da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED SUBTOTAL GASTRECTOMY PROCEDURE, THE POSTERIOR GASTRIC ARTERY WAS DISSECTED WITH A HARMONIC ACE INSTRUMENT. THE ISSUE OCCURRED WHEN THE SURGEON WAS ABOUT TO ANASTOMOSE THE STOMACH AND SUDDENLY EXPERIENCED BLEEDING FROM THE POSTERIOR GASTRIC ARTERY. THE SURGEON WAS UNABLE TO STITCH THE BLEEDING SECTION USING THE ROBOT. THE BLEEDING WAS SUPPRESSED WITH AN UNSPECIFIED INSTRUMENT INSTALLED ON UNIVERSAL SURGICAL MANIPULATOR (USM) 4. THE SURGEON MADE THE CLINICAL DECISION TO CONVERT TO OPEN SURGERY DUE TO BLEEDING. THE AMOUNT OF BLOOD LOSS AT THE TIME OF THE DECISION WAS ABOUT 100ML. THE TOTAL AMOUNT OF BLOOD LOSS WAS ABOUT 500ML. THE OPEN PROCEDURE WAS COMPLETED SUCCESSFULLY WITHOUT THE PATIENT REQUIRING A BLOOD TRANSFUSION.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED SIGMOID COLECTOMY SURGICAL PROCEDURE, A PIECE OF THE CANNULA SEAL FELL INTO THE PATIENT. THE FRAGMENT WAS RETRIEVED DURING THE PROCEDURE. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED VENTRAL HERNIA SURGICAL PROCEDURE, THE CUSTOMER STATED THAT THE CAUTERY WAS NOT WORKING, AND A QUESTION MARK WAS DISPLAYED ON THE INTEGRATED ELECTROSURGICAL UNIT (IESU/ERBE) FRONT PANEL, INDICATING THAT THE ERBE COULD NOT DETERMINE WHICH UNIVERSAL SURGICAL MANIPULATOR (USM) THE INSTRUMENT WAS ENGAGED ON. THE CUSTOMER HAD REPLACED THE CORDS AND EXHAUSTED THEIR SUPPLY. THE CUSTOMER TRIED DIFFERENT CAUTERY INSTRUMENTS, STILL THE ISSUE PERSISTED. THE CUSTOMER POWER CYCLED THE SYSTEM AND REMOVED AC POWER FROM THE ERBE AND THE ISSUE PERSISTED. THE SYMPTOMS INDICATED BAD ENERGY CORD(S) OR BAD ENERGY CONNECTORS ON THE ERBE. THE PROCEDURE WAS CONVERTED TO OPEN SURGERY WITH NO REPORTS OF PATIENT INJURY. AN INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED RADICAL PROSTATECTOMY WITH LYMPHADENECTOMY PROCEDURE, THE MONOPOLAR CURVED SCISSOR (MCS) TIP COVER ACCESSORY CAME LOOSE WHEN REMOVING THE MCS INSTRUMENT AND FELL INSIDE THE PATIENT'S ABDOMEN. AT THE TIME THE EVENT OCCURRED, THE SURGICAL STAFF WAS IN THE PROCESS OF EXCHANGING THE MCS INSTRUMENT WITH A LARGE NEEDLE DRIVER INSTRUMENT. THERE WAS NO DIFFICULTY FELT WHILE REMOVING THE MCS INSTRUMENT. AFTER THE EVENT OCCURRED, THE MCS INSTRUMENT REMAINED OUTSIDE THE PATIENT FOR THE REMAINDER OF THE PROCEDURE AND WAS NO LONGER USED DURING THE PROCEDURE. PER THE SURGEON, THE MCS TIP COVER ACCESSORY LIKELY CAME LOOSE DURING THE INSTRUMENT CHANGE. THE MSC TIP COVER ACCESSORY APPEARED TO HAVE BEEN PROPERLY INSTALLED DURING THE SURGICAL PROCEDURE WITH NO PART OF THE ORANGE SURFACE VISIBLE AFTER INSTALLATION NOR WAS IT INSTALLED BEYOND THE ORANGE SURFACE. THE INSTALLATION TOOL HAD BEEN USED; ELECTROLUBE OR ANY OTHER LUBRICANT HAD NOT BEEN APPLIED PRIOR TO INSTALLATION OF THE MCS TIP COVER ACCESSORY. THE MCS INSTRUMENT AND MCS TIP COVER ACCESSORY HAD BEEN INSPECTED PRIOR TO USE. THE SURGEON DID NOT NOTICE ISSUES WITH THE FUNCTIONALITY OF THE MCS INS

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: REFER TO H10/H11 FOR FOLLOW-UP INFORMATION.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED ANTERIOR RESECTION SURGICAL PROCEDURE, THE CUSTOMER REPORTED THAT THE VISION WAS LOST. THEY ATTEMPTED TO RECONNECT THE CAMERA TO THE ENDOSCOPE CONTROLLER (EC), BUT THE CAMERA HAD A SELF-TEST FAILURE, AND THE COLOR BAR WAS DISPLAYED. THEY REPLACED THE CAMERA WITH A BACKUP ONE, BUT ALL THE AVAILABLE CAMERAS HAD THE SAME SYMPTOM. LASTLY, THEY REBOOTED THE SYSTEM AND CLEANED THE CAMERA CONNECTOR; HOWEVER, THE ISSUE PERSISTED. THE CUSTOMER ELECTED TO CONVERT TO LAPAROSCOPIC PROCEDURE. NO KNOWN IMPACT OR PATIENT CONSEQUENCE REPORTED. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP ON 19-OCT-2022 AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE CAMERAS WERE INSPECTED PRIOR TO USE WITH NO ABNORMALITY. DURING THE PROCEDURE, THE VISION LOSS OCCURRED ON BOTH OF THE SURGEON SIDE CONSOLE (SSC) AND VISION SIDE CART (VSC). INFORMATION REGARDING PATIENT DEMOGRAPHICS, RELEVANT TESTING, AND MEDICAL HISTORY WERE REQUESTED; HOWEVER, THE REPORTER WAS NOT ABLE TO PROVIDE THAT INFORMATION.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED DURING A DA VINCI-ASSISTED PROCEDURE THAT ARM 3 OF THE SINGLE PORT (SP) SYSTEM ENCOUNTERED INSTRUMENT ENGAGEMENT ISSUES. THE OR STAFF STATED THEY UNDOCKED THE ARM AND RE-DRAPED BEFORE CALLING. THEY HAD ALSO POWER CYCLED AND TRIED MORE THAN ONE INSTRUMENT ON ARM 3, BUT ISSUES PERSISTED. THE PATIENT WAS ON THE TABLE, UNDER ANESTHESIA, AND PORTS HAD BEEN PLACED AT THE TIME. THE TSE REVIEWED THE LIVE LOGS AND FOUND ERRORS 23300 AND 31009. THE TSE INFORMED THE OR STAFF THAT ALL TROUBLESHOOTING STEPS HAD BEEN PERFORMED AND ARM 3 NEEDS SERVICE. IT WAS CONFIRMED FOLLOWING A FOLLOW-UP CALL THAT THE SURGEON CONVERTED TO AN XI MULTIPORT SYSTEM. THERE WAS NO REPORT OF PATIENT INJURY. AN ATTEMPT HAS BEEN MADE TO OBTAIN ADDITIONAL INFORMATION FROM THE CUSTOMER CONCERNING THE REPORTED EVENT WITH NO SUCCESS.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT AFTER A DA VINCI-ASSISTED BENIGN HYSTERECTOMY SURGICAL PROCEDURE, THE SCRUB COUNT WAS OFF, AND THE CUSTOMER WAS MISSING A MONOPOLAR CURVED SCISSORS (MCS) TIP COVER. THE CUSTOMER LOCATED THE MCS TIP COVER INSIDE OF THE PATIENT AND REMOVED IT. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE SITE ON (B)(6) 2022 AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE CUSTOMER STATED THAT THE ISSUE WAS IDENTIFIED WHILE CLOSING THE PATIENT. THE MCS INSTRUMENT AND TIP COVER WERE INSPECTED PRIOR TO USE WITH NO ISSUES NOTED. THE MCS TIP COVER WAS RETRIEVED BY GOING BACK IN THE ABDOMEN. ALL FRAGMENTS WERE RETRIEVED, AND THIS WAS CONFIRMED THROUGH INSPECTION OF THE MCS TIP COVER. THE CASE WAS EXTENDED FOR A FEW MINUTES DUE TO THE ISSUE. IT WAS UNKNOWN WHAT TASK WAS PERFORMED WHEN THE MCS TIP COVER FELL INTO THE PATIENT. THE SURGEON DID NOT NOTICE ANY ISSUES WITH THE FUNCTIONALITY OF THE MCS INSTRUMENT DURING THE PROCEDURE. THE MCS INSTRUMENT DID NOT COLLIDE WITH ANOTHER INSTRUMENT. A REDUCER WAS NOT USED. THERE WAS NO DIFFICULTY REMOVING THE MCS INSTRUMENT. THE MCS INSTRUMENT WRIST WAS STRAIGHTENED UPON REMOVAL. NO D

