A. The company is called Intuitive Surgical because its technologies allow surgeons to operate intuitively, with the same direct approach as open surgery and with a similar or better range of motion but through the small ports used in minimally invasive surgery. This is in contrast to traditional laparoscopic surgery, where the surgeon move the instrument handles in the opposite direction as the instrument tips – moving left means right and moving right means left. Many surgeons describe this approach as counter-intuitive. When a da Vinci surgeon moves the console controls clockwise, the tiny wristed instruments inside the patient turn clockwise as well. So with da Vinci Surgery, left means left and right means right. Surgeons say they benefit from this user interface design, which is very similar to performing open surgery.

Q. What is minimally invasive surgery (MIS)?

A. MIS is surgery performed through small incisions – also known as operating ports or keyhole incisions - rather than large incisions required for direct, manual access to the target anatomy. MIS has become standard-of-care for many surgical procedures. Intuitive Surgical's technology enables the use of MIS even for very complex procedures like cancer operations and heart surgery. To learn more about minimally invasive surgery and the potential benefits of da Vinci Surgery to patients, go to: www.daVinciSurgery.com

Q. Why is the product called the da Vinci® Surgical System?

A. The product is called "da Vinci" in part because Leonardo da Vinci is credited with inventing the first robot. da Vinci used unparalleled anatomical accuracy and three-dimensional details to bring his masterpieces to life. The da Vinci Surgical System similarly provides surgeons with such enhanced detail and precision that the System can mimic open surgery while allowing doctors to perform complex procedures through a few tiny incisions.

Q. What are the benefits of using the da Vinci Surgical System compared to traditional methods of surgery?

A. Some of the major benefits for the surgeon when using the da Vinci Surgical System over traditional approaches include: greater surgical precision and control; increased range of motion and improved dexterity; enhanced 3DHD vision and magnification; improved access to the target anatomy; and improved ergonomics.

There are many potential patient benefits when comparing da Vinci Surgery to open surgery, including:*

Less pain^1,2
Less blood loss^3,4,5,6
Shorter hospital stay^3,4,5,6
Fewer complications^7,8,9,10
Excellent cancer control, where indicated^5,11,12,13
Faster return to normal activities^1,4,9,12,14

When comparing da Vinci Surgery to traditional laparoscopic surgery, da Vinci also provides patients with the potential for:* less blood loss^15,16 shorter hospital stay,^15,16 fewer complications¹⁷ and faster return to normal activities.⁹

As is the case with all surgical procedures, none of these benefits can be guaranteed since surgery is specific to each patient and procedure.

Q. Has the da Vinci Surgical System been cleared by the FDA?

A. The U.S. Food and Drug Administration (FDA) has cleared the da Vinci Surgical System for use in a wide range of procedures. Please see the FDA Clearance page for specific clearances and representative uses.

Q: What procedures have been performed using the da Vinci Surgical System?

A: The da Vinci System is a robotic surgical platform designed to enable complex procedures to be performed through a few 1-2 cm incisions, also called operating ports or keyhole surgery. To date, hundreds of thousands of da Vinci procedures have been performed including: general, urologic, gynecologic, transoral, cardiac, thoracic, and pediatric procedures.

Q. Can the da Vinci System be used in all kinds of surgery?

A. No, however da Vinci surgical procedures are routinely performed for a wide range of conditions in specialties including: general, urologic, gynecologic, transoral, cardiac, thoracic, and pediatric. The da Vinci instrumentation currently available is not designed for or indicated for use in surgical specialties outside these areas.

Q: Where is the da Vinci Surgical System being used now?

A: Currently, the da Vinci Surgical System is used worldwide in major centers in the United States, Argentina, Uruguay, Paraguay, Australia, New Zealand, Brazil, Canada, Chile, China & Hong Kong, Columbia, Czech Republic, Russia, Belorussia, Hungary, Kazakhstan, Slovakia, Slovenia, Egypt, India, Israel, Italy, Croatia, Japan, South Korea, Lithuania, Latvia, Mexico, Pakistan, Panama, Poland, State of Qatar, Romania, Greece, Bulgaria, Albania, Cypress, Saudi Arabia, United Arab Emirates, Bahrain, Singapore, Brunei, Indonesia, Malaysia, Philippines, Vietnam, Myanmar, Spain, Portugal, Taiwan, Thailand, Turkey and Venezuela.

