Head and Neck. DVD & Home Theater Gear - DiVinci 5.1 Surround Sound Systems - Does anyone here know anything about them? I'm wanting to upgrade my $50 Wal-Mart surround sound sytem and the DiVinci sets (DV-606, DV-607 & DV-608) have really caught my eye. Physically they look pretty cool and their specs appear to be awesome as.
doi: 10.4103/0972-9941.147696
PMID: 25598602
Abstract
BACKGROUND:
Different skills are required for robotic surgery and laparoscopic surgery. We hypothesized that the laparoscopic experience would not affect the performance with the da Vinci® system. A virtual robotic simulator was used to estimate the operator's robotic dexterity.
MATERIALS AND METHODS:
The performance of 11 surgical fellows with laparoscopic experience and 14 medical students were compared using the dV-trainer®. Each subject completed three virtual endo-wrist modules (“Pick and Place,” “Peg Board,“ and “Match Board”). Performance was recorded using a built-in scoring algorithm.
RESULTS:
In the Peg Board module, the performance of surgical fellows was better in terms of the number of instrument collisions and number of drops (P < 0.05). However, no significant differences were found in the percentage scores of the three endo-wrist modules between the groups.
CONCLUSION:
Robotic dexterity was not significantly affected by laparoscopic experience in this study. Laparoscopic experience is not an important factor for learning robotic skills.
Keywords: Da Vinci, dV-trainer, laparoscopic experience, robotic surgery
INTRODUCTION
The advent of laparoscopic surgery has led to great advances in the field of general surgery, including shorter hospitalizations, reduced postoperative pain, fewer wound infections, and improved cosmesis. However, laparoscopic techniques also have limitations, including an unstable camera platform, the limited motion of straight laparoscopic instruments, two-dimensional (2D) vision, and poor ergonomics for the surgeon.[] The da Vinci surgical system (Intuitive Surgical®, Sunnyvale, CA, USA) was specifically designed to overcome the limitations of current laparoscopic technology.[] The skills required for robotic surgery are, therefore, different from those required for laparoscopic surgery. The surgeon sits at the console and views a three-dimensional (3D) image of the procedure through two viewing holes, while maneuvering the arms with two foot pedals and two hand controllers. Specifically, the endo-wrist instruments allow maneuvering of the robotic arms in a manner that simulates fine human movements. These characteristics enable robotic surgery to overcome the technical limitations of laparoscopy by restoring vision and manual control of open surgery in a minimally invasive environment.
We hypothesized that the laparoscopic experience does not affect robotic dexterity, because the techniques necessary for laparoscopic surgery and robotic surgery are different from each other. A dry lab using the da Vinci surgical system is optimal for comparing robotic dexterity, but this is limited because the expensive robot can only be used for this study, when surgery is not being performed. The dV-trainer (Mimic Technologies®, Seattle, WA, USA) is a compact virtual reality platform that closely reproduces the experience of the da Vinci surgical console. It is the only robotic simulator demonstrated to have face (degree of resemblance with the actual robot), content (usefulness as a training tool as viewed by experts), construct (degree to which the results on the simulator reflect the actual skill of the subject), and concurrent (equivalence between assessment on the simulator and assessment on an actual da Vinci surgical system) validity in multiple studies.[,] Virtual reality simulations can be performed at any time, and they can provide a real-time, objective assessment of users’ performance. Accordingly, surgical fellows experienced in laparoscopic surgery were compared with medical students using the well-validated dV-trainer.
MATERIALS AND METHODS
In February 2011, surgical fellows and medical students were invited to participate in this prospective study. All surgical fellows had >3 years of experience as a surgeon or an assistant in laparoscopic surgery including laparoscopic appendectomy, cholecystectomy, gastrectomy, and colectomy, with no experience with the da Vinci surgical system. All subjects in both groups had not previously used the dV-trainer. After a standardized introduction and 10 min of practice, each subject completed three virtual endo-wrist modules (“Pick and Place,” “Peg Board,” and “Match Board”) in sequence [Figure 1]. Pick and Place consists of placing red, blue, or yellow objects in the corresponding colored boxes. Peg Board consists of grasping rings on a vertical stand with the left hand and then passing these to the right hand before placing them on a peg. Match Board consists of placing nine numbers and letters in specific squares on the board.
