B. Braun Aesculap DSM Manual

Aesculap®
Aesculap Power Systems
USA Instructions for use/Technical description
DSM (Digital Surgical Microscope)

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Aesculap®
DSM (Digital Surgical Microscope)
Note
CAUTION: RX only!
Legend
13D flat panel display
2Touchscreen
3Robotic arm
4DSM head
5Medical grade cart
6Footswitch
The illustrations in these instructions for use (especially illustrations of the
software) may deviate from the actual device.
Contents
1. General information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 Symbols on product and packaging . . . . . . . . . . . . . . . . . . . . . . 3
1.2 Applicable to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.4 Intended use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.5 Indications for Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.6 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2. Safe handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.1 Light emission risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.2 Fluorescent surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.3 Place of use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.4 Ambient conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.5 DSM sterile drape PV012SU . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.6 Footswitch PV014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3. Product description . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3.1 Robotic arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
3.2 DSM head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.2.1 LED indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.2.2 Handle buttons (default setting) . . . . . . . . . . . . . . . . . . . . . . . . 6
3.3 DSM cart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.3.1 Emergency stop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3.3.2 Cart LED indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3.3.3 Cart connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3.4 3D display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3.5 3D display stand (optional) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3.6 Touchscreen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.7 Footswitch PV014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.7.1 Default footswitch button functionality . . . . . . . . . . . . . . . . . . 8
3.7.2 Footswitch status LEDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.7.3 Backup USB cable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.8 Isolation transformer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.9 Wireless keyboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.10 Polarized 3D glasses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3.11 Additional components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4. Preparation and setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
5. Working with the product. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
5.1 Transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
5.2 System set-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
5.2.1 3D display and robotic arm workspace . . . . . . . . . . . . . . . . . . . 9
5.2.2 Connecting the accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
5.2.3 Connecting the power supply . . . . . . . . . . . . . . . . . . . . . . . . . . 10
5.3 Function checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
5.4 Positioning the 3D display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
5.5 Turning the system on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5.6 Setting up the robotic arm and the DSM head . . . . . . . . . . . . 11
5.6.1 Rotating the DSM using the yaw coupler. . . . . . . . . . . . . . . . . 11
5.6.2 Moving the robotic arm out of storage position and draping the
robotic arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5.7 Starting a case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
5.8 Ending a case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
5.9 Saving case media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
5.9.1 Save to default location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
5.9.2 Copy media to drive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.10 Removing the drape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.11 Shutdown procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.11.1 Software shutdown and robotic arm storage. . . . . . . . . . . . . . 13
5.12 Changing footswitch batteries . . . . . . . . . . . . . . . . . . . . . . . . . 13
6. Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
6.1 Home screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
6.2 DSM setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
6.2.1 Preset positions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
6.2.2 Rebalance scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
6.2.3 Robot recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
6.3 Live screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
6.3.1 Zoom, focus, and light controls . . . . . . . . . . . . . . . . . . . . . . . . . 14
6.4 Fluorescence controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
6.4.1 Function checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
6.4.2 DUV 400 imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
6.5 Touchscreen robot control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
6.5.1 Lock On Target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
6.5.2 Robot Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
6.6 Quick Access Bar (QAB) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
6.7 Robotic arm state indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
6.8 Software settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
6.8.1 Camera settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6.8.2 Screen Layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6.8.3 Digital Aperture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6.8.4 DUV 400 (Fluorescence) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6.8.5 Color. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6.8.6 Recording. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
6.8.7 Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
6.8.8 Input Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
6.8.9 DICOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
6.8.10 Handles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
6.8.11 Footswitch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
6.8.12 About . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
7. Reprocessing procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
7.1 Single-use products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

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7.2 Preparation before cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
7.3 Limitations on reuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
7.4 Cleaning/disinfection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
7.4.1 Product-specific safety instructions for the reprocessing
procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
7.5 Wipe disinfection for electrical devices. . . . . . . . . . . . . . . . . . . 21
7.6 Inspection, maintenance and checks . . . . . . . . . . . . . . . . . . . . . 21
7.7 Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
7.8 Storage and transport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
8. Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
9. Troubleshooting list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
9.1 Malfunctions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
9.2 Error messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
9.2.1 Startup errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
9.2.2 License error. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
9.2.3 Recording errors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
9.2.4 DSM head errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
10. Technical Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
11. Technical data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
11.1 Performance data, information about standards . . . . . . . . . . . 23
11.2 Ambient conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
12. Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
13. Distributor in the US/Contact in Canada for product
information and complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
1. General information
1.1 Symbols on product and packaging 1.2 Applicable to
These instructions for use are applicable to the following products:
1.3 Warnings
Warnings make clear the dangers to patient, user and/or product that
could arise during the use of the product. Warnings are labeled as follows:
1.4 Intended use
This device is for use with patients undergoing microsurgery within its
indications for use.
