platform developed by Mimic Technologies

MSim™
that enables realistic training scenarios in a virtual 3D environment.
Controls on the left end of the Surgeon Console arm rest that provide
Left-side pod
ergonomic adjustment. Also used in the Simulator to exit an exercise.
Performance evaluation A screen that contains the metric results of a completed exercise.
Exercise report A comprehensive report based on user metrics that is generated by MScore.
Scope Endoscope.
The part of the da Vinci Si Surgical System consisting of a structure that

Surgeon Console
supports the masters and the stereo 3D viewer.
Simulator assembly Refers to the Skills Simulator hardware, informally known as the “backpack.”
A shorter name for the da Vinci Skills Simulator (see below). Also referred to as
Skills Simulator
the Simulator.
The full name for the Skills Simulator (see above), referred to more briefly as
10/29/13
da Vinci Skills Simulator

the Skills Simulator or just the Simulator.
The viewing system that comprises the upper portion of the Surgeon Console,
Stereo Viewer or 3D Viewer
where the surgeon looks to see the 3D image.
A non-administrator that uses the Skills Simulator to practice

User the various skills and techniques required to perform surgery with the
da Vinci Si Surgical System.
WARNING High level of concern.
_________________________________End of section______________________________

D-1
Index Compatibility 1-10

EMC Tables 1-12
Energy Dissection 4-8, 5-8
A Energy Switching 4-7, 5-8
AC Power Cords 2-6 Environmental Conditions
Accessory Equipment Interconnection 1-10 Operating 1-5
Appendix A - Troubleshooting B-1 Storage and Transport 1-6

Appendix C Environmental Specifications 1-5
System Specifications C-1 Excessive Force 4-2
Audio Exercise History tab 4-22
Connections 2-6 Exercise Scoring 3-7, 4-1, 4-20, 4-24, 5-1
Audio and Video Connectors 6-3 Exercise Types 4-1, 5-1
Audio Cable 2-6 External Monitor (Optional) 2-7
Auto Sense 1-5
F
B FCC Compliance 1-11
Battery
Disposal Information 1-15 G
Blue Fiber Cable General Exercise Tips 4-1, 4-2, 5-1
Protective Cap 6-3 General Information 1-2
Simulator Panel Connection 2-5 General Precautions, Warnings, and Contraindications 1-8
Surgeon Console Connection 6-4
I
C Ingress Protection 1-3
cables, system 2-4 Installation and Service Precautions 1-9
Camera and Clutching 4-3 Intended Use 1-6
Camera Targeting 5-7 Introduction 1-1
Cautions 1-8
Cleaning the System 6-5 L
Compliance and Classifications 1-3
10/29/13
Labels
Connections System 1-4
Cables 2-4 Laser Safety 1-9
Simulator (Side Panel) 2-5 Laying out the system cables 2-4
Contact Information 1-3
Contraindications 1-8 M
Crate Dimensions C-1 Manufacturer’s Declaration
Customer Service Electromagnetic Emissions 1-12
Contact Information 1-3 Electromagnetic Immunity 1-13
Match Board 4-14
D Metric History tab 4-23
Degree of Protection 1-3 Metrics 4-24
Dimensions Mimic 1-3
Crate C-1 Mode of Operation 1-3
Disposal Information MScore 4-20
Battery 1-15
Dots and Needles 4-10, 5-7 N
Needle Targeting 4-16
E
Electrical Rating 1-5 O
Electromagnetic Operation

D-2
Mode 1-3 Simulator
Optional Devices 2-6 Audio Cable 2-6
External Monitor 2-7 Blue Fiber Cable 2-4
USB Devices 2-6 Cable Layout 2-4
Organization, User Manual 1-1 First-Time Use 2-9
Main Components 1-2
P Mounting onto the Surgeon Console 2-1
Peg Board 4-13 Powering On 2-7
Performance Preparation for Storage 6-2
EMC testing 1-11 Removal from Surgeon Console 6-4

Simulation 1-6 Side Panel 6-2
Surgeon Console 1-6 Cable Connections 2-5
Persistent Settings 1-8 Simulator Targets 4-1, 4-25
Touchpad 1-6 Camera Targets 4-25
Pick and Place 4-12 Energy Targets 4-27
Playground 4-18 Grasp Targets 4-26
Power Handoff Targets 4-26
Button, Simulator 6-1 Needle Targets
Connections 2-4 Needle Pass Pair Targets 4-28
Cords 2-6 Needle Pass Targets 4-28
Requirements 1-5, 2-6 Pass Targets 4-27
Specifications 4-1, 5-1, C-1 Specifications
Professional Instructions for Use 1-8 Environmental 1-5
Protection Power 4-1, 5-1, C-1
Degree 1-3 Specifications, Environmental 4-1, B-1, C-1
Ingress 1-3 Stacking Challenge 4-18
Type 1-3 Storage and Transport
Protective Cap Environmental Conditions C-1
Blue Fiber Cable 6-3 Surgeon Console
10/29/13
Audio and Video Connectors 6-3