Q. Will the da Vinci Surgical System make the surgeon unnecessary?

A. On the contrary, the da Vinci System is designed to allow surgeons to operate with greater precision, vision, dexterity and control. It is designed to advance their techniques and enhance their ability to perform complex surgery while using a minimally invasive approach. The System translates the surgeon's hand movements in real time to its miniaturized instruments, while using motion scaling and tremor reduction to improve precision. The system can never be programmed to make decisions on its own or to perform any surgical maneuvers without the surgeon's direct input via the console hand controls.

Q. While using the da Vinci Surgical System, can the surgeon feel anything inside the patient's chest or abdomen?

A. The system relays force feedback sensations from the operating field to the surgeon throughout the procedure. This force feedback provides a substitute for the actual sense of touch and is augmented by the enhanced vision provided by the high definition 3D view. While surgeons are not able to touch or feel the anatomy as in open surgery, they indicate that the improved visualization, precision, dexterity and control that da Vinci offers them during surgery more than compensates for the loss of touch.

Q. Is a surgeon using the da Vinci Surgical System operating in "virtual reality"?

A. No. Although seated at a console a few feet from the patient, the surgeon views an actual image inside the patient’s body while operating in real-time. At no time does the surgeon see a virtual image, or program the system to perform any independent maneuvers outside of the surgeon's direct, real-time control.

Q. Is this "robotic surgery?"

A. Robotic surgical devices are designed to perform entirely independent movements after being programmed by a surgeon. The da Vinci Surgical System is a computer-enhanced system that introduces a computer interface and 3DHD vision system between the surgeon's eyes, hands and the tips of micro-instruments. The system mimics the surgeon's hand movements in real time. It cannot be programmed, nor can it make decisions on its own to move or perform any type of surgical maneuver. So, while the general term "robotic surgery" is often used to refer to our technology, it is not robotic surgery in the strictest sense of the term.

Q. Is this telesurgery? Can you operate over long distances?

A. No. The da Vinci Surgical System could theoretically be used to operate over long distances. This capability, however, is not the primary focus of the company and is not available with the current da Vinci Surgical System.

Q. Is Intuitive Surgical developing the da Vinci System for telesurgical applications?

A. Intuitive Surgical's goal is to extend the benefits of minimally invasive surgery to as many patients as possible. Our strategy to achieve this includes the development of products that allow doctors to rapidly expand their surgical techniques and capabilities. Our robotic surgical platforms currently allow surgeons to perform complex procedures using a minimally invasive approach.

In the interest of improving the surgeon training experience and expanding training programs, we are exploring telesurgery as a way to provide more convenient or expedient surgeon-to-surgeon proctoring and coaching. We see telesurgery as a means to allow surgeons to learn and optimize their robotic-assisted surgery skills under the guidance of leading specialists – with less disruption to clinical schedules due to travel — and therefore less impact on patients.

Q. Is Intuitive's technology patented?

A. Intuitive has an extensive patent portfolio of internally developed technology, as well as a variety of patents acquired or exclusively licensed from leaders in surgical robotics.

Q: Why isn't Intuitive Surgical getting involved in the Defense Advanced Research Projects Agency (DARPA) Defense Sciences project to develop robotic technology for use on the battlefield?

A: The DARPA project was, in fact, the project that inspired the creation of the first da Vinci System, and Intuitive Surgical's da Vinci Surgical System could theoretically be used to operate over long distances. However, optimizing the da Vinci System for remote or telesurgery applications is not the primary focus of the company's product design and development efforts, and this capability is not available with the current da Vinci Surgical System. Intuitive Surgical is optimizing its products for applications in minimally invasive surgery today. We are committed to the development of products that can extend the benefits of minimally invasive surgery to the broadest possible number of patients worldwide.

Q: Where is Intuitive headquartered?

A: Intuitive's principal corporate offices are located in Sunnyvale, California, United States, which is in the Silicon Valley region near San Jose.

Q: How are Intuitive’s products sold?

A: We currently market our system in the United States through a direct sales organization to hospitals. We have European operations headquartered in Aubonne, Switzerland and Asia-Pacific operations headquartered in Shanghai, China. We sell directly in some European countries and use distributors and agents in the rest of the world.

Q: What is the average cost of the da Vinci Surgical System?