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED BENIGN HYSTERECTOMY SURGICAL PROCEDURE, THE CLINICAL SALES REPRESENTATIVE (CSR) CALLED AN INTUITIVE SURGICAL INC. (ISI) TECHNICAL SUPPORT ENGINEER (TSE) TO REPORT THAT THE CANNULA KEPT SLIPPING OUT AND THE SURGEON HAD TO CONVERT TO OPEN SURGERY. THE PATIENT STAYED IN THE HOSPITAL AN EXTRA COUPLE OF DAYS BECAUSE OF THE OPEN SURGERY. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF AN UROLOGY JOURNAL ARTICLE TITLED, ¿SINGLE PORT VS MULTIPORT ROBOTIC PYELOPLASTY: PROPENSITY-SCORE MATCHED ANALYSIS OF PERIOPERATIVE AND FOLLOW-UP OUTCOMES¿ (HARRISON, R., AHMED, M., ET AL., 2022). WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING SINGLE-PORT (SP) ROBOTIC-ASSISTED PYELOPLASTY (RAP) PROCEDURES WERE NOTED. IN THE ARTICLE, THE FOLLOWING IS NOTED: ¿AN INTRAOPERATIVE COMPLICATION OCCURRED DURING ONE SP-RAP CASE. WHILE INCISING THE PERITONEUM TO ACCESS THE ABDOMINAL CAVITY, A SMALL ENTEROTOMY WAS NOTED IN A PORTION OF THE SMALL BOWEL THAT WAS ADHERENT TO THE PERITONEUM IN A PATIENT WITH PRIOR ABDOMINAL SURGERY. THE INJURED AREA WAS REPAIRED IN TWO LAYERS, USING 3-0 VICRYL FOR THE MUCOSA, AND 3-0 SILK FOR THE SEROSA IN A LEMBERT FASHION.¿ ADDITIONALLY, IT IS DOCUMENTED: ¿ONE SP-RAP PATIENT UNDERWENT SURGICAL DEBRIDEMENT FOR A POORLY HEALING, LEFT LOWER ABDOMINAL QUADRANT WOUND (CLAVIEN CLASS IIIB)." INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION FROM THE AUTHOR. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED RADICAL PROSTATECTOMY WITH LYMPHADENECTOMY PROCEDURE, THERE WAS AN ORIENTATION ISSUE WITH THE 30-DEGREE ENDOSCOPE 2 HOURS INTO THE PROCEDURE. THE ENDOSCOPE WAS NOT ABLE TO SWITCH BETWEEN UP AND DOWN VIEW AND ONLY ONE ENDOSCOPE WAS AVAILABLE FOR THIS SURGERY. THERE WAS A BEEP EVERY TIME THE SURGEON WANTED TO CHANGE THE SCOPE ORIENTATION. AN INTUITIVE SURGICAL, INC. (ISI) TECHNICAL SUPPORT ENGINEER (TSE) DID NOT FIND ANY RELATED ERRORS IN THE LIVE LOGS. PRIOR TO CALLING ISI TECHNICAL SUPPORT, THE CUSTOMER HAD ALREADY DISCONNECTED FROM THE VISION SIDE CART (VSC) AND PATIENT SIDE CART (PSC) AND RESEATED THE ENDOSCOPE. THE TSE ASKED THE CUSTOMER IF THEY HAD ALREADY RESEATED THE STERILE ADAPTER, BUT THE CUSTOMER HAD NOT, AND THEY DID NOT WANT TO DO SO AS THE SURGERY WAS IN PROGRESS. NO MECHANICAL SOUND WAS PRESENT FROM THE ENDOSCOPE WHEN THE 30 DEGREE UP/DOWN BUTTON WAS PRESSED. THE CUSTOMER DECIDED TO CONTINUE THE PROCEDURE AS IS. ISI FOLLOWED UP WITH THE INITIAL REPORTER (SURGEON) AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE SURGEON INDICATED THAT THE PROBLEM AROSE AT THE TIME OF PERFORMING A RETRO-BLADDER ANASTOMOSIS ON A PROST

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED PARASTOMAL HERNIA REPAIR, THE SURGEON WAS USING A MONOPOLAR CURVED SCISSOR (MCS) INSTRUMENT AND POTENTIAL ARCING OCCURRED AGAINST A PROGRASP FORCEPS INSTRUMENT. INTUITIVE SURGICAL, INC. (ISI) CONTACTED THE SURGEON AND OBTAINED ADDITIONAL INFORMATION REGARDING THE REPORTED EVENT: THE SURGEON STATED HE WAS TAKING DOWN ADHESIONS WITH THE MCS AND THE PROGRASP FORCEPS INSTRUMENTS. THE SURGEON INDICATED THAT HE DID NOT WITNESS ARCING FROM THE MCS INSTRUMENT; HOWEVER, HE SAW SMOKE. THERE WAS CHARRED TISSUE ON THE BASE OF THE ABDOMEN ON VISCERAL TISSUE NEAR THE PROGRASP FORCEPS INSTRUMENT. UPON EXAMINATION, HE DID NOT NOTICE ANY HOLES IN THE TISSUE AND HENCE DID NOT WARRANT ANY REPAIR. THE SURGEON ASKED FOR THE PROGRASP FORCEPS INSTRUMENT TO BE SWAPPED, AND NO ISSUE WAS REPORTED AFTERWARDS. THE SURGEON CONFIRMED NO FRAGMENTS FELL INSIDE THE PATIENT FROM THE PROGRASP FORCEPS INSTRUMENT. ON POST-OPERATIVE DAY (POD) #6, THE PATIENT UNDERWENT A SECOND OPEN PROCEDURE FOR UNSPECIFIED SYMPTOMS. THE PATIENT WAS IDENTIFIED WITH A BOWEL INJURY ON THE LARGE INTESTINE, RIGHT BELOW THE CANNULA INSTALLATION (INFERIOR LEFT) WHERE THE PROGRASP FORCEPS INSTRU

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED PULMONARY LOBECTOMY THE USER EXPERIENCED AN INCOMPLETE SEAL USING THE SYNCHROSEAL INSTRUMENT (LOT #L10220711-0413) AND ENCOUNTERED AN ¿INSPECT JAWS FOR DAMAGE¿ ERROR MESSAGE. A SECOND SYNCHROSEAL INSTRUMENT (LOT #L10220711-0396) WAS INSTALLED BUT ALSO DISPLAYED THE SAME ERROR MESSAGE. ACCORDING TO THE INITIAL REPORTER, AT THE TIME THE EVENT OCCURRED, THE SURGEON WAS ATTEMPTING TO DISSECT TISSUE WHICH HAD EXCESS MOISTURE AND BLEEDING OCCURRED. AS A RESULT, THE PROCEDURE WAS CONVERTED TO OPEN SURGERY IN ORDER TO CONTROL THE BLEEDING. THE BLEEDING WAS DESCRIBED AS BEING MILD TO MODERATE AND THE ESTIMATED BLOOD LOSS WAS 50 CC. ACCORDING TO THE SURGEON, THE INSTRUMENT FUNCTIONED PROPERLY FOR ONE HOUR AT WHICH POINT THE CUSTOMER EXPERIENCED IMPROPER/INCOMPLETE SEALING AND TISSUE STICKING TO THE INSTRUMENT JAWS. THERE WAS MINIMAL TO NO TENSION ON THE LUNG VESSEL BEING SEALED. NO EVIDENCE OF VESSEL CALCIFICATION WAS NOTED. THE VESSEL WAS NOT GREATER THAN 5MM IN DIAMETER. TISSUE EFFECT WAS OBSERVED DURING THE SEALING CYCLE(S). THE INSTRUMENT JAWS DID NOT COME INTO CONTACT WITH A CLIP, SUTURE, STAPLE, OR OTHER METAL OBJECTS WHEN THE REPORTED IS