There is no patient contact intended with this device.
Symbol Location Description
Base of cart Main power switch.
Press to turn the system ON.
Press again to turn the system OFF
Product label AC input
DSM head DC input
Product label Warning
Product label Risk of electric shock! Do not open.
Robotic arm Take care to avoid injury when in the
vicinity of the display arm or robotic
arm.
Support arms Do not exceed load ratings for support
arms.
Product label Follow instructions for use.
Cart emer-
gency stop
Emergency stop control device
Product label System mass
Product label Manufacturer
Product label Date of manufacture
Product label CSA NRTL Mark
Product label CE marking acc. to DIR 93/42/EEC
Touchscreen
mount label
USB 3.0 port
Coupler label Yaw adjustment slider
Cartpotential
equalization
conductor
Connection point for potential equal-
ization conductor
Product label Marking of electric and electronic
devices according to directive
2002/96/EC (WEEE), see Chapter 12.
Product label Catalog number
Product label Serial number
Product label Revision
Art. no. Designation
PV010 Aesculap DSM (Digital Surgical Microscope)
PV022 Software module DUV 400
PV024 Software module DICOM
PV030 White balance card
DANGER
Danger of death or serious injury.
WARNING
Danger of minor injury or product damage.
CAUTION
Indicates a possible threat of material damage. If
not avoided, the product may be damaged.
Symbol Location Description

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1.5 Indications for Use
Aesculap DSM (Digital Surgical Microscope) PV010
The Aesculap DSM (Digital Surgical Microscope) generates a magnified 3D
view of the surgical field.
Software module DUV 400 PV022
The DUV 400 is an accessory for the AESCULAP® DSM and is used for view-
ing fluorescence of fluorophores, comprising:
■An excitation filter for blue spectral range between 390 nm and
420 nm
■An observation filter for visible light with spectral range greater than
510 nm
1.6 Contraindications
The DSM system must not be used for ophthalmology.
2. Safe handling
CAUTION
Federal law restricts this device to purchase by, or on instruction by a
physician!
►Manually clean the new product after removing its transport packaging
and prior to first use.
►Prior to use, check that the product is in good working order.
►Observe “Notes on Electromagnetic Compatibility (EMC)“, see
TA015615-EMV.
►To prevent damage caused by improper setup or operation, and in order
not to compromise warranty and manufacturer liability:
– Use the product only according to these instructions for use.
– Follow the safety and maintenance instructions.
– Only combine Aesculap products with each other.
►Ensure that the product and its accessories are operated and used only
by persons with the requisite training, knowledge, or experience.
►Keep the instructions for use accessible for the user.
►Always adhere to applicable standards.
►Set up and connect any external video input or output before the sys-
tem is turned on.
►Ensure that exposed cables for the footswitch, head, any external dis-
plays, and power supply are laid flat on the ground and out of high-
traffic areas to minimize potential tripping hazards.
►Do not use the robotic arm as an armrest or to support any unapproved
accessories. Do not place other equipment on the system.
►Do not place objects around or on top of the E-stop or on the DSM head
and arm.
►Ensure the E-stop is not locked prior to surgery.
►Use the protective stop on the touchscreen if there is unintended robot
arm movement.
►Use the E-Stop only if the protective stop malfunctions.
►Check fluorescence functionality prior to surgery using the provided
reference card.
►Ensure that the DSM head working distance is between 20 cm and
45 cm.
►The fluorescence reference card and the touchscreen are not sterile.
Perform fluorescence functional tests before surgery.
►Take precautions to avoid touching any system components and the
patient at the same time.
►Do not push or pull the product by the display, head, or power cable.
