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 NEPHRECTOMY PROCEDURE THE ENDOSCOPE (SERIAL NUMBER (SN): (B)(4)) EXPERIENCED COMMUNICATION ISSUES WHEN INSTALLED. THE OPERATING ROOM STAFF RESEATED THE ENDOSCOPE WHEN THE ERRORS OCCURRED, BUT THE ISSUE PERSISTED. THE SITE POWER CYCLED THE SYSTEM, AND WHEN THE ENDOSCOPE WAS REINSTALLED THE ERRORS RETURNED. THE PATIENT BEGAN TO BLEED DURING THE TROUBLESHOOTING AND THE SITE CONVERTED TO OPEN RATHER THAN REPLACING THE ENDOSCOPE. THE PATIENT IS REPORTEDLY IN GOOD HEALTH AFTER THIS PROCEDURE. ON 19-JAN-2022, INTUITIVE SURGICAL INC. (ISI) CONTACTED THE SURGEON OF THIS PROCEDURE AND ADDITIONAL INFORMATION WAS OBTAINED ABOUT THE COMPLAINT: THE ENDOSCOPE ISSUES OCCURRED AT THE END OF THE PROCEDURE WHEN THE SURGEON WAS REMOVING THE TUMOR. THE PATIENT'S SPLEEN WAS SCRAPED AND ABOUT 50CC'S OF BLOOD WAS LOST IN TOTAL DUE TO THIS EVENT. THE SURGEON SAID THE BLEEDING WAS RESOLVED BY PLACING PRESSURE ON THE TISSUE.

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 DAVINCI-ASSISTED SLEEVE GASTRECTOMY SURGICAL PROCEDURE, THE PATIENT EXPERIENCED POST-OPERATIVE BLEEDING AND RETURNED TO THE FACILITY FOR TREATMENT. INTUITIVE SURGICAL, INC. (ISI) CONTACTED THE SURGEON AND OBTAINED THE FOLLOWING INFORMATION. ON AN UNSPECIFIED POSTOPERATIVE DAY, THE PATIENT PRESENTED WITH HYPOTENSIVE SYMPTOMS. A CT SCAN REVEALED A HEMATOMA. THE SURGEON STATED HE BELIEVES THE POST-OPERATIVE BLEEDING WAS FROM THE RIGHT GASTROEPIPLOIC OR THE SHORT GASTRIC VESSEL AND WAS RELATED TO THE USE OF A SYNCHROSEAL INSTRUMENT ON THOSE VESSELS. THE SURGEON DOES NOT SKELETONIZE THE VESSELS BEFORE SEALING. THE SURGEON STATED HE DOES NOT LIKE HOW THE SYNCHROSEAL CUTS AND HAS TO CUT THE VESSEL MORE THAN ONCE. THE SURGEON INDICATED THAT HE HAS NEVER HAD POST-OPERATIVE BLEEDING INCIDENTS IN HIS PREVIOUS PROCEDURES AND HENCE WILL REVERT TO USING THE VESSEL SEALER EXTEND INSTRUMENT. THE SURGEON CONFIRMED NO SURGICAL INTERVENTION OR BLOOD TRANSFUSIONS WERE RENDERED TO THE PATIENT. HOWEVER, THE PATIENT WAS HOSPITALIZED FOR IV FLUIDS, BLOOD WORK, CT SCAN, AND OBSERVATION.

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 DEVICE MANUFACTUER NARRATIVE 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 THYROIDECTOMY SURGICAL PROCEDURE, THE HARMONIC ACE INSTRUMENT WAS FOUND TO HAVE THE TEFLON PAD MELTED, AND FRAGMENTS WERE FALLING INSIDE THE PATIENT. THE FRAGMENTS WERE NOT RETRIEVED. THE CUSTOMER REMOVED THE INSTRUMENT AND USED A BACKUP INSTRUMENT TO COMPLETE THE PROCEDURE. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE INITIAL REPORTER AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE INSTRUMENT WAS INSPECTED PRIOR TO USE WITH NO DAMAGE OBSERVED. THE TEFLON PAD MELTED LIKE POWDER AS SOON AS THE CUSTOMER STARTED TO USE THE INSTRUMENT. THE FRAGMENTS WERE NOT RETRIEVED AS THEY WERE NOTED TO BE "LIKE POWDER." IT WAS UNKNOWN WHAT CAUSED THE MELTING TO OCCUR AS THE INSTRUMENT DID NOT COLLIDE WITH ANY HARD MATERIALS OR OTHER INSTRUMENTS, AND THE CUSTOMER CONFIRMED THAT ARCING WAS NOT OBSERVED. THE THYROID TISSUE DID NOT APPEAR TO BE TOO THICK. THE SURGEON DID NOT NOTICE ANY ISSUES WITH THE FUNCTIONALITY OF THE INSTRUMENT. NO POST-OPERATIVE TESTS LIKE AN X-RAY OR ULTRASOUND WERE PERFORMED, AND NO ADDITIONAL SURGICAL PROCEDURE WAS PERFORMED. THE PATIENT HAS NOT RETURNED TO THE HOSPITAL DUE TO EXPERIENCING ANY POST-SURGICAL COMPLICA

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, HALF OF THE TIP FROM A HARMONIC ACE INSTRUMENT BROKE OFF IN THE ABDOMINAL CAVITY DURING LIVER RESECTION. THE FRAGMENT WAS RETRIEVED IN THE SAME PROCEDURE. NO OTHER INFORMATION WAS PROVIDED. ON (B)(6) 2022, INTUITIVE SURGICAL, INC. (ISI) OBTAINED THE FOLLOWING INFORMATION FROM THE ROBOTICS COORDINATOR. THE SURGEON WAS USING THE HARMONIC ACE INSTRUMENT DURING A PARTIAL LIVER RESECTION. THE CASE WAS ALMOST COMPLETED, BUT THE FRAGMENT BROKE DURING DISSECTION. THE TEAM NOTICED THIS WHEN THE SURGEON WAS MOVING THE INSTRUMENT TO A DIFFERENT AREA OF THE LIVER. THIS CAUSED A 20-30 MINUTE DELAY IN THE CASE. THE FRAGMENT WAS FOUND AND REMOVED FROM THE PATIENT DURING THE SAME PROCEDURE BY USING A LAPAROSCOPIC GRASPER. IT WAS CONFIRMED TO BE REMOVED VISUALLY SO NOT POST-OPERATIVE TESTS WERE NEEDED. BOTH THE FRAGMENT AND THE INSTRUMENT HAVE BEEN GIVEN TO RISK MANAGEMENT. THE CASE WAS LATER CONVERTED TO AN OPEN PROCEDURE DUE TO PATIENT ANATOMY AND NOT DUE TO THE MALFUNCTION OF THE INSTRUMENT.