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED PULMONARY LOBECTOMY THE USER EXPERIENCED AN INCOMPLETE SEAL USING THE SYNCHROSEAL INSTRUMENT (LOT #L10220711-0413) AND ENCOUNTERED AN ¿INSPECT JAWS FOR DAMAGE¿ ERROR MESSAGE. A SECOND SYNCHROSEAL INSTRUMENT (LOT #L10220711-0396) WAS INSTALLED BUT ALSO DISPLAYED THE SAME ERROR MESSAGE. AS A RESULT, THE PROCEDURE WAS CONVERTED TO OPEN SURGERY IN ORDER TO CONTROL BLEEDING. THERE WAS NO PATIENT HARM REPORTED. INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI ASSISTED SURGICAL PROCEDURE, A SMALL RETAINING SCREW IN THE RUBBERIZED SECTION PROXIMAL TO THE SYNCHROSEAL INSTRUMENT JAW APPEARED TO BECOME DETACHED AND WAS LOST WITHIN THE PATIENT. THE CUSTOMER HAS USED X-RAY ON THE PATIENT BUT WAS UNABLE TO IDENTIFY A FOREIGN OBJECT. THE CUSTOMER HAVE ASKED INTUITIVE SURGICAL (IS) TO CONFIRM THE MATERIAL TYPE OF THE SCREW TO ADD IN ITS LOCATION AND POTENTIAL RETRIEVAL. THE PROCEDURE WAS COMPLETED WITH NO REPORT OF PATIENT INJURY. ON 17-AUG-2022, ADDITIONAL INFORMATION WAS PROVIDED BY THE SPECIALTY SALES MANAGER: DURING THE SURGERY, THEY NOTICED A CIRCULAR WASHER LYING INSIDE THE PATIENT, WHICH WAS REMOVED. UPON INSPECTION OF THE SYNCHROSEAL INSTRUMENT THEY NOTICED THAT THERE IS A SMALL PIN SIZED HOLE ON THE INSTRUMENT WHICH COULD HAVE HAD A PIN INSIDE. THEY WERE NOT SURE AT THIS POINT AS TO WHETHER IT HAD A PIN INSIDE EARLIER. THEY NOTICED THAT THE OTHER SIDE HAD A PIN AND WASHER. THEY THEN TOOK OUT ANOTHER INSTRUMENT AND INSPECTED IT TO UNDERSTAND THE STRUCTURE. ONCE THEY UNDERSTOOD THAT THERE IS A MISSING PIN, THEY NEEDED TO KNOW HOW BIG IT WAS AND WHAT SHAPE THEY SHOULD SEARCH FOR WITHIN THE PATIENT. IT

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED MALIGNANT HYSTERECTOMY SURGICAL PROCEDURE, A CUSTOMER REPORTED THAT SYNCHROSEAL INSTRUMENT WAS BROKEN. A FRAGMENT FELL INTO THE PATIENT¿S ANATOMY AND WAS RETRIEVED IN THE SAME PROCEDURE. THE PROCEDURE CONTINUED AS PLANNED WITH NO REPORTED INJURY. INTUITIVE SURGICAL INC. (ISI) FOLLOWED UP WITH THE INITIAL REPORTER AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE FRAGMENT WAS REMOVED WITH A FORCEPS INSTRUMENT. IT WAS CONFIRMED VIA ENDOSCOPE THAT ALL FRAGMENTS WERE RETRIEVED. NO ADDITIONAL SURGICAL PROCEDURE WAS PERFORMED. AN X-RAY WAS PERFORMED AFTER THE PROCEDURE AS USUAL. THE SURGEON BELIEVED THAT THE SYNCHROSEAL INSTRUMENT COLLIDING WITH ANOTHER INSTRUMENT WAS THE CAUSE OF THE FRAGMENT FALLING INTO PATIENT. THE SYNCHROSEAL WAS INSPECTED PRIOR TO USE WITH NO ISSUE. A VESSEL SEALING TASK WAS BEING PERFORMED WHEN THE FRAGMENT FELL INSIDE THE PATIENT. THE SURGEON DID NOT NOTICE ANY ISSUES WITH THE FUNCTIONALITY OF THE INSTRUMENT DURING THE SURGICAL PROCEDURE. THE CUSTOMER DID NOT REMOVE THE INSTRUMENT PRIOR TO THE INSTRUMENT BREAKAGE. UPON FINAL REMOVAL OF THE INSTRUMENT, THE WRIST OF THE INSTRUMENT WAS STRAIGHTENED. THE SURGICAL S

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED SURGICAL PROCEDURE, THE RUBBER WASHER FROM THE 8 MM SYNCHROSEAL FELL OFF INSIDE PATIENT. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED SIGMOID COLECTOMY SURGICAL PROCEDURE, A SMALL METAL RING FROM THE SYNCHROSEAL INSTRUMENT FELL INTO THE PATIENT. THE FRAGMENT WAS REPORTEDLY RETRIEVED DURING A DIFFERENT PROCEDURE. THE PROCEDURE WAS COMPLETED AS PLANNED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED UNILATERAL INGUINAL HERNIA PROCEDURE, THE SURGEON NOTICED CAUTERIZED TISSUE WHERE ENERGY WAS NOT INTENTIONALLY APPLIED. IT WAS NOTED THAT NOTHING WAS VISIBLY WRONG WITH THE INSTRUMENT. IT IS UNKNOWN WHAT SPECIFIC TISSUE WAS UNINTENTIONALLY CAUTERIZED AND IF ANY MEDICAL INTERVENTION WAS RENDERED DUE TO THE COMPLICATION. ADDITIONALLY, THE SEVERITY OF THE BURN INJURY IS UNKNOWN. FURTHERMORE, IT IS UNKNOWN WHAT SPECIFIC INSTRUMENT WAS INVOLVED WITH THE COMPLICATION. THE SURGICAL PROCEDURE WAS REPORTEDLY COMPLETED WITH NO PATIENT INJURY. INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED RADICAL PROSTATECTOMY PROCEDURE, THE SURGEON WAS UNABLE TO FOCUS THE ENDOSCOPE. AT THE TIME THE ISSUE OCCURRED, THE PATIENT WAS ANESTHETIZED AND PORTS WERE PLACED. THE CUSTOMER HAD POWER CYCLED THE SYSTEM, TRIED TO FOCUS BOTH FROM THE SURGEON SIDE CONSOLE (SSC) AND CAMERA HEAD BUTTONS, AND PERFORMED 3D CALIBRATION BUT THE FOCUSING ISSUE WAS STILL NOT IMPROVED. THE CUSTOMER CONTACTED AN ISI TECHNICAL SUPPORT ENGINEER (TSE) FOR TROUBLESHOOTING ASSISTANCE AND WAS ADVISED TO TIGHTEN THE CAMERA CABLE AND TRY TO REFOCUS AGAIN. THE CUSTOMER REPORTED THAT THE CAMERA CABLE WAS NOT LOOSE AND MECHANICAL SOUND WAS HEARD WHEN HE PRESSED ON THE FOCUS BUTTON OF THE CAMERA HEAD. THE IMAGE STILL COULD NOT BE FOCUSED. THE CUSTOMER WAS ADVISED THAT THE ISSUE MAY BE FROM THE CAMERA HEAD. THE PATIENT REMAINED ANESTHETIZED FOR APPROXIMATELY THREE HOURS BEFORE THE BACKUP CAMERA HEAD ARRIVED. AFTER THE CAMERA HEAD WAS REPLACED BY AN INTUITIVE SURGICAL, INC. (ISI) FIELD SERVICE ENGINEER (FSE), THE PROCEDURE WAS RESUMED AND COMPLETED WITHOUT FURTHER ISSUES. THERE WAS NO INTRAOPERATIVE PATIENT HEALTH DAMAGE OBSERVED; HOWEVER, THE PATIENT ORIGINALLY HAD INTERSTI

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED TONGUE BASE RESECTION-BENIGN SURGICAL PROCEDURE, THE RIGHT MASTER TOOL MANIPULATORS (MTM) WERE NOT MOVING. THE OPERATING ROOM STAFF, CALLED TECHNICAL SUPPORT TO REPORT THAT THE RIGHT-HAND CONTROL ON THE SP WAS FROZEN. PRIOR TO CALLING IN, THE SITE CONVERTED TO OPEN SURGICAL PROCEDURE. THE INTUITIVE SURGICAL, INC. (ISI) TECHNICAL SERVICE ENGINEER (TSE) WAS UNABLE TO VIEW LIVE LOGS FROM THE SYSTEM. THE ISI TSE ASKED IF THE CALLER COULD VERIFY INSTRUMENT ASSIGNMENTS, BUT THE CALLER STATED THAT THE SYSTEM HAD BEEN TAKEN AWAY. THE CALLER STATED THAT THEY PERFORMED A REBOOT ON THE SYSTEM WITH NO CHANGE. THE CALLER WAS REQUESTING THE FIELD SERVICE ENGINEER (FSE) TO FOLLOW UP. ISI MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED SIMPLE PROSTATECTOMY SURGICAL PROCEDURE THAT THE SYNCHROSEAL INSTRUMENT ARCED WHILE USING THE SEAL FUNCTION. THE PROCEDURE WAS COMPLETED WITH NO REPORTS OF PATIENT INJURY. INTUITIVE SURGICAL INC. (ISI) FOLLOWED UP WITH THE CUSTOMER TO CONFIRM THAT THE INSTRUMENT WAS INSPECTED BEFORE THE PROCEDURE WITH NO ISSUES NOTICED. THE SURGEON WAS SEALING PROSTATE TISSUE WITH NO SPECIFIC VESSEL. THERE WAS A WARNING MESSAGE REGARDING INCOMPLETE SEALING FOLLOWED BY VISIBLE ARCHING. IT WAS WORKING FOR ABOUT 60 MINUTES PRIOR TO THIS ISSUE. THERE WAS MILD RETENTION / RETRACTION DURING SEALING. THE VESSELS WERE SMALL, ABOUT LESS THAN 5MM. SOME CHAR HAD BUILT UP ON THE INSTRUMENT. THERE WAS SOME UNEXPECTED BLEEDING, APPROXIMATELY 50CC ESTIMATED BLOOD LOSS (EBL), AFTER SWITCHING TO THE MARYLAND BIPOLAR FORCEPS INSTRUMENT. THERE WAS NO TRANSFUSION PERFORMED. THE BLEEDING WAS RESOLVED WITH BIPOLAR AND MONOPOLAR CAUTERY. THE INITIAL REPORTER ALSO STATED THE FOLLOWING; ¿ MAY HAVE FOUND THE CULPRIT FOR THE BROKEN SYNCHROSEALS HERE AT CENTRAL MAINE MEDICAL CENTER (CMMC). FOOTE DOES A LOT OF INSTRUMENT TO INSTRUMENT INTRA-OPERATIVE CLEANING WHICH I IMAGINE IS W