►To ensure optimal image quality, only use product with 3D glasses sup-
plied by Aesculap. Contact Aesculap if additional pairs are required.
►Do not use polarized prescription glasses as they will distort the 3D
effect.
►Always return the robot to storage position before shutdown.
►Store the head with the lens cap covering the main objective when it
is not in use.
►Do not cover the air vents of the system, touchscreen, or 3D display.
Note
When the emergency stop is pressed, the DSM head may move up to 3 cm
(depending on position) due to mechanical brakes locking into place.
This equipment has been tested and found to comply with the limits for a
Class A digital device, pursuant to Part 15 of the FCC Rules. These limits
are designed to provide reasonable protection against harmful interfer-
ence when the equipment is operated in a commercial environment. This
equipment generates, uses, and can radiate radio frequency energy and, if
not installed and used in accordance with the instruction manual, may
cause harmful interference to radio communications. Operation of this
equipment in a residential area is likely to cause harmful interference in
which case the user will be required to correct the interference at his or
her own expense. You are cautioned that any changes or modifications not
expressly approved in this manual could void your authority to operate this
equipment.
All interface cables used to connect peripherals must be shielded in order
to comply with the limits for a digital device pursuant to Subpart B of Part
15 of FCC Rules. This device complies with Part 15 of the FCC Rules. Oper-
ation is subject to the following two conditions: (1) this device may not
cause harmful interference, and (2) this device must accept any interfer-
ence received, including interference that may cause undesired operation.
■Mode of operation: Continuous
■Protection against electric shock: Class I
2.1 Light emission risks
Retinal blue light and Near-UV emission risk.
►Do not stare at the lamp emission area during operation.
►Minimize exposure to eyes and skin.
►Use appropriate shielding.
►Make sure that no light from the DSM enters the patient’s eyes.
2.2 Fluorescent surgery
►Only use fluorescent agents that are approved for the planned applica-
tion.
►Danger of injury to the eyes due to possibly hazardous UV light. Do not
look at the DSM illumination, minimize exposure to eyes or skin, and
use appropriate shielding.
►Use the lowest comfortable light intensity.
►Ensure that no tissue damage is caused by excessive illumination inten-
sity.
►The room lighting impairs the visualization of fluorescence. For surger-
ies using the DSM fluorescence modules, operate in a darkened room,
if possible.
►Always perform a functional test before using the fluorescence mod-
ules, see Chapter 6.4.1. Use the reference cards to check whether the
fluorescence medium can be excited for the DSM wavelength range
and whether it emits fluorescent light of sufficient intensity.
Note
As in almost all diagnostic procedures, false-positive and false-negative
results can occur in the fluorescence-based digital overlay. Evaluation by
the user based on other methods may be necessary.
DANGER
Risk of fatal injury from electric shock!
►Do not open the product.
►Connect the product only to a grounded power
supply.

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2.3 Place of use
This system is not suitable for use in the presence of flammable anesthet-
ics mixture with air or with oxygen.
►Do not use system in explosive atmospheres.
►To prevent fire or shock hazard, do not expose system to rain or mois-
ture.
2.4 Ambient conditions
The following ambient conditions apply to the use of the product:
2.5 DSM sterile drape PV012SU
The product has been EO-sterilized and is supplied in sterile packaging.
The product must not be reused.
The product is the only sterile component of the system.
►Place a drape prior to surgery.
►Do not use products from open or damaged sterile packaging.
►Do not use the product if it is damaged or defective.
►In case of intraoperative damage of the drape: remove the system from
the operating table and replace the drape.
►Do not use the product after its use-by date.
2.6 Footswitch PV014
►Keep footswitch within a range of max. 10 m to the receiver.
►Do not place the footswitch in or near strong magnetic fields.
►Do not use more than four wireless systems in the same area.
The footswitch is regularly powered by three alkaline batteries of type C
“Baby” (IEC-LR 14), which are placed behind the backside battery cover.
►If they need changing, the terminal must be switched off first in order
to rule out any unintended triggering of functionality.
►Only use footswitch with the specified batteries or backup cable.
►To prevent the footswitch from battery leakage, remove battery from
the case during long periods of non-use.
►Never touch the battery contacts and the patient at the same time.
The maximum mechanical load which the operating elements may be sub-
jected to is max. 1350 N.
The integrated accelerometer prevents an accidental actuation of switch-
ing element if the inclination passes 35°.