Q Overview 1-2
Quiz Exercises 4-1 Suture Sponge 4-9
System
R Cleaning 6-5
Reboot the Skills Simulator B-2 Connections 2-1
Recommended Separation Distances 1-15 Labels 1-4
Representative Uses 1-8 Power Cords 2-6
Required Power 1-5, 4-1, 5-1, C-1 Shutdown and Storage 6-1
Ring and Rail 4-15 system cables 2-4
Ring Walk 4-6
T
S Technical Support 1-3, B-1
Scaling 4-5 Phone Numbers 6-5
Screens Text Messages
Simulation (Users) 2-15 Reference Table C-2
Separation Distances 1-15 Thread the Rings 4-17
Shut down 6-1 Transport 1-9
Side Panel, Simulator 6-2 Transportation and Storage Precautions 1-9
Simulation Exercise Overview 4-1, 4-2, 5-1, 5-6 Tubes 4-11
Simulation Exercises 4-1 Type of Protection 1-3

D-3
U V
User Manual Voltage
Organization 1-1 Electrical Rating 1-5
User Screens Requirements 1-5
Simulation Screen 2-15
10/29/13

Manual de Skills Simulator

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Skills Simulator for the

Trademarks and Attribution

Mimic is a registered trademark of Mimic Technologies, Inc.

MSim and MScore are trademarks of Mimic Technologies, Inc.

Simbionix is a registered trademark of Simbionix USA and Simbionix, Ltd.

Equipment and Software Version

Skills Simulator for the da Vinci® Si™

Intuitive's then current list prices.

Skills Simulator for the da Vinci® Si™

•1.3 General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3

•1.8 Disposal Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-15

2 Connections, Startup, and Use. . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

Skills Simulator for the da Vinci® Si™

3 Onboard Simulator Administrator and Reports Guide . . . . . 3-1

4 Simulation Software by Mimic Technologies. . . . . . . . . . . . . . 4-1

• EndoWrist Manipulation 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12

5 Suturing Skills Simulation Software by Simbionix . . . . . . . . 5-1

Skills Simulator for the da Vinci® Si™

6 Sleep Mode, Shut Down, Disconnection, Maintenance. . . . . 6-1

A Appendix A: da Vinci® OnSite® for Skills Simulator . . . . . . . . A-1

• System Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-2

Skills Simulator for the da Vinci® Si™

C Appendix C: Specifications, Symbols, Glossary . . . . . . . . . . . C-1

•C.3 Symbols Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .C-2

Skills Simulator for the da Vinci® Si™

1.1 User Manual Organization

Skills Simulator for the da Vinci® Si™

Back of Surgeon Console Skills Simulator mounted on back of Surgeon Console

Figure 1.1 Skills Simulator mounted on Surgeon Console

Surgeon Console Required

Skills Simulator for the da Vinci® Si™

Skills Simulation Software by Mimic, MSim and MScore

Suture Skills Simulation Software by Simbionix

1.3 General Information

Intuitive Surgical, Inc. Intuitive Surgical Sàrl

For Technical Support

Compliance and Classifications

Skills Simulator for the da Vinci® Si™

Space reserved for unit identifiers

Figure 1.2 System Labels: IEC 2nd Edition

Skills Simulator for the da Vinci® Si™

Figure 1.3 System Labels: IEC 3rd Edition

Skills Simulator for the da Vinci® Si™

Environmental Conditions: Storage and Transport

1.4 Intended Use

1.5 Simulation Performance

Surgeon Console Performance with Skills Simulator

• When real instruments and simulated Simbionix instruments reach an end-of-movement

Skills Simulator for the da Vinci® Si™

Touchpad Feature Supported (Yes or No)

Skills Simulator for the da Vinci® Si™

1.6 General Precautions, Warnings, and Contraindications

Skills Simulator for the da Vinci® Si™

CAUTION: Equipment is not suitable for use in the presence of a flammable

Installation and Service Precautions

this user manual.

• Do not attempt to perform any repair or maintenance on optical communications

Transportation and Storage Precautions

Skills Simulator for the da Vinci® Si™

CAUTION: Leakage current from interconnected electrical equipment may exceed

Disconnect Skills Simulator During Surgery

from the AC power outlet.