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: THE DAVINCI 30MM ENDOWRIST STAPLER WAS PLACED ON THE PULMONARY ARTERY AND FIRED. WHEN THE STAPLER WAS PROMPTED TO UNCLAMP, AN ERROR SHOWED THAT THE ACTION THAT UNCLAMPS THE STAPLER WAS UNABLE TO FUNCTION. THE ROBOT WAS MANUALLY PUT INTO FAULT MODE TO ALLOW THE BEDSIDE ASSIST TO USE THE WRENCH, WHICH IS THE FALLBACK/SAFETY MEASURE WHEN THIS HAPPENS. WHEN GOING IN THE PROPER ORDER, THE WRENCH WAS UNABLE TO FULLY SPIN, WHICH PREVENTED THE STAPLER FROM UNCLAMPING THE PA. THE DAVINCI REPS WERE ON THE PHONE WITH THEIR TECHNICAL TEAM WORKING THE PROBLEM, AND COMMUNICATING WITH THE SURGEON AND BEDSIDE ASSIST ON HOW TO GET THE STAPLER TO UNCLAMP. FDA SAFETY REPORT ID# (B)(4).

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED RADICAL PROSTATECTOMY WITHOUT LYMPHADENECTOMY PROCEDURE, A SPARK OCCURRED BETWEEN THE MONOPOLAR CURVED SCISSORS (MCS) INSTRUMENT AND SYNCHROSEAL INSTRUMENT. THE SYNCHROSEAL INSTRUMENT STOPPED WORKING COMPLETELY. THE CUSTOMER REMOVED THE INSTRUMENTS AND OBSERVED CRACKS IN THE BLADE PORTION OF THE SYNCHROSEAL INSTRUMENT. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE INITIAL REPORTER AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE SYNCHROSEAL INSTRUMENT REPORTEDLY ARCED DURING THE CASE. THERE WERE CRACKS AND CHAR OBSERVED ON THE INSTRUMENT'S BLADES. THE INSTRUMENTS WERE REPORTEDLY CLOSE TO EACH OTHER DURING THE CASE. IT WAS HARD TO TELL WHERE THE ELECTRICAL ENERGY ARCED TO. THE CUSTOMER REPORTED UNEXPECTED MINOR BLEEDING DURING THE EVENT BUT WAS NOT REALLY SURE WHAT WAS THE CAUSE OF THE BLEEDING. THE CUSTOMER SUSPECTED THAT BLEEDING WAS CAUSED DUE TO THE TIME IT TOOK TO USE THE MARYLAND BIPOLAR FORCEPS INSTRUMENT INSTEAD OF THE SYNCHROSEAL INSTRUMENT AS THE SYNCHROSEAL INSTRUMENT SEALS FASTER. THE PATIENT LOST MINIMAL AMOUNT OF BLOOD, AROUND 50CC¿S. NO BLOOD TRANSFUSION WA

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED RADICAL PROSTATECTOMY WITH OUT LYMPHADENECTOMY PROCEDURE, A SPARK OCCURRED BETWEEN THE MONOPOLAR CURVED SCISSORS (MCS) INSTRUMENT AND SYNCHROSEAL INSTRUMENT. THE SYNCHROSEAL INSTRUMENT STOPPED WORKING COMPLETELY. THE CUSTOMER REMOVED THE INSTRUMENTS AND OBSERVED CRACKS IN THE BLADE PORTION OF THE SYNCHROSEAL INSTRUMENT. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE INITIAL REPORTER AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE SYNCHROSEAL INSTRUMENT ARCED DURING THE CASE. THERE WERE CRACKS AND CHAR OBSERVED ON THE INSTRUMENT'S BLADES. THE INSTRUMENTS WERE REPORTEDLY CLOSE TO EACH OTHER DURING THE CASE. IT WAS HARD TO TELL WHERE THE ELECTRICAL ENERGY ARCED TO. THE CUSTOMER REPORTED UNEXPECTED MINOR BLEEDING DURING THE EVENT BUT WAS NOT REALLY SURE WHAT WAS THE CAUSE OF THE BLEEDING. THE CUSTOMER SUSPECTED THAT BLEEDING WAS CAUSED DUE TO THE TIME IT TOOK TO USE THE MARYLAND BIPOLAR FORCEPS INSTRUMENT INSTEAD OF THE SYNCHROSEAL INSTRUMENT AS THE SYNCHROSEAL INSTRUMENT SEALS FASTER. THE PATIENT LOST MINIMAL AMOUNT OF BLOOD, AROUND 50CC¿S. NO BLOOD TRANSFUSION WAS NEEDED.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED SURGICAL PROCEDURE, THE CUSTOMER CALLED AN INTUITIVE SURGICAL, INC. (ISI) TECHNICAL SUPPORT ENGINEER (TSE) AND REPORTED THAT TWO DIFFERENT UNSPECIFIED STAPLER INSTRUMENTS WERE INSTALLED AND FELL APART WHILE INSIDE THE PATIENT. THE TSE REVIEWED LOGS AND NOTED STERILE ADAPTER ENGAGEMENT CODES IN THE LOGS. THE TSE ASKED IF ALL PIECES WERE COLLECTED AND ACCOUNTED FOR AND THE CUSTOMER STATED THAT ACCORDING TO THE OPERATING ROOM NIGHT STAFF THAT THEY WERE. THE TSE THEN ASKED IF THE STAPLERS WERE AVAILABLE TO BE SENT BACK FOR ANALYSIS AND THE CUSTOMER DOES NOT BELIEVE STAPLERS WERE KEPT. THE TSE ALSO ASKED IF THERE WAS ANY PATIENT INJURY AND THE CUSTOMER REPORTED THAT THERE WAS NO PATIENT INJURY. THE SITE WAS REQUESTING FOR ISI FIELD SERVICE ENGINEER (FSE) TO FOLLOW UP AS SITE WAS WARY OF USING SYSTEM AFTER THE ISSUE OCCURRED. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY AND WITH A LESS THAN A 15-MINUTE DELAY.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED ESOPHAGECTOMY SURGICAL PROCEDURE, BLEEDING OCCURRED FROM ONE OF THE TWO BRANCHES OF THE AORTIC ARCH LEADING TO THE ESOPHAGUS. THE ISSUE OCCURRED 15 MINUTES AFTER SEALING AND TRANSECTING THE SIDE BRANCH WITH A SYNCHROSEAL INSTRUMENT. THE SIDE BRANCH WAS PROPERLY FREED FORM SURROUNDING TISSUE AND THEN SEALED WHILE DEEP IN THE JAWS OF THE SYNCHROSEAL. THE SURGEON PERFORMED A FULL CYCLE OF SEALING, OBSERVED TISSUE EFFECT DURING THE SEALING PROCESS, AND THEN TRANSECTED. THE SURGEON BELIEVES THE SEAL COULD NOT HANDLE THE PRESSURE FROM THE AORTIC BRANCH AND BEGAN BLEEDING 15 MINUTES LATER. THE SURGEON WAS ABLE TO TAMPONADE THE BLEEDING WITH AN UNSPECIFIED INSTRUMENT INSTALLED ON UNIVERSAL SURGICAL MANIPULATOR 1 (USM1) BY USING COMPRESSION. USM2, 3, AND 4 WERE THEN REMOVED. THE SURGEON MADE THE CLINICAL DECISION TO CONVERT TO A THORACOTOMY TO CONTROL THE HEMORRHAGE. THE SURGEON PERFORMED SUTURE LIGATION OF THE BLEEDING SITE ON THE AORTA AND THE PATIENT WAS TRANSFUSED 2 UNITS OF PACKED CELLS. BLOOD LOSS WAS ESTIMATED TO BE BETWEEN 500 AND 600ML. THE SURGEON INDICATED THAT THE PATIENT WAS DOING FINE AND RECOVERING POST-OPERATIVELY. HOWEVER, THE