►Only use footswitch on a firm, even (horizontal) surface.
When using the backup cable:
►When connecting the backup cable, always ensure that connecting ele-
ments (plugs) are clean.
►Ensure that the plug connections are not subjected to mechanical
loads.
►Do not subject backup cable to excessive pulling, pressure or bending.
Do not drive over cable.
►Always perform function test in combination with the DSM when the
device is switched back on.
Note
Wireless mode is not possible when the foot switch is connected via USB
cable.
3. Product description
The Aesculap DSM is a freestanding, digital surgical microscope in a look-
over configuration. The DSM does not utilize traditional microscope bin-
oculars within the field of use and is intended to be an alternative to tra-
ditional optical microscopes. The DSM software is a component of the
medical device.
The main components of the DSM system are:
■3D flat panel display 1– live surgical view
■Touchscreen 2– control interface
■Robotic arm 3
■DSM head 4– 3D camera, illumination, and handle controls
■Medical-grade cart 5with embedded computers
■Footswitch 6
■Visualization software
■Sterile drape
3.1 Robotic arm
The robotic arm is a six-jointed arm that supports the DSM head. Its
touch-guided movement allows the user to manipulate it through the
workspace. The robotic arm may be controlled via the handles, footswitch,
or touchscreen. On the 3D display, the robot state indicator shows the cur-
rent state of the robotic arm. The robotic arm workspace is illustrated
below.
Fig.1
Legend
aMax. radius
Temperature 10 °C to 35 °C
Relative humidity 30 % to 90 %; non-condensing
Atmospheric pressure 700hPato1060hPa
WARNING
Infection hazard for patients and/or users and
impairment of product functionality due to reuse.
Risk of injury, illness or death due to contamination
and/or impaired functionality of the product!
►Do not reprocess the product.
a = 1,24 m
425 mm
390 mm

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3.2 DSM head
The DSM head contains two sets of optics and two high-resolution sensors
to convert the analog signal to a digital video stream.
Fig.2
Legend
aBottom of DSM head
bMin. working distance
cMax. working distance
3.2.1 LED indicator
The DSM head has an LED indicator on the back panel. The indicator colors
are explained below.
Fig.3
3.2.2 Handle buttons (default setting)
The DSM is designed to be controlled primarily through the buttons on the
handles of the sides of the head. The default layout of the handles is shown
below. In the software Handles settings, the handle button commands can
be customized.
Fig.4
Legend
3.3 DSM cart
The images acquired by the DSM head are delivered to the system com-
puter (EPU) in the cart. This is a special-purpose computer, optimized to
process the images for storage, manipulation, and stereoscopic display.
The signals generated for display employ the Digital Video Interface (DVI),
delivering high resolution and high refresh rate stereoscopic display
images to the display devices. The DVI signals can be delivered to display
devices with DVI or HDMI cable connections.
The system computer is also fitted with a 2 TB storage drive or larger that
stores at least 100 hours of 3D HD videos. The videos can be immediately
accessed for playback due to real-time compression of the video stream as
it is recorded. The compressed video files can easily be transferred to exter-
nal storage for backup and archival and to free space on the internal stor-
age drive.
The cart also holds a second computer controlling the robotic arm.
3.3.1 Emergency stop
The robotic arm emergency stop is located at the top of the cart. The
robotic arm movement is always under the control of the operator.
►If there is a malfunction and the robotic arm moves in an unintended
way, first attempt to press the Protective Stop button on the touch-
screen.
►If the touchscreen does not respond, use the emergency stop to remove
power from the arm and cease all movement.
Note
When the emergency stop is pressed, the DSM head may move up to 3 cm
(depending on position) due to mechanical brakes locking into place.
Indicator Description
Blinking blue The DSM head is starting up
Solid green The DSM head is ready for use
Solid yellow A minor error has occurred. See software mes-
sage for details.
Solid red A major error has occurred. User should switch
to a backup system immediately
a
b = 200 mm
c = 450 mm
a
b
c
d
e
f
g
h
i
j
k
Assisted drive
Zoom +
White light +
Focus -
Auto focus
White light -
Zoom -
Assisted drive
Record
Focus +
Snapshot
l
m
n
o
p
q
r
s
t
u
v
Move up
Move left
Move down
Assisted drive
Move forward
Way point save/delete
Move right
Lock-on mode
Waypoint select/move
Move backward
Assisted drive
a
b
c
d
e
f
g
h
i
j
k
L
l
m
l
n
o
p
q
r
s
t
u
v
R

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3.3.2 Cart LED indicators
There are three LED indicators near the base of the cart that display the
status of the DSM, system computer (EPU), and robotic arm components.