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 PROCEDURE, THE PANCREAS WAS INJURED DURING THE INSERTION OF THE AIR-SEAL PORT IN A PATIENT WITH A SMALL BODY HABITUS. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE SURGEON AND OBTAINED THE FOLLOWING INFORMATION: THE SOURCE OF BLEEDING WAS PANCREATIC TISSUE, WHICH WAS DAMAGED WHEN A THIRD-PARTY AIRSEAL PORT WAS INSERTED IN THE PATIENT. THE BLEEDING WAS INITIALLY STOPPED BY APPLYING COMPRESSION AND HEMOSTATIC POWDER. THE SURGEON BELIEVES THAT THE CAUSE OF THE PANCREATIC INJURY WAS DUE TO THE PETITE STATURE OF THE PATIENT AND THE CEPHALAD DIRECTION OF THE INSERTION OF THE AIRSEAL PORT. ACCORDING TO THE SURGEON, THERE WAS NO MALFUNCTION OF AN ISI PRODUCT THAT CAUSED THE PANCREATIC INJURY. AT THE END OF THE PROCEDURE, THE PANCREATIC INJURY, THAT WAS SUSTAINED DURING PORT PLACEMENT, BEGAN TO RE-BLEED. A HEPATOBILIARY PANCREATIC SURGEON WAS CALLED INTO THE OPERATION TO SUTURE THE PANCREAS TO ACHIEVE HEMOSTASIS. THE SURGEON BELIEVES THAT THE CAUSE OF THE RE-BLEEDING WAS DUE TO A PSEUDOANEURYSM FORMED DURING TISSUE DAMAGE, SUTURING, OR DECREASE IN THE INSUFFLATION PRESSURE. NO ADDITIONAL TISSUE RESECTION WAS REQUIR

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 TRANSTHORACIC-NECK ANASTOMOSIS SURGICAL PROCEDURE, A PIECE OF HARMONIC ACE INSTRUMENT BROKE INSIDE THE PATIENT. THE BROKEN PIECE WAS RETRIEVED DURING THE SAME PROCEDURE. THE CUSTOMER USED A BACKUP INSTRUMENT. THE PROCEDURE WAS COMPLETED WITH NO REPORTED PATIENT INJURY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE INITIAL REPORTER (NURSE) AND OBTAINED ADDITIONAL INFORMATION: THE CUSTOMER DID NOT NOTICE ANY DAMAGE ON THE INSTRUMENT PRIOR TO USE. THE BROKEN PIECE WAS RETRIEVED WITH A LAPAROSCOPIC GRASPER INSTRUMENT. NO POST-OPERATIVE TESTS WERE PERFORMED. THE SURGEON DID NOT NOTICE ANY ISSUES WITH THE FUNCTIONALITY OF THE INSTRUMENT. THE INSTRUMENT DID NOT COLLIDE WITH ANY OTHER INSTRUMENTS OR OTHER HARD MATERIAL DURING THE SURGICAL 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: 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 HYSTERECTOMY SURGICAL PROCEDURE, THE MONOPOLAR CURVED SCISSORS (MCS) TIP COVER ACCESSORY WAS DISLODGED FROM THE MCS INSTRUMENT AND DROPPED IN THE CAVITY UPON REMOVING THE INSTRUMENT FROM THE PATIENT. THE SCRUB TECHNICIAN NOTICED THAT AND NOTIFIED THE SURGEON IMMEDIATELY. THE SCOPE WAS INTRODUCED AGAIN TO FIND AND RETRIEVE THE MCS TIP COVER ACCESSORY FROM THE BOWELS OF THE PATIENT. 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 ROBOTICS COORDINATOR STATED THAT THEY WERE ABLE TO REMOVE THE MCS TIP COVER WITH ANOTHER DA VINCI INSTRUMENT WITH NO REPOT OF PATIENT INJURY. THERE WERE NO INSTRUMENT FUNCTIONAL ISSUES AND THERE WAS NO ISSUE WITH REMOVING THE MCS FROM THE PATIENT. THEY NOTICED THE MCS TIP COVER ACCESSORY WAS NOT ON THE MCS THE MOMENT THEY REMOVED THE INSTRUMENT FROM THE PATIENT. NO MEDICAL INTERVENTION WAS REQUIRED TO ADDRESS THE ISSUE. ELECTROLUBE WAS USED AFTER THE TIP COVER HAD BEEN INSTALLED; NOT PRIOR TO INSTALLATION. THE ROBOTICS COORDINATOR CLARIFIED THAT THEY ARE CONCERNED WITH USING THE MCS T

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 SURGICAL PROCEDURE, THE MONOPOLAR CURVED SCISSORS (MCS) TIP CAME OFF OF THE MCS INSTRUMENT AND COULD NOT BE LOCATED. AN X-RAY WAS PERFORMED AND THE MCS TIP WAS NOT SEEN. THE INSTRUMENTS WERE REPORTEDLY INSPECTED PRIOR TO THE PROCEDURE AND NOTHING LOOKED OUT OF THE ORDINARY. THERE WAS NO COLLISION WITH ANY OTHER INSTRUMENT OR HARD MATERIALS DURING THE PROCEDURE. IT WAS UNKNOWN HOW LONG THE INSTRUMENT HAD BEEN IN USE WHEN THE ISSUE OCCURRED. ACCORDING TO THE NURSE, SHE AND THE SURGEON FELT THAT THE MCS TIP CAME OFF BECAUSE IT IS NOT ATTACHED TO THE INSTRUMENT AND SHOULD BE MORE SECURE. SHE MENTIONED THAT THE MCS TIP WAS VERY DIFFICULT TO INSTALL AND STATED THAT FUTURE DESIGNS SHOULD HAVE THE TIP PRE-INSTALLED. THE INSTRUMENT WILL NOT BE RETURNED FOR ANALYSIS SINCE THERE WAS NO INSTRUMENT ISSUE, AND THE MCS TIP CANNOT BE FOUND TO BE RETURNED. THE PATIENT HAS NOT RETURNED DUE TO ANY POST-SURGICAL COMPLICATIONS.

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 THYROIDECTOMY SURGICAL PROCEDURE, THE CUSTOMER NOTED THAT A SKILLED SURGEON ATTEMPTED TO USE THE HARMONIC ACE INSERT TO DISSOCIATE TISSUE, BUT THE BLADE WOULD NOT WORK. THE CUSTOMER REPLACED THE HARMONIC ACE INSERT WITH A BACK-UP DEVICE OF THE SAME KIND AND COMPLETED THE PROCEDURE WITH NO REPORTED INJURY. ON (B)(6) 2022, INTUITIVE SURGICAL, INC. (ISI) PERFORMED FOLLOW-UP AND OBTAINED THE FOLLOWING ADDITIONAL/UPDATED INFORMATION REGARDING THE REPORTED EVENT: THE BLADE OF THE HARMONIC ACE INSERT FELL INSIDE THE PATIENT AND WAS RETRIEVED IMMEDIATELY WITH OTHER INSTRUMENTS DURING THE SAME PROCEDURE. THE PATIENT HAS NOT RETURNED TO THE HOSPITAL DUE TO EXPERIENCING ANY POST-SURGICAL COMPLICATIONS RELATED TO RETAINING A FOREIGN OBJECT. NO ADDITIONAL SURGICAL INTERVENTION WAS CONDUCTED.