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT AFTER COMPLETION OF A DA VINCI-ASSISTED LOW ANTERIOR RESECTION (LAR) PROCEDURE, THE PATIENT'S URINE OUTPUT WAS BORDERLINE LOW, SO BASIC LABS WERE ASSESSED. ON POSTOPERATIVE DAY (POD) #1 (B)(6) 2022), THE PATIENT HAD LOW URINE OUTPUT AND WAS ENCOURAGED TO TRY CLEAR FLUIDS. THE PATIENT'S CREATININE LEVELS WERE NOTED TO HAVE RISEN TO 2.32 (FROM 1.02), SODIUM WAS 127 AND THE HEMOGLOBIN WAS NOTED TO BE LOW AT 8.8. THE PATIENT WAS STARTED ON IV FLUIDS AND CANDESARTAN, CHLORTHALIDONE AND SPIRONOLACTONE WERE HELD AT THIS TIME. THE PATIENT WAS DIAGNOSED WITH ACUTE KIDNEY INJURY DUE TO HYPOVOLEMIA, AND HYPONATREMIA. ON POD #2 (B)(6) 2022), SHE WAS AGAIN ENCOURAGED TO INCREASE ORAL INTAKE. THE CREATININE WAS TRENDING DOWNWARD AT 1.81, SODIUM WAS 129 AND HEMOGLOBIN WAS STABLE AT 8.3. DIARRHEA WAS ALSO NOTED (STARTED ON POD #2). ON POD #3 (B)(6) 2022), THE PATIENT'S URINE OUTPUT WAS NOTED TO BE ADEQUATE. THE PATIENT WAS DISCHARGED THAT SAME DAY WITH A RECOMMENDATION TO FOLLOW UP WITH HER PRIMARY CARE PHYSICIAN IN 1-2 WEEKS ON AN OUT-PATIENT BASIS WITH BMP FOLLOW UP. A PATHOLOGY REPORT ON (B)(6) 2022 DEMONSTRATED INVASIVE MODERATELY DIFFERENTIATED ADENOCARCINOMA ARISING IN A

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED SINGLE PORT (SP) SIMPLE PROSTATECTOMY SURGICAL PROCEDURE, AN ERROR 25741 WAS DISPLAYED WHEN DOCKING. THE SITE TRIED TO RECOVER THE FAULT BY PERFORMING AN EMERGENCY POWER OFF (EPO), AND CYCLING THE CANNULA MOUNT LEVER, HOWEVER, THE ERROR PERSISTED. THE PROCEDURE WAS CONVERTED TO A DA VINCI MULTIPORT SYSTEM. INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED HYSTERECTOMY PROCEDURE, THE E-100 GENERATOR TURNED OFF UNEXPECTEDLY AND WHEN THE SURGEON WAS ATTEMPTING TO USE THE SYNCHROSEAL INSTRUMENT, THE SURGEON REPORTED HAVING TROUBLE MOVING THE INSTRUMENT. THE SURGEON INDICATED THAT THE INSTRUMENT WAS NOT WORKING OR RESPONDING CORRECTLY AND WOULD NOT OPEN. BY THE TIME THE SURGICAL STAFF TURNED THE GENERATOR BACK ON, THE SURGEON HAD REPORTEDLY OBSERVED BLEEDING AND ELECTED TO CONVERT THE PROCEDURE TO OPEN SURGERY. ON (B)(6) 2022, INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE SURGEON AND RECEIVED THE FOLLOWING ADDITIONAL INFORMATION REGARDING THE REPORTED EVENT: AFTER THE ISSUE OCCURRED WITH THE SYNCHROSEAL INSTRUMENT, THE SURGICAL STAFF OPENED A SECOND SYNCHROSEAL INSTRUMENT. THE SURGEON WAS ABLE TO USE THE BACKUP SYNCHROSEAL INSTRUMENT WITHOUT ANY ISSUES. HOWEVER, THE SURGEON ELECTED TO CONVERT THE CASE TO OPEN SURGERY DUE TO BLOOD LOSS AND TO CONTROL BLEEDING. THE CAUSE OF THE BLEEDING WAS NOT PROVIDED. HOWEVER, THE SURGEON MENTIONED THAT THE DA VINCI SYSTEM WAS A CONTRIBUTING FACTOR TO THE INTRA-OPERATIVE COMPLICATION SINCE HE COULD NOT CONTROL BLEEDING AND WAS UNABLE TO CAUTERIZE. TH

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF A VIDEOSURGERY AND OTHER MINIMALLY INVASIVE TECHNIQUES ARTICLE TITLED, ¿SINGLE PLUS ONE-PORT ROBOTIC SURGERY USING THE DA VINCI SINGLE-SITE PLATFORM VERSUS CONVENTIONAL MULTI-PORT LAPAROSCOPIC SURGERY FOR LEFT-SIDED COLON CANCER¿ (BAE, S. U., JEGON, W. K. AND BAEK, S. K., 2022). THE STUDY COMPARES THE CLINICAL AND COSMETIC OUTCOMES OF SINGLE PLUS ONE-PORT ROBOTIC SURGERY (SPORS) WITH THOSE OF MULTI-PORT LAPAROSCOPIC SURGERY (MPLS),WHICH IS PRESENTLY THE STANDARD SURGICAL TREATMENT FOR COLON CANCER. THE STUDY INCLUDED 36 PATIENTS WHO UNDERWENT SPORS AND 61 PATIENTS WHO UNDERWENT MPLS FOR LEFT-SIDED COLON CANCER BETWEEN AUGUST 2014 AND JANUARY 2016. WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING DA VINCI-ASSISTED SURGICAL PROCEDURES WERE NOTED: TWO PATIENTS IN THE SPORS GROUP DEVELOPED A SUPERFICIAL SURGICAL SITE INFECTION AT THE SPECIMEN EXTRACTION SITE. ONE INSTANCE OF POSTOPERATIVE ANASTOMOTIC SITE BLEEDING OCCURRED IN THE SPORS GROUP, BUT REOPERATION OR ANOTHER INTERVENTION WAS NOT REQUIRED. ADDITIONALLY, IN THE SPORS GROUP, THERE WAS ONE CASE OF POST-OPERATIVE ILEUS AND TWO CASES OF POST-OPERATIVE PSEUDOMEMBRANOUS COL

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF A VIDEOSURGERY AND OTHER MINIMALLY INVASIVE TECHNIQUES ARTICLE TITLED, ¿SINGLE PLUS ONE-PORT ROBOTIC SURGERY USING THE DA VINCI SINGLE-SITE PLATFORM VERSUS CONVENTIONAL MULTI-PORT LAPAROSCOPIC SURGERY FOR LEFT-SIDED COLON CANCER¿ (BAE, S. U., JEGON, W. K. AND BAEK, S. K., 2022). THE STUDY COMPARES THE CLINICAL AND COSMETIC OUTCOMES OF SINGLE PLUS ONE-PORT ROBOTIC SURGERY (SPORS) WITH THOSE OF MULTI-PORT LAPAROSCOPIC SURGERY (MPLS),WHICH IS PRESENTLY THE STANDARD SURGICAL TREATMENT FOR COLON CANCER. THE STUDY INCLUDED 36 PATIENTS WHO UNDERWENT SPORS AND 61 PATIENTS WHO UNDERWENT MPS FOR LEFT-SIDED COLON CANCER BETWEEN AUGUST 2014 AND JANUARY 2016. WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATION INVOLVING DA VINCI SURGICAL PROCEDURES WERE NOTED: ONE PATIENT REQUIRED CONVERSION FROM SINGLE PORT TO REDUCED PORT LAPAROSCOPIC SURGERY DUE TO AIR LEAK AND COLLISIONS OF ROBOTIC ARMS. IT WAS FURTHER NOTED, "REGARDING SINGLE PORTS, THE SINGLE-SITE PORT USED IN THE FIRST 3 CASES WAS NOT FLEXIBLE AND HAD POOR DURABILITY. IN ANOTHER CASE, A THIRD PATIENT CHANGED FROM A SINGLE PORT OF A GLOVE PORT TO SECURE DISTANCE BETWEEN INSTRUMENT TIPS AND THE

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: ON 14-MAY-2020, INTUITIVE SURGICAL, INC (ISI) BECAME AWARE OF A HEAD & NECK ARTICLE TITLED, ¿ONE-YEAR OUTCOMES FOR DA VINCI SINGLE PORT ROBOT FOR TRANSORAL ROBOTIC SURGERY¿ (VAN ABEL, K. M., YIN, L. X., ET AL., 2020). WITHIN THE JOURNAL ARTICLE, AN OPERATIVE COMPLICATION INVOLVING A DA VINCI SURGICAL PROCEDURE WAS NOTED. WITHIN THE ARTICLE, THE FOLLOWING IS NOTED: ¿THERE WERE 4 POSTOPERATIVE HEMORRHAGES FOR AN OVERALL BLEED RATE OF 5.1 %. THE DETAILS ON THESE POSTOPERATIVE HEMORRHAGE EVENTS ARE REPORTED IN TABLE 3. THERE WERE TWO MORTALITIES IN THIS COHORT OF 78, ONE SECONDARY TO A POST-TONSILLECTOMY HEMORRHAGE AND ANOTHER SECONDARY TO A POSTOPERATIVE PULMONARY EMBOLUS, FOR AN OVERALL MORTALITY RATE OF 2.6%¿ PROCEDURE INFORMATION PROCEDURE CATEGORY PROCEDURE NAME TRANSORAL ROBOTIC SURGERY. ISI FOLLOWED-UP WITH THE AUTHOR, WHO STATED THE FOLLOWING REGARDING THE REPORTED COMPLICATIONS: "NO, THERE WAS NO ALLEGATION OR CLAIM THAT A MALFUNCTION OF THE SYSTEM OR INSTRUMENT WAS INVOLVED IN THESE COMPLICATIONS. THESE ARE KNOWN RISKS WITH THIS SURGICAL PROCEDURE, DOCUMENTED WITH THE SI AND TRANSORAL LASER MICROSURGERY AS WELL. WE DID NOT IDENTIFY A RATE HIGHER THAN THE PUBLISHED AVERAGES."