Three virtual endo-wrist modules: (a) Pick and Place, (b) Peg Board, (c) Match Board
![Da Vinci Speakers Manual Dexterity Da Vinci Speakers Manual Dexterity](/uploads/1/2/5/8/125845549/448730915.jpg)
Performance was recorded using a computerized built-in scoring algorithm created by the manufacturer. The measured variables included the time to complete the exercise (seconds), economy of motion (cm), number of instrument collisions, excessive instrument force (seconds), instruments out of view (cm), master workspace range (cm), and number of drops. A percentage score derived from a proprietary algorithm that combined a selection of these variables was also reported.
After completion of all tests, the data were statistically evaluated using IBM SPSS version 20.0 (IBM, Armonk, NY, USA). Continuous variables are presented as mean, and standard deviation. Direct comparisons of surgical fellows and medical students were performed using an independent-sample t-test or the Mann-Whitney U-test depending on the data distribution. Differences of P < 0.05 were considered as statistically significant.
RESULTS
Eleven surgical fellows and 14 medical students participated in this study. There was no significant difference between the groups in terms of the sex of the participants (male:female = 10:4 vs. 8:3, P = 1.000), but surgical fellows were significantly older than the students (age: 25.57 ± 2.14 years vs. 35.63 ± 2.25 years, P < 0.001).
In the Pick and Place module, none of the variables was significantly different between the groups [Table 1]. Surgical fellows scored significantly a better in the number of instrument collisions (4.11 ± 2.98 vs. 1.18 ± 1.60, P = 0.016), and the number of drops (2.67 ± 1.80 vs. 1.00 ± 1.01, P = 0.028), but the percentage score was not significantly different in the Peg Board module (41.56 ± 16.31 vs. 51.36 ± 18.27, P = 0.239) [Table 2]. No significant differences were found between surgical fellows and medical students in the Match Board module [Table 3]. When the scores for all three modules were tallied, the mean score was 53.21 ± 20.12 for the medical students and 54.61 ± 19.58 for the surgical fellows (P = 0.764).
Table 1
Table 2
Table 3
DISCUSSION
The intensive training needed for laparoscopic surgery, and the demand for high technical standards may discourage surgeons, who perform open surgery from performing minimally invasive surgery. However, the advent of robotics has increased the interest in minimally invasive surgery among laparoscopically naïve surgeons. Nevertheless, the surgeons may be reluctant to perform robotic surgery, assuming that learning robotic skills will be difficult without laparoscopic experience. In a previous study,[] that evaluated the impact of laparoscopic experience on performance with the da Vinci surgical system, the authors concluded that the laparoscopic experience was the strongest predictor of performance. They assessed robotic dexterity using three tasks performed with the da Vinci surgical system: Two of the three tasks involved creating a double knot and needle driving. However, these two tasks require an understanding of tying knots, and handling a round needle, skills that may have been lacking among the medical students participating in the previous study. We, therefore, assessed robotic dexterity using three endo-wrist modules of the dV-trainer, as these are not related to surgical skills and knowledge.
Construct validity is regarded as one of the most important aspects of simulator evaluation, because it determines whether a device can discriminate between experienced and inexperienced surgeons.[] Perrenot et al.[] performed a large study of the validity of the dV-trainer and found that the Pick and Place and Peg Board modules offered good construct validity. The Match Board module was less relevant because of its difficulty. Conversely, the Match Board module has been associated with good construct validity in other studies.[,] The current study used these three virtual endo-wrist modules, as they have been proven useful for comparing robotic skills.
Our results indicated that the laparoscopic experience is not strongly correlated with robotic dexterity when using the dV-trainer. The total scores for the three modules were broadly similar. This finding can be explained by difference between laparoscopic and robotic techniques. For example, with the da Vinci surgical system, a hand movement to the right outside the body causes the instrument inside a patient to be moved to the right. By contrast, during laparoscopy, the instrument tip moves in the opposite direction of the surgeon's hand, and surgeons have to adjust their hand-eye coordination to translate their hand movements in this “reverse” environment. Moreover, endo-wrist instruments are unique in that they allow seven-degrees of freedom of motion, which replicates the full range of motion of the surgeon's hand.
In addition, our results can also be affected by the fact that learning robotic skills is relatively easy. Hubens et al.[] compared the efficacy of the da Vinci surgical system using both the 3D and 2D view options with traditional manually assisted laparoscopic techniques for performing standardized exercises. The inexperienced students performed the tasks significantly quicker and with fewer errors, when assisted by the robot in the 3D and 2D view modes compared with traditional laparoscopic surgery. Ahlering et al.[] reported the initial experience of a surgeon without laparoscopic experience with robot-assisted radical prostatectomy. They concluded that a laparoscopically naïve yet, experienced open surgeon could successfully apply open surgical skills to the minimally invasive environment in 8-12 cases using the da Vinci surgical system.