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: ROBOTIC CASE IN PROGRESS WITH 45 MM STAPLER. STAPLER CLAMPED DOWN ON TISSUE AND WAS NOT ABLE TO DISCONNECT. SURGEON PRESSED EMERGENCY RELEASE BUTTON ON CONSOLE AND ASSIST USED EMERGENCY SCREW TO UNLOCK STAPLER FROM PATIENT WITH NO SUCCESS. DAVINCI REP CALLED AND CAME IN TO ASSIST. SURGEON WAS ABLE TO REMOVE STAPLER AND PROCEED WITH SURGERY. INSTRUMENT MALFUNCTION. WORKING WITH INTUIT REMOTELY, VENDOR WAS ABLE TO WORK WITH PHYSICIAN TO SUCCESSFULLY DISENGAGE STAPLER FROM BOWEL. INSTRUMENT WAS LABELLED AND REMOVED FROM SERVICE. VENDOR HAS SUBMITTED REQUEST FOR IR. A (B)(6) YEAR OLD MALE WITH QUADRIPLEGIA SUSTAINED AFTER DIVING INTO 3 FT OF WATER. HE UNDERWENT C4-5/6 ACDF WITH PLATING ON (B)(6) 2021. HE WAS INTUBATED FOR RESPIRATORY DISTRESS AND HAD TRACH PLACED (B)(6) 2021. PEG PLACED ON (B)(6) 2021. HIS HOSPITAL COURSE WAS COMPLICATED BY BRADYCARDIA WITH ASYSTOLE, NEUROGENIC SHOCK AND MUCUS PLUGGING. LAST COLONOSCOPY ~ 3 YEARS AGO, HE DOES HAVE A HISTORY OF COLON POLYPS, NO KNOWN FAMILY HISTORY OF COLON CANCER. HISTORY OF UMBILICAL HERNIA REPAIR WITH MESH MANY YEARS AGO. HE IS NOW AT A FACILITY FOR REHABILITATION. WE HAVE BEEN CONSULTED FOR COLOSTOMY TO HELP EASE CARE. HE WISHES TO

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 15-OCT-2021, INTUITIVE BECAME AWARE OF A JOURNAL OF GASTRIC CANCER ARTICLE TITLED, "INTRACORPOREAL ESOPHAGOJEJUNOSTOMY DURING REDUCED-PORT TOTALLY ROBOTIC GASTRECTOMY FOR PROXIMAL GASTRIC CANCER: A NOVEL APPLICATION OF THE SINGLE-SITE® PLUS 2-PORT SYSTEM" (CHOI, S., SON, T., ET AL., 2021). WITHIN THE JOURNAL ARTICLE, POST-OPERATIVE COMPLICATIONS INVOLVING DA VINCI SURGICAL PROCEDURES WERE NOTED: "ANASTOMOSIS-RELATED COMPLICATIONS WERE OBSERVED IN 2 PATIENTS. THE PATIENT WAS DISCHARGED ON POD 6 AFTER PROXIMAL GASTRECTOMY AND WAS RE-ADMITTED 14 DAYS AFTER DISCHARGE. THE PATIENT DEVELOPED ESOPHAGOJEJUNOSTOMY LEAKAGE, WHICH WAS TREATED WITH ENDOSCOPIC STENT INSERTION. ANOTHER PATIENT DEVELOPED ESOPHAGOJEJUNOSTOMY SITE STENOSIS THAT REQUIRED ENDOSCOPIC DILATATION DURING HOSPITALIZATION, AFTER WHICH THE PATIENT WAS DISCHARGED ON POSTOPERATIVE DAY (POD) 29. THE OTHER PATIENT WHO UNDERWENT COMPLETION TOTAL GASTRECTOMY DEVELOPED AN INTESTINAL OBSTRUCTION THAT REQUIRED ADDITIONAL SURGERY (LAPAROSCOPIC SEGMENTAL RESECTION OF THE SMALL BOWEL), AFTER WHICH THE PATIENT WAS DISCHARGED ON POD 35." INTUITIVE SURGICAL, INC. (ISI) HAS REACHED OUT TO THE AUTHOR TO OBTAIN ADDITIONAL INFORMATION BUT

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, A 3RD DEGREE BURN WAS OBSERVED AROUND THE TROCAR SITE WHERE THE CAMERA PORT WAS LOCATED (3¿- 4¿ ABOVE THE UMBILICUS). THERE WAS NO ENERGY USED TO MAKE THE SURGICAL PORT INCISION AND NO REPORT OF ARCING OF ELECTRICAL ENERGY DURING THE CASE. IT WAS BELIEVED THAT BOTH THE PATIENT¿S ANATOMY AND THE DA VINCI INSTRUMENTS AND/OR ACCESSORIES MAY HAVE CONTRIBUTED TO THE BURN. THE PATIENT¿S UTERUS WAS ENLARGED AT 30 CM. IT IS ALLEGED THAT ALONG WITH THE PATIENT¿S SMALL STATURE AND MOVEMENT OF THE INSTRUMENTS DURING THE CASE, AN OCCLUSION MAY HAVE OCCURRED MAKING IT DIFFICULT FOR THE SMOKE TO EVACUATE. THE DA VINCI SYSTEM, INSTRUMENTS AND ACCESSORIES USED DURING THE PROCEDURE WERE INSPECTED PRIOR TO USE, AND NO ABNORMALITIES WERE FOUND. THERE WERE NO MEDICAL OR SURGICAL INTERVENTIONS REQUIRED AT THE TIME OF THE EVENT. ALSO, THE PATIENT DID NOT REQUIRE HOSPITALIZATION DUE TO THE BURN. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE SURGEON AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION: THE SURGEON REASSESSED THE INJURY AT THE PATIENT'S POST-OPERATIVE VISIT TWO WEEKS AFTER THE PROCEDURE. PER THE SURGE

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: 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: 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: 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: 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 HIATAL-HERNIA PERIESOPHAGEAL SURGICAL PROCEDURE, THE SYNCHROSEAL INSTRUMENT DID NOT WORK TO STOP THE BLEEDING. IT IS UNCLEAR WHAT SURGICAL TASK THE SURGEON WAS ATTEMPTING TO PERFORM WHEN THE REPORTED EVENT OCCURRED. THE SURGEON HAD TO SWITCH TO A VESSEL SEALER EXTEND INSTRUMENT TO STOP THE BLEEDING. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE ISI EXECUTIVE SALES REPRESENTATIVE (ESR) WHO WAS PRESENT FOR THE PROCEDURE AND OBTAINED ADDITIONAL INFORMATION ON 16-NOV-2021. THE INSTRUMENT WAS INSPECTED PRIOR TO USE AND NO DAMAGE WAS NOTED. THE SYNCHROSEAL INSTRUMENT WAS NOT SEALING THE SHORT GASTRIC VESSELS ALONG THE GREATER CURVATURE OF THE STOMACH IN THE SYNCH AND SEAL MODES. THE CUTTING FUNCTION WAS WORKING IN THE SYNCH MODE BUT NOT THE SEALING FUNCTION ALTHOUGH THE GENERATOR GAVE THE APPROPRIATE TONES. AS A RESULT, THE VESSELS WERE OOZING/ BLEEDING. THE ESTIMATED BLOOD LOSS WAS LESS THAN 750 ML. THE SURGEON THEN USED A VESSEL SEALER EXTEND INSTRUMENT TO OBTAIN CONTROL AND STOP THE BLEEDING FROM THE SHORT GASTRIC VESSELS. THERE WERE NO ERRORS THAT OCCURRED AT THE TIME OF THE INC