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED LIVER RESECTION SURGICAL PROCEDURE, THE SURGEON HAD TO CONVERT TO OPEN SURGERY. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE INITIAL REPORTER AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE CUSTOMER REPORTED THAT THE SURGEON DECIDED TO CONVERT TO OPEN SURGERY BASED ON COMFORT LEVEL. THE SURGEON HAD PLANNED TO CONVERT TO OPEN AND THE ROOM WAS ALREADY SETUP. THERE WERE NO DA VINCI CONTRIBUTING FACTORS TO CONVERTING THE PROCEDURE; THIS WAS A DECISION MADE COMPLETELY BY THE SURGEON. THE CUSTOMER FOLLOWED UP WITH THE PATIENT THE NEXT DAY AND THE PATIENT WAS DOING WELL.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: INTUITIVE SURGICAL INC. (ISI) BECAME AWARE OF A SURGERY ARTICLE TITLED, ¿PERIOPERATIVE OUTCOMES OF MINIMALLY INVASIVE ILEOCOLIC RESECTION FOR COMPLICATED CROHN DISEASE: RESULTS FROM A REFERRAL CENTER RETROSPECTIVE COHORT¿ (ABDALLA, S., ET AL., 2022). A STUDY WAS CONDUCTED TO COMPARE THE INTRAOPERATIVE AND POSTOPERATIVE OUTCOMES OF MINIMALLY INVASIVE ILEOCOLIC RESECTION (MISICR) FOR COMPLICATED VERSUS UNCOMPLICATED CROHN DISEASE (CD). A RETROSPECTIVE ANALYSIS OF ALL CONSECUTIVE ADULT PATIENTS WITH CD UNDERGOING MISICR FROM 01-SEP-2014 AND 31-MAR-2021 WAS CONDUCTED. PATIENTS WERE DIVIDED INTO 2 GROUPS, COMPLICATED AND UNCOMPLICATED, BASED ON THE PREOPERATIVE AND INTRAOPERATIVE FINDINGS. PERIOPERATIVE OUTCOMES WERE COMPARED BETWEEN PATIENTS WITH COMPLICATED CD (COMPLICATED GROUP) AND PATIENTS WITHOUT THESE LESIONS (UNCOMPLICATED GROUP). THE FOCUSED WAS ON ROBOTIC AND LAPAROSCOPIC ILEOCOLIC RESECTIONS (ICR) FOR CD. WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING A DA VINCI SURGICAL PROCEDURE WERE NOTED: INTRAOPERATIVE COMPLICATIONS OCCURRED IN 4 PATIENTS WITHOUT DIFFERENCES BETWEEN GROUPS. IN THE UNCOMPLICATED GROUP, 2 PATIENTS HAD AN UNINTENDED FULL-THICKNESS BOWEL INJUR

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF AN UROLOGY ARTICLE TITLED, ¿INTRAOPERATIVE DECISION-MAKING: THERMAL INJURY DURING ROBOTIC PYELOPLASTY¿ (HIGGINS, M., AND SALTZMAN, A., 2020). WITHIN THE CLINICAL JOURNAL ARTICLE, IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED PYELOPLASTY PROCEDURE, AN INADVERTENT THERMAL INJURY TO A URETER OCCURRED DUE TO ARCING FROM A MONOPOLAR CURVED SCISSORS (MCS) INSTRUMENT TO A FENESTRATED BIPOLAR FORCEPS (FBF) INSTRUMENT. THE INJURY OCCURRED WHILE THE SURGEON WAS PERFORMING INITIAL PROXIMAL URETERAL DISSECTION AND WHILE ACTIVATING ENERGY WITH THE MCS INSTRUMENT WHICH WAS TOUCHING THE FBF INSTRUMENT. AT THE TIME THE INJURY OCCURRED, THE FBF INSTRUMENT WAS BEING USED TO PROVIDE UPWARD URETERAL RETRACTION. ON 22-JUN-2020, ISI OBTAINED THE FOLLOWING ADDITIONAL INFORMATION FROM THE AUTHOR OF THE ARTICLE REGARDING THE REPORTED EVENT: THERE IS NO ALLEGATION OR CLAIM THAT A MALFUNCTION OF A DA VINCI SYSTEM, AN INSTRUMENT, OR AN ACCESSORY OCCURRED DURING THE SURGICAL PROCEDURE INVOLVING THE OPERATIVE COMPLICATION. THERE IS ALSO NO ALLEGATION OR CLAIM THAT A MALFUNCTION OF A DA VINCI SYSTEM, AN INSTRUMENT, OR AN ACCESSORY CAUSED OR CONTRIBUTED TO THE OPER

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED VIA A SOCIAL MEDIA POST THAT DURING A DA VINCI-ASSISTED SURGICAL PROCEDURE, THE SURGEON PRESSED THE INCORRECT PEDAL AND BURNED THE COLON. THE SURGEON RECOGNIZED THE ERROR AND WAS ABLE TO STAPLE MORE PROXIMALLY. ON 29-SEP-2020, INTUITIVE SURGICAL, INC. (ISI) OBTAINED THE FOLLOWING ADDITIONAL INFORMATION REGARDING THE REPORTED EVENT: DURING AN UNDISCLOSED DA VINCI-ASSISTED SURGICAL PROCEDURE, THE SURGEON PRESSED THE INCORRECT ENERGY PEDAL ON THE SURGEON SIDE CONSOLE (SSC) AND THE PATIENT SUSTAINED A SMALL 2ND DEGREE BURN ON THE SMALL INTESTINE; REPAIRED BY RESECTING 2CM OF THE SMALL INTESTINE. THE PATIENT WAS REPORTED AS FINE. THE SURGEON CONFIRMED THAT THERE [WASN¿T A] DA VINCI ERROR. THE SURGEON ATTRIBUTED THE ISSUE TO HIS ¿MALFUNCTION¿; SURGEON ERROR, NOTHING ELSE. THE SURGEON WAS UNWILLING TO PROVIDE ANY ADDITIONAL INFORMATION REGARDING THE INCIDENT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF AN ANNALS OF SURGICAL TREATMENT AND RESEARCH ARTICLE TITLED, ¿INITIAL EXPERIENCES OF ROBOTIC SP CHOLECYSTECTOMY: A COMPARATIVE ANALYSIS WITH ROBOTIC SI SINGLE-SITE CHOLECYSTECTOMY¿ (CRUZ, C. J., HUYNH, F., ET AL., 2021). WITHIN THE JOURNAL ARTICLE, AN OPERATIVE COMPLICATION INVOLVING A DA VINCI SURGICAL PROCEDURE WAS NOTED: ¿ONE PATIENT HAD A SMALL BOWEL INJURY DURING PORT PLACEMENT DUE TO UNEXPECTED INTRA-ABDOMINAL ADHESIONS, WHICH WAS REPAIRED INTRA-CORPOREALLY.¿ INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: DURING THE PROCEDURE, THE SCRUB TECH NOTICED THAT THE INSTRUMENT PULLED OUT FROM THE ABDOMEN WAS MISSING THE TIP COVER. SHE LOOKED AROUND AND MADE SURE IT WASN'T IN HER FIELD AND INFORMED THE SURGEON AND ASSISTANT SURGEON. THE TEAM IN THE ROOM LOOKED THRU AND AROUND THE STERILE FIELD, AND ALSO WENT THRU THE TRASH, BUT WERE UNABLE TO FIND THE MISSING TIP COVER. THE SURGEON AND ASSISTANT EXPLORED INSIDE THROUGH THE SCOPE BEFORE AND AFTER SPECIMEN WAS REMOVED. XRAY DID NOT REVEAL ANY FOREIGN BODY. FDA SAFETY REPORT ID# (B)(4).