However, laparoscopic experience is clearly beneficial for some aspects of robotic surgery.[] In particular, laparoscopic experience is useful for access, not only for placement of ports but also for laparoscopically treatable adhesions that prevent the placement of the ports. In addition, when multi-quadrant abdominal access is needed, laparoscopic skills can be used to reduce docking time. For example, in rectal cancer surgery, colonic mobilization is laparoscopically performed by some surgeons before bringing the robot to the bedside for rectal dissection.[]
Estimating robotic dexterity using the dV-trainer is a weakness of this study. The dV-trainer is a well-validated simulator of the da Vinci system that can discriminate between expert and novice robotic surgeons. However, the instrument cannot simulate the da Vinci system completely, which results in instrument bias. Another possible study limitation is the small number of participants. Surgical fellows outperformed medical students in some variables of the Peg Board module, but the percentage score was not significantly different between the groups. If the number of participants was larger, then the percentage score in the Peg Board module may have been significantly, different between the groups.
CONCLUSION
Our study found that scores of three virtual endo-wrist modules were not significantly affected by the operator's laparoscopic experience. These results greatly suggest that the laparoscopic experience is not an important factor for learning robotic performance, although laparoscopic experience is beneficial for some aspects of robotic surgery so far.
Footnotes
Source of Support: This study was supported by a Korea University Grant (K1132271)
Conflict of Interest: None declared.
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Articles from Journal of Minimal Access Surgery are provided here courtesy of Wolters Kluwer -- Medknow Publications
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This is the first audio brand that has taken me so long to understand before I felt comfortable to share anything substantial on it with our readership. When the full chain of Da Vinci Grandezza electronics -- consisting of two huge 30kg/ea. driver stages feeding directly into the grids of 300Bs inside the mono-parallel singled-ended amplifiers via a pair of 5-pin special XLR cable -- drove my Kharma Midi-Exquisite speakers, the musical experience shocked a few of my audio buddies. | |||||||||||||||
This tube-based amplification chain seems truly state of the art. The whole concept puts signal purity ahead of everything. Signal goes to a transformer-based passive followed by the huge driver stage and the 300B mono amp. (I don't known of any other manufacturer building such huge transformer-coupled mono driver stages.) The whole system is based on interstage transformer coupling, a technique similar to Wavac Audio Labs from Japan. Da Vinci, however, takes this further by applying a hand-made transformer for each tube for each channel. These transformers are developed individually for each valve and hand-wound in the atelier of Da Vinci. The transformers are insulated with oil-paper and encapsulated in MuMetal cans to reduce electromagnetic interference. All cathode wire-wound copper resistors too are said to be developed individually for each tube and hand-crafted. Special high-voltage oil paper capacitors are applied as well for 'continuous interstage coupling'. This design endowed with a mere 16 watts would prove to drive my Kharmas better even than quite a few huge transistor amplifiers. [The first transformer is a transformer potentiometer or TVC and thus the input transformer for the Passive Control Unit. The second transformer is an interstage unit for the 6C45 tube in the Line Driver Stage. The third is the output transformer for the 300B driver and input transformer for the parallel single-ended amplifier. The 4th and 5th transformers are the output transformers of the final stage and paralleled, one per 300B.] | |||||||||||||||
The subsequent arrival of Da Vinci's Intonation speakers however was a little bit more difficult for me to understand regarding where right and wrong should fall. The first month's experience with the Intonation made me feel that I'd used the word seamless too casually in the past. In comparison with the Intonation, the musical picture projected by the Kharmas showed fractures here and there, especially in the high frequencies where the diamond tweeter was drawing too much attention despite the presence of tubes. While Kharma's ceramic midrange produced crispy vocals, it was nowhere close to the supreme vocal quality of the Supravox widebander employed in the Intonation with which you can feel the human flesh as it were. The radiant performance of Kathleen Battle in Vienna's New Year Concert in 1987 under the magical wand of Karajan was produced with such a commanding presence, it simply sounded like true human blood. My nephew who is a soprano singer in Hong Kong was attracted by the realism of Battle's voice radiating into my room. Although she is definitely not an audiophile, she was truly shocked by the realism. How can such big speakers inside a small room recreate a voice that is so free, so open and smooth, with varying energy over each changing octave? Of course, Franck Tchang's magical acoustic resonators share responsibility for such a seeming impossibility. Franck tweaks my room on each of his annual visits to Hong Kong as my setups mature. | |||||||||||||||