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 ESOPHAGECTOMY TRANSTHORACIC CHEST ANASTOMOSIS SURGICAL PROCEDURE, THE METAL TIP OF THE HARMONIC ACE INSTRUMENT BROKE OFF. THE FRAGMENT WAS RETRIEVED DURING THE PROCEDURE. THE CUSTOMER WAS TAKING OUT TISSUE WHEN THE INSTRUMENT BROKE. THE INSTRUMENT WRIST STRAIGHTENED UPON REMOVAL. THE INSTRUMENT DID NOT COLLIDE WITH ANY OTHER INSTRUMENTS. 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 HYSTERECTOMY SURGICAL PROCEDURE, TIP OF THE HARMONIC ACE INSTRUMENT BROKE AND FELL INSIDE THE PATIENT. THE CUSTOMER WAS ABLE TO RETRIEVE THE FRAGMENT IN THE SAME PROCEDURE. THE FRAGMENT AND THE INSTRUMENT WILL BE RETURNED FOR EVALUATION. THEY WERE DISSECTING WHEN THE FRAGMENT FELL INSIDE THE PATIENT. THERE WAS NO TIP OR INSTRUMENT COLLISION. THE WRIST OF THE INSTRUMENT WAS STRAIGHTENED UPON REMOVAL. THE PROCEDURE WAS COMPLETED WITH NO REPORTED INJURY. INTUITIVE SURGICAL, INC. (ISI) CONTACTED THE ORIGINAL REPORTER AND OBTAINED ADDITIONAL INFORMATION ON 15-NOV-2021. THE INSTRUMENT WAS INSPECTED IN THE NORMAL PRE-OPERATION INSPECTION AND NOTHING OUT OF THE ORDINARY WAS NOTED. THE INSTRUMENT WAS USED FOR APPROXIMATELY 1.5 HOURS. THE FRAGMENT WAS RETRIEVED BY THE BEDSIDE ASSIST USING A LAPARSCOPIC INSTRUMENT. BOTH THE INSTRUMENT AND THE FRAGMENT WERE GIVEN TO THE MATERIALS DEPARTMENT TO COMPLETE THE RETURN. NO INJURY WAS OBSERVED TO THE PATIENT AT THE TIME OF THE ISSUE. HE WAS NOT AWARE IF ANY POST-OPERATIVE TESTS WERE PERFORMED TO VERIFY ALL FRAGMENTS WERE RETRIEVED AND HE WAS NOT AWARE IF THE PATIENT HAD EXPERIENCED ANY POST-SURGICAL COM

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: 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 REPORTED THAT AFTER UNDERGOING A DA VINCI-ASSISTED LOW ANTERIOR RESECTION (LAR) WITH TOTAL MESORECTAL EXCISION (TME) AND LOW ANASTOMOSIS ON (B)(6) 2021, THE PATIENT WAS DISCHARGED ON POST-OPERATIVE DAY (POD) #2, THE PATIENT DEVELOPED A POST-OPERATIVE INFECTION ON POD #13. THE UMBILICAL INCISION HAD ECCHYMOSIS CONSISTENT WITH PRESSURE FROM THE ROBOT AND SOME SEROUS DRAINAGE WAS OBSERVED. THE INCISION WAS OPENED, AND THE SEROSANGUINOUS DRAINAGE WAS EXPELLED. THE WOUND WAS THEN PACKED WITH ½-INCH IODOFORM, COVERED WITH 4X4 GAUZE. THE INFECTION WAS RESOLVED BY POD #43.

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 INITIALLY REPORTED BY THE SITE¿S ROBOTIC COORDINATOR TO INTUITIVE SURGICAL INC, (ISI) CUSTOMER SERVICE, THAT DURING A DA VINCI-ASSISTED PULMONARY LOBECTOMY, THE SYNCHROSEAL INSTRUMENT ALLEGEDLY MISFIRED AND DID NOT ADEQUATELY SEAL A VESSEL. AS A RESULT, BLEEDING WAS OBSERVED. ON 02-NOV-2021, ISI OBTAINED THE FOLLOWING ADDITIONAL INFORMATION REGARDING THE REPORTED EVENT FROM A SITE ROBOTICS NURSE, STEMMING FROM INFORMATION PROVIDED BY OPERATING ROOM (OR) STAFF WHO WERE PRESENT FOR THE CASE: THE SYNCHROSEAL INSTRUMENT DID NOT ACTIVATE AT ONE TIME DURING THE SURGICAL PROCEDURE BUT THE PHYSICIAN CONTINUED TO USE THE DEVICE. A SECOND BACKUP INSTRUMENT WAS NOT OPENED AND USED DURING THE CASE. THE ROBOTICS NURSE IS UNSURE OF THE AMOUNT OF BLOOD LOSS AND CONFIRMED THAT THE INSTRUMENT WAS RETURNED FOR EVALUATION. NO OTHER ADDITIONAL INFORMATION WAS PROVIDED.