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: ON 26-NOV-2020, INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF THE GENERAL THORACIC AND CARDIOVASCULAR SURGERY ARTICLE TITLED, ¿IS LEFT-SIDE DAVINCI PROCEDURE CHALLENGING? INITIAL EXPERIENCES OF A SINGLE INSTITUTE.¿ WITHIN THE ARTICLE, THE FOLLOWING IS NOTED: CASE #3 INVOLVED A 69 YEAR OLD MALE PATIENT WITH STAGE 1B CANCER WHO UNDERWENT A DA VINCI-ASSISTED LEFT UPPER LOBECTOMY PROCEDURE ON AN UNSPECIFIED DATE. THE CAUSE OF THE CONVERSION PER TABLE 3 IN THE ARTICLE WAS AN ¿INJURY OF PA¿ (PULMONARY ARTERY). ¿IN CASE 3, WHEN DISSECTING THE ARTERIAL BRANCH TO THE APICO-POSTERIOR SEGMENT OF THE LEFT UPPER LOBE, THE ROOT OF THE BRANCH WAS INJURED AND THE SURGERY WAS CONVERTED TO OPEN THORACOTOMY.¿ THERE IS NO ALLEGATION THAT A MALFUNCTION OF A DA VINCI SYSTEM, INSTRUMENT, OR ACCESSORY OCCURRED IN RELATION TO THE REPORTED EVENT. INTUITIVE SURGICAL, INC. (ISI) HAS MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: ON 22-APR-2020, INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF A JOURNAL OF ULTRASOUND ARTICLE TITLED, ¿INFERIOR EPIGASTRIC ARTERY PSEUDOANEURYSM SECONDARY TO PORT PLACEMENT DURING A ROBOT-ASSISTED LAPAROSCOPIC RADICAL CYSTECTOMY.¿ PER THE CLINICAL ARTICLE, DURING A DA VINCI-ASSISTED RADICAL CYSTECTOMY WITH BRICKER URETEROILEOCUTANEOSTOMY AND EXTENDED PELVIC LYMPH NODE DISSECTION, THE PATIENT DEVELOPED AN INFERIOR EPIGASTRIC ARTERY (IEA) PSEUDOANEURYSM SECONDARY TO AN 8-MILLIMETER (MM) PORT PLACEMENT. THE PRE-OPERATIVE COMPUTED TOMOGRAPHY (CT) SCAN SHOWED NO LYMPHOADENOMEGALY AND BILATERAL HYDRONEPHROSIS, AND NO OTHER LOCALIZATION THAN THE BLADDER. THE PSEUDOANEURYSM WAS INITIALLY DIAGNOSED POST-OPERATIVELY BY CONTRAST-ENHANCED ULTRASOUND (CEUS); SUBSEQUENTLY, A CT SCAN AND AN ANGIOGRAPHY TEST WERE PERFORMED. THE PSEUDOANEURYSM WAS THEN TREATED SUCCESSFULLY WITH COIL EMBOLIZATION OF THE INFERIOR EPIGASTRIC ARTERY. NO COMPLICATIONS OCCURRED DURING OR AFTER THE EMBOLIZATION PROCEDURE. ON 03-JUN-2020, IS OBTAINED THE FOLLOWING ADDITIONAL INFORMATION FROM THE AUTHOR OF THE CLINICAL ARTICLE REGARDING THIS EVENT: "THERE WAS NO MALFUNCTION OF THE DA VINCI SYSTEM, THIS COMPLICATION CAN OCC

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED RADICAL CYSTECTOMY WITH OTHER URINARY DIVERSION SURGICAL PROCEDURE, THE RIGHT EYE IN THE SURGEON SIDE CONSOLE (SSC) WAS BLACK. THE RIGHT AND LEFT IMAGES WORKED FINE IN THE VISION SIDE CART (VSC). THE BLUE FIBER CABLE WAS PROPERLY CONNECTED TO THE SSC AND THE LED WAS BLUE. THE TECHNICAL SUPPORT ENGINEER (TSE) ASKED THE CALLER TO EMERGENCY POWER OFF (EPO) THE SSC AND VISION SIDE CART (VSC), BUT THE RIGHT MONITOR REMAINED COMPLETELY BLACK. THE SURGEON WAS UNDECIDED TO AS TO WHETHER TO CONVERT OR ABORT THE PROCEDURE AT THAT TIME. THERE WAS NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE INITIAL REPORTER AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THERE WAS A ONE HOUR DELAY AS THE PROCEDURE WAS CONVERTED TO OPEN SURGERY. THE ISSUE DID NOT OCCUR DURING A CRITICAL STEP. IT IS UNKNOWN IF SYSTEM FUNCTIONALITY WAS CHECKED UPON POWERING ON THE SYSTEM. THE SYSTEM WAS ONLY ABLE TO SEE THROUGH ONE EYE OF THE HRSV.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: DAVINCI ROBOTIC SURGERY WAS PREFORMED ON THIS PATIENT, WHILE THE SURGEON WAS IN THE CONSOLE, THE INSTRUMENTS WERE USED TO TAKE DOWN ADHESIONS AND AFTER THAT OCCURRED, THE ARMS EXPERIENCED AN ISSUE. THE SURGEON DESCRIBED IT "AS THE LEFT HAND WAS MOVED WITH THE VESSEL SEAL DEVICE, THE ROBOTIC ARM MOVED ERRATICALLY AND IMMEDIATELY I NOTED A THROUGH AND THROUGH PERFORATION OF THE SIGMOID COLON." THE INSTRUMENT WAS LEFT IN PLACE AND A GENERAL SURGERY CONSULT WAS COMPLETED IMMEDIATELY FOR REPAIR. AFTER DISCUSSION WITH THE TEAM, WE BELIEVE THAT THE ROBOTIC ARM DRAPE WAS FAULTY AND WE IMMEDIATELY CALLED THE REP AND THE TECH SUPPORT PERSON. THEY RECOMMENDED THAT WE PULL ALL THOSE DRAPES WITH THAT LOT NUMBER #DM1220807. FDA SAFETY REPORT ID# (B)(4).

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED SLEEVE GASTRECTOMY SURGICAL PROCEDURE, THE JAWS OF HARMONIC ACE FELL INSIDE OF THE PATIENT. THE FALLEN PIECE WAS RETRIEVED DURING THE SAME PROCEDURE WITH A BACKUP INSTRUMENT. THE INSTRUMENT IS NOT AVAILABLE FOR RETURN. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE INITIAL REPORTER AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE CUSTOMER WAS ABLE TO RETRIEVE THE BROKEN PIECE WITH A LAPAROSCOPIC INSTRUMENT. NO ADDITIONAL PROCEDURES WERE REQUIRED TO RETRIEVE THE BROKEN PIECE. NO POST-OPERATIVE TESTS NEEDED TO BE PERFORMED TO CHECK FOR ANY REMAINING PIECES. THE CUSTOMER WAS NOT SURE WHAT THE SURGEON THOUGHT CAUSED THE INSTRUMENT TO BREAK. THE INSTRUMENT WAS USED MAYBE 20 MINS PRIOR TO BREAKING. THE INSTRUMENT WAS INTACT WHEN IT WAS REMOVED FROM THE STERILE PACKAGE. THE CUSTOMER WAS DISSECTING TISSUE WHEN THE INSTRUMENT BROKE. RIGHT BEFORE THE CUSTOMER NOTICED THE INSTRUMENT WAS BROKEN THE HARMONIC MACHINE HAD AN ERROR BUT SHE COULD NOT REMEMBER WHAT THE ACTUAL ERROR SAID. THE CUSTOMER COULD NOT RECALL IF THE INSTRUMENT COLLIDED WITH ANY OTHER INSTRUMENT DURING THE PROCEDURE

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED PROSTATECTOMY PROCEDURE, A BURNING ACCIDENT OCCURRED WHILE THE SURGEON WAS USING A MONOPOLAR CURVED SCISSORS (MCS) INSTRUMENT AT THE BEGINNING OF THE PROCEDURE. THE TIP OF THE MCS INSTRUMENT HEATED UP AND BURST INTO FLAMES WHEN THE SURGEON ACTIVATED THE MCS INSTRUMENT FOR THE FIRST TIME. THE MCS INSTRUMENT WAS ON ITS THIRD USAGE. THERE WAS INJURY TO THE PATIENT'S SMALL INTESTINE AND ABDOMINAL WALL NEAR THE TROCAR AS A RESULT. A BACKUP MCS INSTRUMENT WITH TIP COVER WAS USED. THE FRAGMENTS THAT FELL IN THE PATIENT FROM THE BURNT TIP COVER WERE RETRIEVED DURING THE SAME PROCEDURE. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE OPERATING ROOM NURSE AND OBTAINED THE FOLLOWING INFORMATION: THERE WAS NO ERROR GENERATED BY THE SYSTEM AFTER INSTALLING THE INSTRUMENT. THE FLAME WAS SEEN ARISING FROM THE TIP OF THE MCS. WHEN THE INSTRUMENT WAS REMOVED FROM THE CANNULA, THE MCS INSTRUMENT WAS STILL FLAMING. THE SURGEON SUTURED THE HOLE IN THE INTESTINE AND CLEANED UP THE RESIDUE. THE SURGEON USED A BACKUP FORCE TRIAD GENERATOR, NEW CAUTERY CABLE, MCS INSTRUMENT AND TIP COVER TO COMPLETE THE PROCEDURE. THE PATIENT DID NOT HAVE ANY IMPLANTS. N