The indicator colors are explained below.
3.3.3 Cart connections
Fig.5
On the touchscreen arm, there are the following connections:
■2 × USB 3.0 ports a
At the back of the cart, there are the following connections:
■2 × Ethernet ports b
■2 × HDMI output ports c
■2 × USB 2.0 ports d
At the front of the cart, there are the following connections:
■2 × Ethernet ports e
■1 × HDMI output port f
■1 × HDMI input port g
■1 × SDI input port h
■Main power cord connection i
■6 mm potential equalization port j
Connecting a secondary display (output)
The system can support simultaneously displaying the live view on multi-
ple displays.
The following 3D displays are approved for use with the DSM:
►Connect the display to the HDMI output port cat the back of the cart,
see Fig.5.
►Configure the additional displays in the DSM software “Display” set-
tings panel, see Chapter 6.8.7.
The individual display settings are specially configured at the factory.
When the PV644 or PV015 display is used in a high-temperature environ-
ment, the brightness of the display backlight is reduced to lower the tem-
perature inside the unit. When this function is activated, the power indi-
cator flashes in amber. It is not recommended to drape the displays.
Connecting a video stream from another device (input)
Video streams from other devices may be connected to facilitate display in
conjunction with the 3D image from the DSM head.
The following devices are approved for providing video input:
►Connect the device to the HDMI input port gor SDI input port hat the
front of the cart, see Fig.5.
►Configure the video input in the DSM software “Input Source” settings
panel, see Chapter 6.8.8.
Connecting to a potential equalization system
Directly above the main power cord connection i, the DSM system is
equipped with a 6 mm potential equalization port jthat can be connected
to the healthcare facility potential equalization system.
►Connect the display to the potential equalization port jat the front of
the cart, see Fig.5.
Connecting to a PACS/RIS server
There are two Ethernet ports on the both the front and back panels of the
cart.
►Ensure that the Ethernet cable and connector comply with at least Cat-
5e EIA/TIA-568A-5, preferably Class D values from ISO/IEC 11801:2002
or EN 50173-I:2002.
►Connect an Ethernet cable to one of the Ethernet ports bor eto link
the system with the facility PACS server, see Fig.5.
►Configure the connection in the software DICOM settings. See
TA015615-DCS for the complete DICOM Conformance Statement.
3.4 3D display
The default 26” 3D display has a circularly-polarized, micro-polarizing fil-
ter that displays the right and left image alternately. Circularly-polarized
glasses are worn to ensure that the left eye only sees the left image and
the right eye only sees the right image. The 3D display has a refresh rate
of 60 frames per second (FPS) simultaneously for each eye. The display
comes optimally pre-configured from the factory.
►If the display settings are causing inadequate visualization, please con-
tact customer support for assistance.
3.5 3D display stand (optional)
The system can support remote 3D displays on a display stand approved by
Aesculap. If the default 26” 3D display does not come with the system, an
optional display can be the primary display.
The following display stands are approved for use with the DSM:
Indicator Description
Solid green The component is ready for use.
Solid yellow A minor error has occurred.
Solid red Warning – the component is not ready for use.
Art. no. Designation
PV008 26” display
PV646 32” display
PV644 31” 4K display
PV015 55” 4K display
a
b c d e f g h i j
Art. no. Designation
PV460 Full HD 3 chip camera control unit
PV470 Full HD CMOS camera control unit
PV480 2D camera platform
Art. no. Designation
PV016 Monitor stand for 55" monitor
PV818 Mobile monitor stand

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3.6 Touchscreen
The system can be controlled by using the touchscreen. The touchscreen is
2D only and not sterile.
►Position the touchscreen for quick and convenient access.
3.7 Footswitch PV014
The system can be controlled by using the wireless footswitch. The foot-
switch is uniquely paired with the DSM system in the DSM software “Foot-
switch” settings panel, see Chapter 6.8.11.