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 INITIALLY REPORTED THAT DURING A DA VINCI-ASSISTED LOBECTOMY PROCEDURE, DURING "VASCULARIZATION" OF THE HILAR REGION OF THE LUNG, THE PATIENT EXPERIENCED BLEEDING. THE CAUSE OF THE BLEEDING WAS NOT DISCLOSED. THE SURGEON COULD NOT CONTROL THE BLEEDING; MEDIUM-LARGE CLIPS WERE USED TO IN AN ATTEMPT TO CONTROL THE BLEED WITHOUT SUCCESS. AS A RESULT, THE SURGEON DECIDED TO CONVERT TO OPEN CHEST SURGERY. ON 25-OCT-2021, INTUITIVE SURGICAL, INC. (ISI) CONTACTED THE SURGEON AND OBTAINED THE FOLLOWING INFORMATION REGARDING THE REPORTED EVENT: DURING A DA VINCI-ASSISTED RIGHT PULMONARY LOBECTOMY PROCEDURE, THE PATIENT EXPERIENCED BLEEDING DURING HILAR VASCULAR TREATMENT WITH THE SYNCHROSEAL INSTRUMENT. THE SURGEON INDICATED THAT THE CAUSE OF THE BLEED MIGHT HAVE BEEN RELATED TO "TENSION" OR DAMAGE TO AN UNSPECIFIED VESSEL WHEN "PEELING" AND "NOT CUTTING" WITH THE SYNCHROSEAL INSTRUMENT. IT IS UNCLEAR WHAT THE SURGEON MEANT BY "PEELING." THE SURGEON TRIED TO STOP THE BLEEDING WITH THE MEDIUM-LARGE CLIP APPLIER INSTRUMENT AND SUCTIONING. THE SURGEON APPLIED JUST ONE CLIP BUT WAS UNABLE TO PLACE A SECOND CLIP FOR AN UNKNOWN REASON. THE SURGEON COULD NOT CONTROL THE BLEEDING. DUE TO 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: INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF A JOURNAL OF A BRITISH JOURNAL OF SURGERY (BJS) OPEN ARTICLE TITLED, ¿OUTCOMES OF ROBOTIC LOW ANTERIOR RESECTION VERSUS TRANSANAL TOTAL MESORECTAL EXCISION FOR RECTAL CANCER¿ (BUAN, J. L. B., SO, W. Z., ET AL., 2022). WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING ROBOTIC LOW ANTERIOR RESECTION (RLAR) PROCEDURES WERE NOTED. PER THE ARTICLE, THE FOLLOWING WAS NOTED: "RLAR WAS PERFORMED WITH THE DA VINCI SI VR (INTUITIVE SURGICAL, SUNNYVALE, CALIFORNIA, USA) SYSTEM IN TWO PHASES, WITH REDOCKING AS STANDARD PRACTICE AT THIS INSTITUTION," AND, "IN THE RLAR GROUP SIX PATIENTS HAD COMPLICATIONS OF GRADE III AND ABOVE, OF WHOM FOUR HAD ANASTOMOTIC LEAKS, ONE HAD A POSTOPERATIVE BILOMA FROM A SYNCHRONOUS LIVER RESECTION, AND ONE HAD NARROWING OF THE AFFERENT LIMB OF THE DE-FUNCTIONING ILEOSTOMY THAT REQUIRED SURGICAL REVISION." ISI FOLLOWED UP WITH THE AUTHOR AND OBTAINED THE FOLLOWING INFORMATION: THE AUTHOR WAS UNABLE TO PROVIDE THE NAMES OF THE SURGEONS BUT CONFIRMED THAT THE STUDY HAD (B)(6) SURGEONS INVOLVED IN THESE CASES. WITH REGARDS TO THE PATIENT WITH THE BILOMA, THE PATIENT REQUIRED A LIVER RESECTION DUE TO LIVER META

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 OF A BRITISH JOURNAL OF SURGERY (BJS) OPEN ARTICLE TITLED, ¿OUTCOMES OF ROBOTIC LOW ANTERIOR RESECTION VERSUS TRANSANAL TOTAL MESORECTAL EXCISION FOR RECTAL CANCER¿ (BUAN, J. L. B., SO, W. Z., ET AL., 2022). WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING ROBOTIC LOW ANTERIOR RESECTION (RLAR) PROCEDURES WERE NOTED. PER THE ARTICLE, THE FOLLOWING WAS NOTED: "RLAR WAS PERFORMED WITH THE DA VINCI SI VR (INTUITIVE SURGICAL, SUNNYVALE, CALIFORNIA, USA) SYSTEM IN TWO PHASES, WITH REDOCKING AS STANDARD PRACTICE AT THIS INSTITUTION," AND, "IN THE RLAR GROUP SIX PATIENTS HAD COMPLICATIONS OF GRADE III AND ABOVE, OF WHOM FOUR HAD ANASTOMOTIC LEAKS, ONE HAD A POSTOPERATIVE BILOMA FROM A SYNCHRONOUS LIVER RESECTION, AND ONE HAD NARROWING OF THE AFFERENT LIMB OF THE DE-FUNCTIONING ILEOSTOMY THAT REQUIRED SURGICAL REVISION." ONLY ONE OF THE PATIENTS WHO EXPERIENCED AN ANASTOMOTIC LEAK REQUIRED A RE-OPERATION IN WHICH THE PELVIC ABSCESS WAS DRAINED TRANSANALLY AND THE LEAK WAS MANAGED WITH THE ENDO-SPONGEVR SYSTEM. ADDITIONALLY, PER THE JOURNAL ARTICLE, THE FOLLOWING IS NOTED: "DISTAL TRANSECTION WAS PERFORMED WITH ENDOSCOPIC

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 INITIALLY REPORTED THAT A FEW HOURS AFTER A DA VINCI-ASSISTED SLEEVE GASTRECTOMY PROCEDURE, THE PATIENT EXHIBITED SIGNS OF A LEAK. THE PATIENT HAD 4.5 L OF BLOOD IN HIS STOMACH THAT WAS DRAINED IN A SUBSEQUENT PROCEDURE. ON 15-OCT-2021, INTUITIVE SURGICAL, INC. (ISI) CONTACTED THE SURGEON AND OBTAINED THE FOLLOWING ADDITIONAL INFORMATION REGARDING THE REPORTED EVENT: THE PATIENT WAS AN AFRICAN AMERICAN MALE, WEIGHING (B)(6) LBS, WITH A MEDICAL HISTORY OF OBESITY, SLEEP APNEA, AND HYPERTENSION. IT WAS REPORTED THAT A FEW HOURS AFTER A DA VINCI ASSISTED SLEEVE GASTRECTOMY PROCEDURE, THE PATIENT'S BLOOD PRESSURE DROPPED, AND HE EXHIBITED SIGNS OF INTERNAL BLEEDING. THE PATIENT UNDERWENT A DIAGNOSTIC LAPAROSCOPY, AND APPROXIMATELY 4.5 LITERS OF BLOOD WAS IDENTIFIED IN HIS STOMACH. THE SURGEON REMOVED THE CLOTS AND DRAINED THE BLOOD. AS A PRECAUTION, SHE PLACED CLIPS ON THE STAPLE LINES, APPLIED SURGICEL ON THE SEAL OF THE SHORT GASTRIC ARTERY, AND SEALED THE OMENTUM WITH A HARMONIC SCALPEL INSTRUMENT. THE SURGEON COULD NOT CONFIRM THE SOURCE OF THE BLEEDING; HOWEVER, SHE BELIEVES IT COULD HAVE BEEN DUE TO SPASM OF THE SHORT GASTRIC ARTERY RIGHT AFTER THE PROCEDURE, WHICH COULD H

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: AN INTUITIVE SURGICAL, INC. (ISI) CUSTOMER SERVICE (CS) REPRESENTATIVE RECEIVED AN INCOMING CALL AND IT WAS INITIALLY REPORTED THAT AN UNSPECIFIED PATIENT HAD A DA VINCI SURGERY FOR UTERUS REMOVAL AND THAT SHE HAD PHYSICAL CHANGES AFTERWARDS TO HER STOOL, HER SLEEP PATTERNS, AND HER URINARY CONTINENCE. WHEN ADDITIONAL DETAILS WERE REQUESTED, THEY WERE REFUSED BY THE INITIAL REPORTER. NO HOSPITAL, SURGEON, PROCEDURE DATE/DATE RANGE, OR PATIENT INFORMATION WAS ABLE TO BE OBTAINED. ISI HAS REACHED OUT TO THE INITIAL REPORTER TO OBTAIN ADDITIONAL INFORMATION BUT HAS NOT YET RECEIVED A RESPONSE.