A: The average selling price of the da Vinci System varies according to model, features, service contract, etc. Please see our investor presentation for more details.

Q: How many da Vinci Systems have been sold?

A: As of March 31, 2012, 2,226 Systems were installed in hospitals worldwide. Please see our investor presentation for more details.

Q: How many employees does Intuitive have?

A: As of March 31, 2012 we had a total of 2,018 employees.

While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctor about da Vinci Surgery are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor. All persons depicted are models unless otherwise noted. © 2012 Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S, da Vinci Si, Single-Site, InSite, TilePro and EndoWrist are trademarks or registered trademarks of Intuitive Surgical. All other product names are trademarks or registered trademarks of their respective holders.

*Potential benefits are specific to the procedure referenced in the footnoted publication.

1. Estape R, Lambrou N, Diaz R, Estape E, Dunkin N, Rivera A. A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy. Gynecologic Oncology 113 (2009) 357–361
2. Ko EM, Muto MG, Berkowitz RS, Feltmate CM.Robotic versus open radical hysterectomy: a comparative study at a single institution. Gynecol Oncol. 2008 Dec;111(3):425-30. Epub 2008 Oct 16.
3.Poston RS, Tran R, Collins M, Reynolds M, Connerney I, Reicher B, Zimrin D, Griffith BP, Bartlett ST. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008 Oct;248(4):638-46.
4. Ascher-Walsh CJ and Capes TL Robot-assisted laparoscopic myomectomy is an improvement over laparotomy in women with a limited number of myomas. J Minim Invasive Gynecol, May-Jun 2010;17(3):306-10.
5. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC. A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol. 2008 Oct; 199(4):360.e1-9.
6. Seamon L, Bryant S, Rheome P, Kimball K, Huh W, FowlerJ, Philipps G. Comprehensive surgical staging for endometrial cancer in obese patients. Gynecologic Oncology. 2009.
7. Carlsson S, Nilsson AE, Schumacher MC, Jonsson MN, Volz DS, Steineck G, Wiklund PN. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology. 2010 May;75(5):1092-7.
8. Ham WS, Park SY, Kim WT, Koo KC, Lee YS, Choi YD. Open versus robotic radical prostatectomy: A prospective analysis based on a single surgeon's experience. Journal of Robotic Surgery. 2008;2(4):235-241.
9. Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy androbotic techniques. Gynecologic Oncology. 2008 Dec;111(3):407-11.
10. Ng CK, Kauffman EC, Lee MM, Otto BJ, Portnoff A, Ehrlich JR, Schwartz MJ, Wang GJ, Scherr DS. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol. 2010 Feb;57(2):274-81. Epub 2009 Jun 10.
11. Boggess JF, Gehrig PA, Cantrell L, Shafer A, Ridgway M, Skinner EN, Fowler WC. A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol. 2008 Oct; 199(4):357. e1-7.
12. Coelho RF, Rocco B, Patel MB, Orvieto MA, Chauhan S, Ficarra V, Melegari S, Palmer KJ, Patel VR. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol. 2010 Dec;24(12):2003-15. Epub 2010 Oct 13.
13. Drouin SJ, Vaessen C, Hupertan V, Comperat E, Misraï V, Haertig A, Bitker MO, Chartier-Kastler E, Richard F, Rouprêt M. Comparison of mid-term carcinologic control obtained after open, laparoscopic, and robot-assisted radical prostatectomy for localized prostate cancer. World J Urol. 2009 Oct;27(5):599-605. Epub 2009 May 7.
14. Hohwü L, Akre O, Pedersen KV, Jonsson M, Nielsen CV, Gustafsson O Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: A comparison of length of sick leave. Scandinavian Journal of Urology and Nephrology, 2009;43:259-264.
15. Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, Wang AJ, Stifelman MD. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol. 2009 Sep;182(3):866-72. Epub 2009 Jul 17.
16. Payne T, Dauterive F. A comparison of total laparoscopic hysterectomy to robotically-assisted hysterectomy: surgical outcomes in a community practice. The J of Minimally Invasive Gynecology (JMIG). 2008 May/June.
17. Baik SH, Kwon HY, Kim JS, Hur H, Sohn SK, Cho CH, Kim H. Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study. Ann Surg Oncol. 2009 Jun;16(6):1480-7. Epub 2009 Mar 17.

PN 871076 Rev G 07/11