Another area of definitive strength with the Intonation is anything with strings. Most other speakers may be able to delineate the details of one string versus another but never really prove capable of demonstrating the elasticity of the strings. Now I even felt the softness of the wooden violin body. Yet the softness of strings does not undermine transients. (A local audiophile now with Cessaro horns too shares this view on the extraordinary capability of string reproduction by the Da Vinci speaker.) The timbre is slightly on the rich side of my perceived neutrality yet coherence is simply one whole musical picture. The active bass system blends quite well with the Supravox although occasional readjustments of the crossover point and subwoofer output are required for certain recordings. The bass moves quite a lot of air. The 16-inch highly efficient woofer produces the kind of bass foundation that is simply unmatched by smaller bass drivers. This bass is fast though not as fast as the Hørning Eufrodite with its paralleled isobaric bass system. I guess this is simply physics. A sole 16-incher won't match the speed of massively paralleled smaller drivers. The Intonation also does not extend as low as the Hørning but its dipole bass energy transmission mechanism is more direct. | |||||||||||||||
When I sit down and close my eyes, I feel as though listening in a concert hall. This is similar to what has been reported by JLam, Marvel, Studiogrey, Charles, Ken Chiu and a few other audio buddies. This could also be attributed to the immense soundstage capabilities of the Orpheus Heritage DAC over the Argento SMR Extreme Edition digital cable. | |||||||||||||||
If the performance was so good, why did it take me so long to understand this system? The confusion arose from the dramatic differences between the playback of classical music and jazz/pop. The foremost confusion centered on the high treble. I am used to listening to a lot of detail in the high frequency area | |||||||||||||||
as handled by the diamond tweeter of the Kharma. In the case of the Intonation, when I use my analytical mind to search for the details that were present before, they seem exchanged for blackness. Admittedly, the sound is far more comfortable to listen to than before. I asked myself, why should I care about those details when the rich tonality and coherence are simply so much better than with the Kharmas? It must have been the audiophile bug inside me confusing my thoughts. The Intonation's treble seemed definitely sufficient because hall ambience was plenty obvious during Belafonte Live in Carnegie Hall. Violin never sounded dark and dull. In the case of Dvorak's New World Symphony conducted by Kubelik, the bass moved quite a lot of air to fill the whole room without boom. (Many ear witnesses were surprised by how the whole Da Vinci system produced such large-scale orchestral fare in a small room.) | |||||||||||||||
When I played other types of music by John Coltrane and Mile Davis, the whole system sounded a bit dark, lacking the flares and sparkles inherent in this material. My immediate perception was that the bass overpowered the midrange and treble. Most of the time, I set the crossover point at 55Hz as I sensed a sudden drop of the Supravox around 60Hz. I knew I couldn't change physics. An active 16-inch bass driver in a small room was going to produce lots of bloom. So I lowered the bass output bit by bit alongside of lowering the crossover point to below 50Hz. There was some mild improvement but the problem persisted. With such settings, I could not replay classical music because there seemed to be a big hole in the lower midbass now. I then came to the conclusion that this was a system purely for classical music. At this juncture, my father suggested to add a super tweeter. In his perspective, it was not a problem of frequency extension but the lack of leading-edge speed. I was reluctant to add a super tweeter due to the mismatch of sensitivity, the lack of convenient placement location for a super tweeter as well as the need for another pair of speaker cables. I was afraid of creating further challenges and felt stuck for a month. That said, every time I returned to classical music over the Da Vinci, it was truly a unique listening experience and unmatched by all the other brands I'd come across thus far in my space. | |||||||||||||||
To put the comparison in proper context, let's be realistic about how this system cannot be as ultra-dynamic as a Hong Kong listener's recent Cessaro hornspeaker installation. To a certain extent, the dynamics of the passive 215-2000-EXC Supravox widebander don't fully match the speed of the active bass system using the 215-400-EXC either. Yet the musical experience conveyed to me and my fellow fanatics remained unprecedented. It sounded like the real thing. The musical rendering by the | |||||||||||||||
Da Vinci system was neither the Jadis type of French romanticism nor the Linn type of British genteels. The Da Vinci system peeled down layers upon layers of tonal color in front of the listener. It was never polite on orchestral crescendos nor brutal to force excess energy onto the body. If one dissects the musical picture according to the usual hifi attributes, they were all present but perhaps not that spectacular relative to the competition - say the glorious midrange portrayed by Kondo. The musical landscape portrayed by the Da Vinci system is always one full and uncut big picture brimming with color hues and more than adequate speed and dynamic. It is especially magical and inspiring to play back live recordings over this system. Then you feel as though you are there. | |||||||||||||||