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED LOW ANTERIOR RESECTION (LAR) PROCEDURE, THERE WAS ARCING FROM THE MONOPOLAR CURVED SCISSORS (MCS) INSTRUMENT FROM A LOCATION OTHER THAN THE TIP. THE PATIENT SUSTAINED A RESULTING BURN INJURY TO THE INTESTINAL TRACT. A BACKUP MCS INSTRUMENT WAS USED, AND THE PROCEDURE WAS COMPLETED ROBOTICALLY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE OR NURSE AND OBTAINED THE FOLLOWING INFORMATION: THE INSTRUMENT AND CANNULA WERE INSPECTED BEFORE USE. THE SURGEON STATED THAT THERE WAS SOMETHING "WRONG" WITH THE MCS FROM THE BEGINNING OF THE PROCEDURE BUT NO INFORMATION WAS PROVIDED TO FURTHER DESCRIBE WHAT THE ISSUE WAS. THE GROUNDING PAD WAS PLACED PROPERLY ON THE PATIENT AND THERE WERE NO DEFECTS SEEN. ISI CONTACTED THE SURGEON AND ADDITIONAL INFORMATION WAS OBTAINED ABOUT THE COMPLAINT: THE INSTRUMENT WAS INSPECTED PRIOR TO USE WITH NOTHING ABNORMAL NOTICED. THE SURGEON REPORTEDLY NOTICED DAMAGE TO THE INSTRUMENT AND/OR ACCESSORY PRIOR TO THE ARCING EVENT. THE CANNULA WAS INSPECTED PRIOR TO USE AND THE PIN GAUGE TEST WAS PERFORMED. IT WAS REPORTED THAT ARCING WAS OBSERVED COMING FROM THE MIDDLE PART OF THE TIP COVER AND THAT THIS GENERAT

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT AFTER A COMPLETED SINGLE PORT (SP) COLORECTAL IDE STUDY LOW ANTERIOR RESECTION (LAR) WITH TOTAL MESORECTAL EXCISION (TME) PROCEDURE ON (B)(6) 2022, THE PATIENT DEVELOPED BILATERAL EDEMA OF THE LOWER EXTREMITIES AND GIDDINESS. THE LEG SWELLING AND GIDDINESS WERE NOTED ON (B)(6) 2022, DURING A FOLLOW-UP VISIT WITH HER PRIMARY CARE PHYSICIAN (PCP) AND THE PATIENT'S ORAL LOSARTAN WAS PLACED ON HOLD BY HER PCP, AND SHE WAS ADVISED TO FOLLOW-UP IN 2-3 WEEKS¿ TIME. ON (B)(6) 2022, THE PATIENT WENT TO THE ER FOR GENERALIZED WEAKNESS AND DIZZINESS FOR A FEW WEEKS. THE DIZZINESS WAS WORSE UPON STANDING UP. SHE ALSO HAD LOSS OF APPETITE. THERE WAS NO PAIN. SHE STATED THAT THE WEAKNESS AND LOSS OF APPETITE STARTED EVER SINCE SHE HAD A BARIUM ENEMA ON (B)(6) 2022. A BLOOD TEST SHOWED ACUTE RENAL FAILURE WITH CREATININE 2.2, BUN 106, SODIUM 119, POTASSIUM 5.4. INTUITIVE SURGICAL, INC. (ISI) MADE MULTIPLE FOLLOW-UP ATTEMPTS TO OBTAIN ADDITIONAL INFORMATION FROM THE SITE. HOWEVER, NO FURTHER DETAILS HAVE BEEN RECEIVED AS OF THE DATE OF THIS REPORT.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: IT WAS REPORTED THAT DURING A DA VINCI-ASSISTED RADICAL PROSTATECTOMY WITH LYMPHADENECTOMY PROCEDURE, ARCING WAS OBSERVED FROM THE MONOPOLAR CURVED SCISSORS (MCS) INSTRUMENT. THE EXTERNAL ILIAC ARTERY, WHICH WAS IN CONTACT WITH THE ELECTRICAL LEAKAGE SITE WAS INJURED, RESULTING IN ARTERIAL BLEEDING. THE BLEEDING POINT WAS SUTURED AFTER CLAMPING THE ARTERY. THE VIDEO OF THE PROCEDURE WAS REVIEWED BY THE SURGEON AND SHOWED THAT A FEW MINUTES BEFORE THE MCS TIP COVER ACCESSORY WAS FOUND TO BE TORN, THE WRIST OF THE MCS INSTRUMENT WAS OBSERVED TO BE SEVERELY BENT AND COLLIDED WITH A PROGRASP FORCEPS INSTRUMENT WHICH WAS OUT OF VIEW FROM THE SURGICAL FIELD. ALSO, AFTER THE ARCING INCIDENT, THE MCS TIP COVER ACCESSORY WAS REMOVED AND UPON EXAMINATION, THERE WERE MULTIPLE HOLES SEEN ON THE MCS TIP COVER ACCESSORY.INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE SURGEON AND OBTAINED THE FOLLOWING INFORMATION: THE CANNULA, MCS INSTRUMENT, AND MCS TIP COVER ACCESSORY WERE INSPECTED BEFORE USE AND THERE WAS NO ABNORMALITY FOUND. THE MCS TIP COVER ACCESSORY APPEARED TO BE PROPERLY INSTALLED DURING THE CASE. THE MCS INSTRUMENT WAS IN USE FOR ABOUT 1 HOUR BEFORE THE ARCING OCCURRED. ARCING OR

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: ON (B)(6) 2022, INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF AN INTRA-OPERATIVE COMPLICATION, WHICH WAS RECEIVED VIA A USER MEDWATCH REPORT #MW5110571. WITHIN THE USER MEDWATCH REPORT, IT WAS REPORTED THAT DURING AN UNSPECIFIED DA VINCI-ASSISTED SURGICAL PROCEDURE, WHICH ALLEGEDLY THE SURGEON USED TO TAKE DOWN THE ADHESIONS, AND ¿AFTER THAT OCCURRED, THE ARMS EXPERIENCED AN ISSUE¿. THE SURGEON DESCRIBED IT ¿AS THE LEFT HAND WAS MOVED WITH THE VESSEL SEAL DEVICE, THE ROBOTIC ARM MOVED ERRATICALLY¿ AND IMMEDIATELY THE SURGEON NOTED ¿A THROUGH AND THROUGH PERFORATION OF THE SIGMOID COLON¿. THE INSTRUMENT WAS LEFT IN PLACE AND A GENERAL SURGERY CONSULT WAS COMPLETED IMMEDIATELY FOR REPAIR. OTHER INFORMATION RECEIVED FROM THE USER REPORT FURTHER INDICATED THAT ¿AFTER DISCUSSING WITH THE TEAM, WE BELIEVE THAT THE ROBOTIC ARM DRAPE WAS FAULTY¿. ISI IS NOT ABLE TO CONDUCT FOLLOW-UP INVESTIGATION WITH THE USER FACILITY/SURGEON REGARDING THE REPORTED ISSUE DUE TO THE LACK OF FACILITY/SURGEON¿S NAME, ADDRESS AND PHONE NUMBER, ETC. ADDITIONALLY, ISI IS UNABLE TO CONDUCT THE SYSTEM OR INSTRUMENT LOG REVIEW DUE TO LACK OF SYSTEM/INSTRUMENT DETAIL (I.E. SYSTEM SERIAL #, SURGEON NAME, TYPE OF PR

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF A JOURNAL ONCOLOGY ARTICLE TITLED, ¿OPERATIVE AND SURVIVAL OUTCOMES OF ROBOTIC-ASSISTED SURGERY FOR COLORECTAL CANCER IN ELDERLY AND VERY ELDERLY PATIENTS: A STUDY IN A TERTIARY HOSPITAL IN SOUTH KOREA¿ (CUELLAR-GOMEZ, H., RUSLI, S. M., ET AL., 2022). WITHIN THE JOURNAL ARTICLE, POST-OPERATIVE COMPLICATIONS INVOLVING A DA VINCI SURGICAL PROCEDURE WERE NOTED. A RETROSPECTIVE STUDY WAS PERFORMED TO EVALUATE THE POSTOPERATIVE AND SURVIVAL OUTCOMES OF ROBOTIC-ASSISTED COLORECTAL CANCER SURGERY (RACS) IN ELDERLY PATIENTS. ALL PATIENTS =75 YEARS WHO UNDERWENT A ROBOTIC-ASSISTED CURATIVE RESECTION AT A SINGLE CENTER BETWEEN JANUARY 2007 AND JANUARY 2021 WERE EXTRACTED FROM A PROSPECTIVELY MAINTAINED COLORECTAL CANCER DATABASE. PER THE ARTICLE, POST-OPERATIVE COMPLICATIONS WERE REPORTED ACCORDING TO THE MODIFIED CLAVIEN-DINDO CLASSIFICATION, TOGETHER WITH THE TYPE OF COMPLICATION, LENGTH OF HOSPITAL STAY (LOS), AND REOPERATION RATE (PATIENTS RE-OPERATED WITHIN 30 DAYS FROM INITIAL SURGERY). MAJOR COMPLICATIONS WERE OBSERVED IN 2.1% OF PATIENTS AND THE 30-DAY MORTALITY RATE WAS 0%. REPORTED COMPLICATIONS INCLUDED: ANASTOMOTIC LEAKAGE (4); INTRA