3.7.1 Default footswitch button functionality
Fig.6
Legend
The footswitch button commands can be customized in the DSM software
“Footswitch” settings panel, see Chapter 6.8.11.
3.7.2 Footswitch status LEDs
►Change the batteries of the footswitch when the battery indicator
flashes orange, see Chapter 5.12.
3.7.3 Backup USB cable
Fig.7
Alternatively, the footswitch can be powered by the 4.5 m optional backup
cable.
3.8 Isolation transformer
The system contains a medical-grade isolation transformer to ensure
patient and product safety. The transformer is configured at the factory to
accept 100 V AC, 120 V AC, or 220 V AC to 240 V AC from the supply
mains. The DSM computers, 3D display, and touchscreen are connected
directly to the isolation transformer. The isolation transformer is con-
nected to the outlet power source – the isolation transformer outlet plug
is the mains disconnect device. The isolation transformer prevents out-
ages, sags, surges, and bad harmonics.
3.9 Wireless keyboard
The system includes a wireless keyboard with an integrated touchpad. The
wireless keyboard is rechargeable. There are no batteries to be replaced. A
three-hour charge provides up to ten days of use when typing about two
hours a day with the backlight on, or about one year without backlight. The
backlight is off by default. When the keyboard is turned on, the battery
indicator shows the charge level.
►To charge the battery, connect the keyboard to a USB port aon the side
of the touchscreen mount using the Micro-USB cable supplied, see
Fig.5.
The battery indicator blinks green while charging.
►Charge until the indicator light stops blinking.
Note
The keyboard can be used while it charges.
Note
If the battery power is low (indicator blinking red), the keyboard backlight
is disabled.
3.10 Polarized 3D glasses
Passively, circularly-polarized glasses are needed to see the display in 3D.
The glasses may be worn over prescription glasses. Keep the glasses clean
and free of scratches. To ensure optimal image quality, the system should
only be used with Aesculap-supplied 3D glasses. Polarized prescription
glasses will distort the 3D effect and should not be used.
►Contact Aesculap if additional pairs are required.
The following 3D glasses are approved for use with the DSM:
a
b
c
d
e
Waypoint save/delete
Auto focus
Focus -
Zoom -
White light -
f
g
h
i
j
Waypoint select/move
Lock-on mode toggle
Focus +
Zoom +
White light +
Symbol State Designation
Connection
Solid
green
Radio connection established, footswitch
engaged
Blinking
green
No radio connection, e.g. radio range error
or receiver not online
Blinking
red
Pairing mode active
Follow pairing instructions, see
Chapter 6.8.11.
Off Footswitch in power save mode
Battery
Solid
orange
Warning 1: “Battery low”
Battery voltage = 3.3 V to 3.2 V (± 10 %)
Blinking
orange
Warning 2: “Battery low”
Battery voltage ≤ 3.2 V (± 10 %)
Fast blink-
ing orange
Battery is empty: No further operation is
possible.
Battery voltage < 3.0 V (± 10 %)
Off Depending on Connect LED:
Connect LED ON: Battery voltage > 3.55 V
Connect LED OFF: Footswitch in sleep mode
a
b
c
d
e
f
g
h
i
j
Indicator Description
Blinking green The battery is charging.
Solid green The battery has adequate charge, or charging is
complete.
Blinking red Battery power is low. Recharge the battery.
Art. no. Designation
PV621 3D polarization glasses
PV622 3D anti-fog glasses
PV623 3D polarization glasses with clip
PV624 3D eye shield glasses kit

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3.11 Additional components
The DSM system comes with additional components to help configure the
system to work best in the operating room.
Aesculap doesn’t provide a sterile drape for the DSM cart. If required, the
sterile drape should meet the following recommendations:
4. Preparation and setup
Non-compliance with the following instructions will preclude all respon-
sibility and liability in this respect on the part of Aesculap.
►When setting up and operating the product, adhere to
– national regulations for installation and operation,
– national regulations on fire and explosion protection.
Note
For the safety of patients and users it is essential that the mains power cord
and, especially, the protective earth connection are intact. In many cases
defective or missing protective earth connections are not registered imme-
diately.
►Connect the device via the potential equalization terminal jat the front
of the cart to the potential equalization system of the room used for
medical purposes, see Fig.5.