In the end, I bit the bullet and acquired a pair of Murata ES103 super tweeters. I connected them to the 300B mono amplifiers via a pair of Argento Serenity speaker cable. I located the Murata on top of the Intonation speaker with the front lining up with the central axis of the midrange and woofer. With huge expectations, I hit the 'play' button on the Orpheus Zero transport. Next a wicked smile inched slyly across my face. Like many others who have applied the Muratas, I felt as though nothing had been added yet this action seemed to clean up lots of dirt in the lower midbass. Transients not restricted to the top end seemed to be faster across all the frequency ranges. Attacks in the lower midbass were far more tuneful than before both with speed and weight. Did I mention that hall ambience was abundant without betraying the tweeters' location as 'somewhere up there'? Now the hall ambience extended into the Z-axis, making the soundstage even more palpable than before. The trumpet of Miles Davis had a stronger sense of metal and the agility of the upper highs carried more energy. The excitation of certain lyrics by Belafonte was more apparent and further enriched the whole musical experience with a vivid quality. I tried hard to locate the presence of the super tweeter. Honestly, I felt they were there but not noticeable. But this was still during only the first two hours. I allowed things to burn in non-stop for another 2 weeks. I then wrote to Da Vinci reporting that the addition of the Muratas had solved the problem. (At this juncture, Da Vinci is researching the possibility of using another fullrange driver from Feastrex of Japan for the Intonation.) After two weeks, the super tweeter had clearly run its course because I found the leading edge to be highlighted and a little bit forward. Then I moved the super tweeter back inch by inch to find the right spot. If I moved it back by two inches from the original position, the sound of Byrn Terfel lost some virility. I finally ended up 1.2 inches behind the original position. With the addition of the Murata ES103s, I now feel everything has becomes livelier while the strengths of the Da Vinci system remain untouched. The remaining problem is my small room. Again, I cannot change physics. I have to accept the occasional attack of standing waves from the interaction of the 16-inch woofers with my spatial dimensions especially during Jazz recordings (too bad that I cannot see the full improvement brought by the Muratas due to room limitations but I am sure the performance would extend all the way into the deep bass should space permit so in the future.) | |||||||||||||||
Overall, the sound of the Da Vinci system is not only holographic but almost palpable (a big credit also goes to the SRA Ohio XL+2 vibration control platform which is simply in a class of its own). This setup does not deliver the kind of pin-point focus to seem real but instead the ultimate revelation of timbral color. The tonal density of vocals is solid and filled with varying tonal shadings. In fact, many visitors comment that the system does not sound like digital at all. On some older recordings, some feel it is very close to vinyl. I repeat again that I feel very much like being inside Carnegie Hall with Belafonte sharing the laughter and applause with the audience. The huge speaker simply disappears in my room along the rear and sidewalls. I am sure that when Srajan visits me again in the future, he will be far happier with my sound than last time. In closing, there are no fancy technologies on tap here, just pure circuit craftsmanship from the old days alongside employment of the best components which are mostly hand-made. Peter at Da Vinci reminded me a few times that he is not trying to build a speaker to compete with other modern offerings in frequency extension and exotic driver materials. Coming from the Kharmas, it took me a while to understand Peter's philosophy. I am glad I finally did. | |||||||||||||||
This is truly a unique system to serve music appreciation. I understand how the definition of musicality varies from person to person. Some put more weight on dynamics, others more on soundstage, others on tonal purity. Regardless of | |||||||||||||||
your preferences, the Da Vinci experience really resembles an experience closest to the concert hall. In the end, you must experience it for yourself. Words really cannot do justice to what this system is capable of... | |||||||||||||||
Quality of packing: Good for the speakers, average for the electronics. Reusability of packing: Not reusable. Ease of unpacking/repacking: Very easy. Condition of component received: Flawless. Completeness of delivery: Perfect. Website comments: Good. Photography could be better. Warranty: Five years parts and labor. Human interactions: Dealing with Jolanda is very pleasant. Peter doesn't speak English and relies on Jolanda for translation which delayed answers to certain technical questions. Pricing: Expensive but cheaper than a complete Kondo system Final comments: State of the art system for music appreciation especially with classical. It really sound like you're there in the concert hall. Vocals, strings and piano find no fault even from real musicians assessing playback. |