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 INITIALLY REPORTED BY A DOCTOR THAT AFTER A DA VINCI-ASSISTED MALIGNANT HYSTERECTOMY SURGICAL PROCEDURE, A URETERAL STRICTURE OCCURRED AND WAS PROBABLY DUE TO HEAT DAMAGE. THE DOCTOR SPECULATES THAT HEAT WAS TRANSFERRED FROM THE WRIST OF THE SYNCHROSEAL INSTRUMENT TO THE URETER AND THAT THERMAL DAMAGE TO THE URETER CAUSED A STRICTURE. THE PROCEDURE WAS COMPLETED ROBOTICALLY. INTUITIVE SURGICAL, INC. (ISI) FOLLOWED UP WITH THE SURGEON FROM THE SITE AND OBTAINED THE FOLLOWING INFORMATION ON (B)(6) 2021. THE SYNCHROSEAL INSTRUMENT WAS EXAMINED BEFORE USE AND THERE WERE NO ABNORMALITIES SEEN. THE SURGEON DID NOT HAVE ANY ISSUES USING THE SYNCHROSEAL INSTRUMENT AND THERE WERE NO INTRA-OPERATIVE COMPLICATIONS DETECTED DURING THE PROCEDURE. THE JAWS OF THE SYNCHROSEAL INSTRUMENT WERE NOT IMMERSED IN CONDUCTIVE FLUIDS AND DID NOT COME INTO CONTACT WITH ANY NON-TARGET TISSUE OR METALLIC OBJECTS WHILE ENERGIZED. ADDITIONALLY, THE SYNCHROSEAL INSTRUMENT WAS NOT USED TO ENERGIZE THE TIPS OF OTHER INSTRUMENTS AND THE SURGEON HAD GOOD VISIBILITY OF THE JAWS AS WELL AS THE ANATOMY SURROUNDING THE INSTRUMENT DURING SYNCHROSEAL ACTIVATIONS. THERE WAS NO ARCING/BURNING SEEN. THE SURGEON CONFI

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 OF ROBOTIC SURGERY ARTICLE TITLED, ¿HELLER MYOTOMY PERFORATION: ROBOTIC VISUALIZATION DECREASES PERFORATION RATE AND REVISIONAL SURGERY IS A PERFORATION RISK¿ (ENGWALL-GILL, A. J., SOLEIMANI, T. ET AL., 2021). WITHIN THE JOURNAL ARTICLE, A POST-OPERATIVE COMPLICATION INVOLVING A DA VINCI SURGICAL PROCEDURE WAS NOTED: "ONLY ONE PATIENT, WHO WAS IN THE ROBOTIC GROUP, SHOWED A LEAK ON POSTOPERATIVE ESOPHAGRAM. THIS DIRECTLY CONTRIBUTED TO HER PROLONGED POSTOPERATIVE STAY. THIS PATIENT HAD SUSTAINED A PERFORATION AT HER ORIGINAL LAPAROSCOPIC SURGERY AND THEN SUSTAINED PERFORATION AGAIN WHILE UNDERGOING REVISIONAL ROBOTIC SURGERY. IN THIS PARTICULAR CASE, THERE WAS MINIMAL LEAK OF CONTRAST INTO A CONTAINED PERFORATION, WHICH RESPONDED TO SUPPORTIVE MEASURES, ANTIBIOTICS, AND NUTRITION. SHE WAS HOSPITALIZED FOR A TOTAL OF 11 DAYS DUE TO AN EARLY POSTOPERATIVE COMPLICATION OF PNEUMONIA." ISI HAS REACHED OUT TO THE AUTHOR TO OBTAIN ADDITIONAL INFORMATION BUT HAS NOT YET RECEIVED A RESPONSE.

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 02-SEP-2021, INTUITIVE SURGICAL (ISI) BECAME AWARE OF AN UPDATES IN SURGERY ARTICLE TITLED, ¿FEASIBILITY AND SAFETY OF ROBOTIC-ASSISTED TOTAL PANCREATECTOMY (RATP): THIS STUDY INCLUDES PATIENTS OPERATED BETWEEN OCTOBER 2008 AND DECEMBER 2019: A PILOT WESTERN SERIES¿ (KAUFFMANN, E. F., NAPOLI, N., ET AL., 2021). WITHIN THE ARTICLE, THE FOLLOWING WAS NOTED: "REGARDING THE MAIN ENDPOINT OF THIS STUDY, AS SHOWN IN TABLE 3, SEVERE POST-OPERATIVE COMPLICATIONS DEVELOPED IN 6 PATIENTS (24.0%) AFTER RATP AND IN 13 PATIENTS (26.0%) AFTER OTP (P=0.85)." ISI HAS REACHED OUT TO THE AUTHOR TO OBTAIN ADDITIONAL INFORMATION BUT HAS NOT YET RECEIVED A RESPONSE.

da Vinci Surgical System — Death report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: ON 30-AUG-2021, INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF AN UPDATES IN SURGERY ARTICLE TITLED, ¿IMPACT OF BODY MASS INDEX ON THE EARLY EXPERIENCE OF ROBOTIC PANCREATICODUODENECTOMY¿ (CHAO, Y. J., LIAO, T. K., ET AL., 2021). WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING DA VINCI SURGICAL PROCEDURES WERE NOTED: "ALL OPERATIONS WERE PERFORMED USING THE DA VINCI SI SURGICAL SYSTEM. TWO PATIENTS (2.9%) WERE CONVERTED TO OPEN SURGERY IN THE OBESE GROUP DUE TO SEVERE INFLAMMATION AT THE PANCREATIC HEAD AND TUMOR ADHESIVE TO THE SUPERIOR MESENTERIC VEIN AND NONE IN THE NORMAL-WEIGHT AND OVERWEIGHT GROUPS. THIRTY THREE PATIENTS EXPERIENCED COMPLICATIONS WITH AN OVERALL COMPLICATION RATE OF 51.5%, AND THE MAJOR COMPLICATION RATE (CLAVIEN GRADE = III) WAS 19.1%. THERE WERE 17.6% CLINICALLY RELEVANT POST-OPERATIVE PANCREATIC FISTULA (CR-POPF) (16.1% GRADE B POPF, 1.5% GRADE C POPF), 8.9% GRADE B/C POST PANCREATECTOMY HEMORRHAGE (PPH), 11.8% GRADE B/C DELAYED GASTRIC EMPTYING (DGE), AND 5.9% BILE LEAKAGE. TWELVE PATIENTS (17.6%) HAD PERIPANCREATIC FLUID COLLECTIONS, AND EIGHT OF THEM REQUIRED DRAINAGE. ONE PATIENT REQUIRED REOPERATION DUE TO FAILED EMBOLIZATION OF THE PSEU

