Abstract
Lack of tactile sensation has been a limitation of robotic-assisted thoracic surgery (RATS). The da Vinci 5 System (launched in 2024) integrates force feedback (FFB), a technology that measures instrument-tip forces and relays them to console hand controllers. This study characterizes forces applied during RATS and evaluates the impact of FFB. Da Vinci 5 system data for all RATS procedures using FFB instruments performed in the US between March 29, 2024 and April 30, 2025 were reviewed. Common thoracic surgeries were analyzed, including lung resections, mediastinal, esophageal, and diaphragmatic procedures. Mean instrument-tip forces (Newtons, N) were compared by procedure and instrument type. Forces and time spent above > 6.5 N were compared across FFB settings. Data from 444 procedures by 73 unique surgeons were analyzed. Median forces during lung resections (1.45 N anatomic resection, 1.42 N wedge) were significantly lower compared to mediastinal procedures (1.61 N), esophageal (1.74 N), and diaphragm surgery (1.59 N) (p < 0.001). Higher forces were measured with the use of retraction (Cadiere or Fenestrated Bipolar) than dissecting (Maryland) instruments (p < 0.001). Median forces decreased progressively with higher FFB settings (off, 1.79 N vs. low, 1.67 N vs. medium, 1.45 N vs. high, 1.32 N, p < 0.001). Proportion of duration at force > 6.5 N similarly declined with increased FFB setting (p < 0.001). FFB technology is associated with reduced average and peak instrument forces during RATS, particularly at medium and high settings. Retraction instruments experienced the highest forces. Further research is needed to define optimal force thresholds and clinical impact.