Note
The potential equalization lead can be ordered from the manufacturer as
art. no. GK535 (4 m length) or TA008205 (0.8 m length).
5. Working with the product
5.1 Transport
►Do not push the product while transporting. Only pull the product,
especially over elevator and door thresholds.
5.2 System set-up
5.2.1 3D display and robotic arm workspace
To help with positioning the DSM in the operating room, the cart dimen-
sions, the minimum and maximum extensions of the 3D display arm, and
the height and maximum extension of the robotic arm are shown below.
Fig.8
Legend
aMax. length (arm fully extended)
bMax. monitor height
cMin. monitor height
dHighest point (roll through doors)
eRadius
Art. no. Designation Function
FS095 Mains cord
orange angled
Switzerland
FS096 Europe
FS097 Great Britain and Ireland
FS098 Japan, USA, Canada
PV012SU DSM sterile drape Sterile drape for the head and robotic
arm, sold separately. Single use only
PV030 White balance
card
White-balancing the DSM head image
sensors. The reverse side of the card is
used for checking the focus and align-
ment of the DSM head optics.
PV032SU DUV 400 refer-
ence card
For checking the functionality of the
DUV 400 imaging module (optional).
Single use only for accuracy check
TA015635 Lens cap Protecting the lens of the DSM head
when it is being stored
Minimum height 30 cm
Maximum height 75 cm
Minimum width 70 cm
Maximum width 115 cm
Additional recommenda-
tions
■Must not hang over the castors
■Must not cover the cart vents
WARNING
Risk of injury and/or product malfunction due to
incorrect operation of the electromedical system!
►Adhere to the instructions for use of any medi-
cal device.
a = 2,34 m
b = 2,03 m
c = 1,47 m
e = 1,24 m
d = 1,86 m

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There are two recommended layouts for the operating room.
Neurosurgery operating room layout (example)
Fig.9
Legend
aSurgeon
bAssistant
cScrub nurse
Spinal surgery operating room layout (example)
Fig.10
Legend
aSurgeon
bAssistant
cScrub nurse
5.2.2 Connecting the accessories
Combinations of accessories that are not mentioned in the present
instructions for use may only be employed if they are specifically intended
for the respective application, and if they do not compromise the perfor-
mance and safety characteristics of the products.
Also note that any equipment connected at the interfaces must demon-
strably meet the respective IEC standards (e.g. IEC 60950 for data process-
ing equipment, IEC/DIN EN 60601-1 for electromedical devices).
All configurations must comply with basic standard IEC/DIN EN 60601-1.
Any individual connecting devices with one another is responsible for such
configuration and must ensure compliance with basic standard IEC/DIN
EN 60601-1 or applicable national standards.
►Please address the B. Braun/Aesculap partner or Aesculap Technical
Service with any inquiries in this respect; for a contact address, see
Chapter 10.
►Every time a new piece of equipment is added and cables are connected
to the DSM system, power down the system prior to connecting cables,
then power it back up once the cables are connected.
5.2.3 Connecting the power supply
►Connect the main power cable to a hospital-grade power outlet. Do not
use un-approved extension cords or power strips. Use uninterruptible
power source when loss of power would result in an unacceptable risk.
►Lay the power cable in areas with minimal foot traffic.
5.3 Function checks
Before turning the DSM system on
►Check that the castors are locked once the cart is in the desired loca-
tion. Make sure the cart is stable and cannot roll in any direction.
►Connect the main power cable, see Chapter 5.2.3.
►Connect any external input or output video or Ethernet cables, see
Chapter 3.3.3.
►Check that there are no unnecessary objects or people within the range
of the robotic arm workspace.
►Check that the DSM head optical path is clean and free from dust.
►Ensure that exposed cables for the footswitch, any external displays,
and power supply are laid flat on the ground and out of high-traffic
areas to minimize potential tripping hazards.
After turning the system on and before starting the surgery
►Position the yaw coupler as desired, see Chapter 6.2.1.
►Move the robotic arm from “Storage” to “Drape” position, see
Chapter 6.2.1.
►Follow the instructions printed on the drape packaging to correctly
apply the drape to the DSM head and robotic arm.
►Position DSM at the OR table.
►Position the 3D display for the surgeon’s viewing preference.
►Check that the “Zoom”, “Focus”, and “White Light Level” handle buttons
are functioning properly.