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) 2021, THE SUBJECT (B)(4) UNDERWENT ROBOT-ASSISTED ULTRA-LOW ANTERIOR RESECTION WITH PERIAORTIC LYMPH NODE DISSECTION, TOTAL MESORECTAL EXCISION, PRIMARY LOW PELVIC COLOANAL ANASTOMOSIS USING THE DA VINCI SP SURGICAL SYSTEM AND LAPAROSCOPIC DIVERTING LOOP ILEOSTOMY. ON (B)(6) 2021, THE SUBJECT MET ALL STUDY ELIGIBILITY CRITERIA AND SIGNED THE INFORMED CONSENT. THE SUBJECT HAD VERY DIFFICULT ANATOMY IN PART DUE TO THE PREVIOUS STAGED PROCEDURE AND THE LOCATION OF THE LESION IN THE LOW RECTUM. AFTER OBTAINING SINGLE PORT ACCESS, THE PORT WAS PLACED, ROBOT WAS DOCKED, AND AN ADDITIONAL 12 MM PORT WAS PLACED IN THE RIGHT QUADRANT. PERIOAORTIC LYMPH NODE DISSECTION WAS PERFORMED. THE SPECIMEN WAS EXTRACORPOREALIZED BY UNDOCKING THE DA VINCI SP SYSTEM USING THE WOUND RETRACTOR PLACED AT THE UMBILICUS. THE ANVIL WAS THEN SECURED TO THE CIRCULAR LAP STAPLER (SIZE 29) WITH A PURSE STRING SUTURE. THE DA VINCI SP SYSTEM WAS THEN RE-DOCKED, PNEUMOPERITONEUM WAS REESTABLISHED AND A LOW PELVIC COLOANAL ANASTOMOSIS WAS CREATED WHICH WAS INTACT AND TENSION-FREE. THE DOUGHNUTS WERE CHECKED AND WERE INTACT. THE AIR INSUFFLATION TEST ALSO REVEALED NO BUBBLES OR LEAKS. AT THIS JUNCTURE, THE T

da Vinci Surgical System — Injury report filed with FDA (MAUDE). A MAUDE report does not establish that the device caused the outcome. Reported narrative: A ROBOTIC FORCE BIPOLAR INSTRUMENT WAS USED DURING THE CASE. "A SPRING?" BROKE DURING THE CASE. AT FIRST IT WAS UNKNOWN IF ANY FRAGMENTS FELL OFF INTO THE PATIENT. AN X-RAY WAS ORDERED AND TAKEN. NO DENSITIES WERE SEEN ON THE X-RAY. A NEW INSTRUMENT WAS OPENED AND THE CASE WAS COMPLETED. THIS INSTRUMENT WILL BE SENT BACK TO INTUITIVE FOR EVALUATION AND REIMBURSEMENT; 3/12 LIVES REMAIN ON INSTRUMENT. THERE ARE NO APPARENT MISSING SCREWS NOR BROKEN CABLES UPON VISUAL INSPECTION, HOWEVER THE JAWS OF THE INSTRUMENT AREN'T ABLE TO BE OPENED ALL THE WAY. 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: 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: ON 03-SEP-2021, INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE, VIA AN ISI CLINICAL JOURNAL REVIEW, OF A JOURNAL HERNIA ARTICLE TITLED ¿COMPARISON OF PERIOPERATIVE OUTCOMES BETWEEN NON-OBESE AND OBESE PATIENTS UNDERGOING ROBOTIC INGUINAL HERNIA REPAIR [RIHR]: A PROPENSITY SCORE MATCHING ANALYSIS¿ (KUDSI, O. Y., BOU-AYASH, N., ET AL., 2021). A SINGLE-CENTER, ¿TEACHING COMMUNITY HOSPITAL,¿ RETROSPECTIVE REVIEW OF COLLECTED DATA SURROUNDING RIHR PROCEDURES WAS PERFORMED WITH THE STUDY PERIOD BEING BETWEEN FEBRUARY 2013 AND AUGUST 2020. PATIENTS WERE DIVIDED INTO NON-OBESE (< 30 KG/M2) AND OBESE (= 30 KG/M2) GROUPS. OF A TOTAL OF 547 PATIENTS, 414 WERE NON-OBESE AND 133 WERE OBESE. SURGICAL TECHNIQUE: ROBOTIC TRANSABDOMINAL PRE-PERITONEAL (RTAPP) INGUINAL HERNIA REPAIR: AFTER APPROPRIATE PREPARATION, A VERESS NEEDLE [NON-ISI PRODUCT] INSERTED INTO THE LEFT UPPER QUADRANT WAS USED TO ESTABLISH PNEUMOPERITONEUM. THREE 8.5 MM TROCARS WERE INSERTED 8 CM APART AND 4 CM ABOVE THE UMBILICUS LEVEL. THE PATIENT SIDE CART OF THE DA VINCI SURGICAL ROBOTIC SYSTEM (INTUITIVE SURGICAL, SUNNYVALE, CA) WAS DOCKED. POLYESTER MESH MATERIAL WAS USED. WITHIN THE JOURNAL ARTICLE, COMPLICATIONS WERE NOTED: "IN

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: 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: 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: ON 29-AUG-2021, INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF A SCIENTIFIC REPORTS ARTICLE TITLED, ¿COMPARISON OF SHORT-TERM SURGICAL OUTCOMES USING DA VINCI S, SI AND XI SURGICAL SYSTEM FOR ROBOTIC GASTRIC CANCER SURGERY¿ (OJIMA, T., NAKAMURA, M., ET AL., 2021). WITHIN THE JOURNAL ARTICLE, AN OPERATIVE COMPLICATION INVOLVING A DA VINCI XI SURGICAL PROCEDURE WAS NOTED: A (B)(6) YEAR OLD MALE UNDERWENT A DA VINCI-ASSISTED DISTAL GASTRECTOMY PROCEDURE. THE PROCEDURE WAS CONVERTED TO OPEN DUE TO A "PORTAL VEIN INJURY." IT WAS REPORTED THAT THE PATIENT LOST 2540 ML OF BLOOD DURING THIS PROCEDURE AND NO POST-OPERATIVE COMPLICATIONS OCCURRED. THE PROCEDURE WAS A TOTAL OF 598 MINUTES

