FDA Adverse Event Malfunction Summary report: N

DAVINCI XI

MDR report key: 22388704 · Received July 2, 2025

Report

Report Number
2955842-2025-28770
Event Type
Malfunction
Date Received
July 2, 2025
Date of Event
June 13, 2025
Report Date
June 13, 2025
Manufacturer
INTUITIVE SURGICAL, INC
Product Code
NAY
PMA / PMN Number
K131861
Removal / Correction Number
N/A
Product Problem
Yes
Report Source
Manufacturer report
Reporter Location
MI, US
Reporter Occupation
NURSE
Health Professional
Yes

Narratives

Additional Manufacturer Narrative · 0

THE PROBABLE ROOT CAUSE IS ATTRIBUTED TO THE SFL, ACT, AND THE LOW VOLTAGE DIFFERENTIAL SIGNALING (LVDS) HARNESS IN THE DISTAL SUJ.

Additional Manufacturer Narrative · 0

UPON VISUAL INSPECTION, NO ISSUE WAS FOUND THAT WOULD BE RELATED TO THE REPORTED EVENT. THE UNIVERSAL SURGICAL MANIPULATOR (USM) WAS INSTALLED ONTO A GOLDEN SYSTEM WHERE THE COMPONENT FUNCTIONED AS EXPECTED. THE USM WAS THEN INSTALLED ONTO PATIENT FIXTURE TEST PLATFORM (PFTP) WHERE ALL RELEVANT TESTING WAS PASSED WITHIN SPECIFICATION. ONCE TESTING WAS COMPLETED, THE AXES CONTROLLER SPAR BOARD (ACS) PRINTED CIRCUIT ASSEMBLY (PCA) WERE INSPECTED, BUT NO FAULTS COULD BE IDENTIFIED. AS A RESULT OF THESE FINDINGS, FAILURE ANALYSIS CONCLUDE THAT THE ACS PCA ARE CONSISTENT WITH THE REPORTED EVENT AND IS THE POTENTIAL ROOT CAUSE FOR THIS ISSUE. CORRECTION: H8. WAS UPDATED TO INITIAL USE OF DEVICE.

Additional Manufacturer Narrative · 0

AN INTUITIVE SURGICAL, INC. (ISI) FIELD SERVICE ENGINEER (FSE) WAS DISPATCHED TO THE CUSTOMER SITE TO FURTHER INVESTIGATE THE REPORTED EVENT. THE FSE WENT ON-SITE AND REPLACED THE DISTAL SET-UP JOINT (DSUJ). THE SYSTEM WAS VERIFIED AND READY FOR USE. INTUITIVE SURGICAL INC. (ISI) RECEIVED THE DSUJ FOR FAILURE ANALYSIS INVESTIGATION. THE UNIT WAS ANALYZED, AND THE REPORTED 26002 AND 319 ERRORS WERE CONFIRMED AND REPLICATED. IN LOG REVIEW, THE 319 ERROR WAS FOUND INDICATING NODE 194 THROUGH 198 WE DO NOT PRESENT AT STARTUP, CONFIRMING THE FAULT OCCURRED IN THE FIELD. UP VISUAL INSPECTION, NO ISSUES WERE FOUND THAT WOULD BE RELATED TO THE REPORTED EVENT. THE UNIT WAS INSTALLED ONTO A GOLDEN SYSTEM WHERE ERROR 319 WAS TRIGGERED IN NORMAL MODE, REPLICATING THE REPORTED EVENT. THE UNIT WAS THEN INSTALLED ONTO A PSC FIXTURE TEST PLATFORM (PFTP) WHERE IT FAILED NODE CHECK B AND C. A GOLDEN ACT WAS INSTALLED AND THE UNIT FAILED NODE CHECK B AND C, A GOLDEN SFL WAS ALSO INSTALLED, AND THE UNIT PASSED ALL TESTS. THE GOLDEN ACT WAS REMOVED AND THE ORIGINAL ACT REINSTALLED, THE UNIT WAS RETESTED AND PASSED ALL TESTS. THE ORIGINAL SFL WAS INSTALLED (WITH THE ORIGINAL ACT), UNIT WAS RETESTED AND PASSED ALL TESTS.

Description of Event or Problem · 0

REFER TO H11 FOR FOLLOW-UP INFORMATION.

Description of Event or Problem · 0

REFER TO H11 FOR FOLLOW-UP INFORMATION.

Description of Event or Problem · 0

IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED CHOLECYSTECTOMY SURGICAL PROCEDURE, THE CUSTOMER ENCOUNTERED A NON-RECOVERABLE 26002 ERROR, WHICH WAS ATTRIBUTED TO ARMNET 4. THE SITE WAS IN THE MIDDLE OF REBOOTING WHEN THEY CALLED IN, AND THE SYSTEM DID NOT COMPLETE THE SELF-TEST DUE TO THE UNIVERSAL SURGICAL MANIPULATOR 3 (USM3) SET UP JOINT (SUJ) ERRORS. THE TECHNICAL SERVICE ENGINEER (TSE) INSTRUCTED THE CUSTOMER TO PERFORM ANOTHER REBOOT, AFTER WHICH "DA VINCI IS READY" WAS HEARD, ALLOWING THE PROCEDURE TO CONTINUE AND THE CUSTOMER ENDED THE CALL. THE STAFF CALLED BACK AT THE END OF THE PROCEDURE TO REPORT ANOTHER NON-RECOVERABLE FAULT 26002 OCCURRED, LEADING TO THE DISABLING OF USM4. THE CUSTOMER ADVISED THAT THE SURGEON WAS STILL USING THE VISION SIDE CART AND ENDOSCOPE BUT HAD FINISHED USING THE USMS. THE TSE WAS UNABLE TO CONFIRM ERROR 26002 IN THE SYSTEM LOGS BUT NOTED 319 ERRORS ON ARMNET 4. THE TSE REMAINED ON THE PHONE WITH THE CUSTOMER UNTIL THEY PERFORMED A HARD REBOOT/EPO ON THE PATIENT SIDE CART, WHICH RESULTED IN A SUCCESSFUL SYSTEM REBOOT WITH NO ERRORS. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
1603 DAVINCI XI PATIENT SIDE CART, 4-ARM NAY INTUITIVE SURGICAL, INC 380652-22 N/A

Patients

Seq Age Sex Outcome Treatment
1 NA Unknown DA VINCI INSTRUMENTS AND ACCESSORIES