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 02-SEP-2021, DURING AN INTUITIVE SURGICAL, INC. (ISI) CLINICAL JOURNAL REVIEW, INTUITIVE BECAME AWARE OF A SURGICAL ENDOSCOPY ARTICLE TITLED, ¿ROBOTIC TRANSAXILLARY LATERAL NECK DISSECTION FOR THYROID CANCER: LEARNING EXPERIENCE FROM 500 CASES¿ FROM JANUARY 2008 TO JULY 2019 WHEREBY WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS AFTER DA VINCI SURGICAL PROCEDURES WERE NOTED: TRANSIENT HYPOCALCEMIA WAS THE MOST COMMON COMPLICATION (30.4%), FOLLOWED BY CHYLE LEAKAGE (5.2%), PERMANENT HYPOCALCEMIA (4.0%), TRANSIENT HOARSENESS (4.0%), AND SEROMA FORMATION (3.2%). FIVE (1.0%) PATIENTS HAD A PERMANENT RLN INJURY, AND THE NERVE WAS SACRIFICED DUE TO CANCER INVASION IN ONE PATIENT. THREE (0.6%) PATIENTS HAD HEMATOMA FORMATION, AND ONE OF THEM (0.2%) UNDERWENT BLEEDER LIGATION. TWO (0.4%) PATIENTS DEVELOPED HORNER¿S SYNDROME." THE JOURNAL ARTICLE CITED THAT, ¿FOLLOWING THE SURGERY, ALL PATIENTS RECEIVED LEVOTHYROXINE FOR THYROID-STIMULATING HORMONE (TSH) SUPPRESSION. ALL PATIENTS UNDERWENT RADIOACTIVE IODINE (RAI) ABLATION (3.7¿5.5 GBQ), POST-THERAPY WHOLE-BODY SCANS, AND DIAGNOSTIC WHOLE-BODY SCANS.¿ THE JOURNAL ARTICLE CITED THE FOLLOWING: "THIS STUDY AIMED TO DEMONSTRATE THE TECH

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: INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF AN ANNALS OF TRANSLATIONAL MEDICINE ARTICLE TITLED, ¿RISK FACTORS FOR LYMPH NODE METASTASIS OF THE LEFT RECURRENT LARYNGEAL NERVE IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA¿ (CHEN, C., MA, Z., SHANG, X. ET AL., 2021). WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING DA VINCI SURGICAL PROCEDURES WERE NOTED: "THERE WERE 6 CASES WITH VOCAL CORD PARALYSIS (16.38%), 3 WITH ANASTOMOTIC LEAKAGE (3.19%), AND 10 WITH PULMONARY INFECTION (10.64%) AFTER ESOPHAGECTOMY." ADDITIONAL INFORMATION OBTAINED FROM THE JOURNAL ARTICLE: THIS WAS A RETROSPECTIVE STUDY OF PATIENTS WHO UNDERWENT MCKEOWN MINIMALLY INVASIVE ESOPHAGECTOMY (MIE) (NO NEOADJUVANT THERAPY) AT TIANJIN MEDICAL UNIVERSITY CANCER INSTITUTE AND HOSPITAL (FROM JANUARY 2016 TO DECEMBER 2019). DA VINCI ROBOT-ASSISTED (DA VINCI SI/XI) AND THORACIC LAPAROSCOPIC VIDEO-ASSISTED MIE WERE PERFORMED IN 3 STAGES. FIRST, THORACOSCOPY OR THE DA VINCI ROBOT WAS USED TO MOBILIZE THE ESOPHAGUS AND DISSECT THE THORACIC LNS IN THE PRONE POSITION WITH THE RIGHT HAND HOLDING THE HEAD. SECOND, THORACOSCOPY OR THE DA VINCI ROBOT WAS USED TO CREATE THE GASTRIC CONDUIT AND DISSECT THE ABDOM

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 30-AUG-2021, INTUITIVE SURGICAL, INC. (ISI) BECAME AWARE OF A UPDATES IN SURGERY ARTICLE TITLED, ¿IMPACT OF BODY MASS INDEX ON THE EARLY EXPERIENCE OF ROBOTIC PANCREATICODUODENECTOMY¿ (CHAO, Y. J., LIAO, T. K., ET AL., 2021). WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING DA VINCI SURGICAL PROCEDURES WERE NOTED: "ALL OPERATIONS WERE PERFORMED USING THE DA VINCI SI SURGICAL SYSTEM. TWO PATIENTS (2.9%) WERE CONVERTED TO OPEN SURGERY IN THE OBESE GROUP DUE TO SEVERE INFLAMMATION AT THE PANCREATIC HEAD AND TUMOR ADHESIVE TO THE SUPERIOR MESENTERIC VEIN AND NONE IN THE NORMAL-WEIGHT AND OVERWEIGHT GROUPS. THIRTY THREE PATIENTS EXPERIENCED COMPLICATIONS WITH AN OVERALL COMPLICATION RATE OF 51.5%, AND THE MAJOR COMPLICATION RATE (CLAVIEN GRADE = III) WAS 19.1%. THERE WERE 17.6% CLINICALLY RELEVANT POST-OPERATIVE PANCREATIC FISTULA (CR-POPF) (16.1% GRADE B POPF, 1.5% GRADE C POPF), 8.9% GRADE B/C POST PANCREATECTOMY HEMORRHAGE (PPH), 11.8% GRADE B/C DELAYED GASTRIC EMPTYING (DGE), AND 5.9% BILE LEAKAGE. TWELVE PATIENTS (17.6%) HAD PERIPANCREATIC FLUID COLLECTIONS, AND EIGHT OF THEM REQUIRED DRAINAGE. ONE PATIENT REQUIRED REOPERATION DUE TO FAILED EMBOLIZATION OF THE PSEUD

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 TRANSLATIONAL ANDROLOGY AND UROLOGY ARTICLE TITLED, ¿ROBOT-ASSISTED LAPAROSCOPIC RETROPERITONEAL LEIOMYOSARCOMA RESECTION WITH INFERIOR VENA CAVA GRAFT REPLACEMENT: A CASE REPORT¿ (CHENG, G., RUAN, H., ET AL., 2021). WITHIN THE JOURNAL ARTICLE, OPERATIVE COMPLICATIONS INVOLVING DA VINCI SURGICAL PROCEDURES WERE NOTED: "OWING TO THE UNEXPOSED SIGHT OF RIGHT RENAL ARTERY, THE ACCIDENTAL INJURY OCCURRED INTRAOPERATIVELY AND THUS THE PATIENT SUFFERED FROM RIGHT RENAL INSUFFICIENCY WITH LOWER GFR RATE." ADDITIONAL INFORMATION OBTAINED FROM THE ARTICLE: THE ESTIMATED BLOOD LOSS DURING THE PROCEDURE WAS ABOUT 2,000 ML AND THE PATIENT WAS TRANSFUSED BLOOD PLASMA WITH 600 ML INTRAOPERATIVELY. THE PATIENT WAS GIVEN AN INFUSION OF HEPARIN (AN ANTICOAGULANT) INTRA-OPERATIVELY. MRI DONE AT 1 WEEK POST-OPERATIVELY SHOWED THAT THE CONTINUITY OF RIGHT RENAL ARTERY IMAGING WAS INTERRUPTED AND SIGNALING OF THE RIGHT KIDNEY WAS WEAKER THAN THE LEFT ONE, WHICH IMPLIED STRICTURE OF RIGHT RENAL ARTERY. DURING THE 3-MONTH FOLLOW-UP OF THE PATIENT, DYNAMIC RENOGRAPHY REVEALED THAT GFR OF THE RIGHT KIDNEY WAS SIGNIFICANTLY DECREASED TO 27.4 ML/MIN, WHICH IND