►Check that the 3D image colors, focus, and alignment look correct.
►Check that the robotic arm assisted drive is moving smoothly and pre-
dictably.
►Check that the footswitch is paired with the system and the buttons
are working properly.
►If using fluorescence visualization (DUV 400), check the fluorescence
module using a reference card to ensure proper working order.
5.4 Positioning the 3D display
►For ideal viewing, position the 3D display next to the patient table,
between 4 and 6 feet (1 to 2 meters) away from the surgeon.
►Position the screen perpendicular to and at the same height as the sur-
geon’s eyes when he or she is seated at the operating table.
The 3D display arm’s maximum extension and height are shown below:
DANGER
Risk of injury due to unapproved configuration
using additional components!
►For all applied components, ensure that their
classification matches that of the application
component (e.g. Type BF or Type CF) of the
respective device.
a
b
c
a
b
c
a
b
c
DANGER
Risk of fatal injury from electric shock!
►Connect the product only to a grounded power
supply.

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Fig.11
Legend
aTop of the screen
bMax. monitor height (top of the screen)
cMin. monitor height (top of the screen)
5.5 Turning the system on
►Perform the relevant items of the function checks, see Chapter 5.3.
Fig.12
Legend
aMain power button
►Press the main power button alocated on the back panel of the DSM
cart, next to the power cable connection and LED indicators.
The displays, head, computers, robotic arm, and software are set to
automatically start when the system is turned on.
►Wait for the system to initialize (about 90 seconds).
The system will be ready for use once the DSM software has opened
and the notification “DSM initializing, please wait…” is no longer dis-
played.
5.6 Setting up the robotic arm and the DSM head
5.6.1 Rotating the DSM using the yaw coupler
Depending on the surgical approach and operating room layout, it may be
advantageous to rotate the DSM head 90° to the left or right.
Note
Only adjust the yaw coupler before draping, using the proper “Reconfigure
Coupler” workflow. Do not adjust the yaw coupler during surgery.
►Once the system has fully started up, go to the “Robot” tab in the DSM
home screen, see Fig.22.
►Under “Coupler”, press the “Reconfigure Coupler” button.
►Press and hold the “Hold or Reconfigure position” button until the arm
is fully extended.
Fig.13
Legend
aSliders of the yaw coupler
►Unlock the sliders aand rotate the DSM manually into the desired posi-
tion.
The available coupler positions are illustrated below. The geometry lim-
its of the robotic arm will change based on the coupler position.
Fig.14
►Press the “Hold for Drape position” button in the DSM software until
the movement is finished.
5.6.2 Moving the robotic arm out of storage position and draping
the robotic arm
The DSM head and distal portion of the robotic arm must be draped using
the provided Aesculap sterile drape PV012SU prior to surgery.
Note
Additionally, the DSM cart may be draped at the user’s discretion (cart
drape not provided by Aesculap). For drape dimensions, see Chapter 3.11.
►Once the system has fully started up, move the robotic arm into the
“Drape” position, see Chapter 6.2.1.
►Once the DSM is in the “Drape” position, follow the instructions printed
on the drape packaging to correctly apply the drape to the DSM head
and robotic arm.
►If the drape affects the balance of the robotic arm, rebalance the DSM,
see Chapter 6.2.2.
►Perform all the remaining items of the function checks before starting
the surgery, see Chapter 5.3.
a
c = 1,47 m
b = 2,03 m
a
a
-90° 0° 90°

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5.7 Starting a case
Once the DSM arm has been draped and all pre-operative checks are com-
plete, a new case can be started.
Fig.15
►Select a surgeon profile and a patient in the “Case” tab.
– or –
►Add a new Surgeon profile or Patient by using the Add button.
DSM settings and preferences are saved for each Surgeon profile.
The Delete button is disabled when the “Default Surgeon” or
“Default Patient” is selected, but it can be used to delete custom pro-
files.
►When the DICOM settings are configured to a networked database,
select the “DICOM” toggle and search for a patient. To search all listed
patients in the database, enter an asterisk (*) in the first and last name
search fields.
►Once the desired surgeon and patient have been chosen, press “Start
Case” to advance to the live screen, see Chapter 6.3.
5.8 Ending a case
►Select the End Case button to end the current case.
If recordings or snapshots were taken during the case, there will be
options to save and/or upload the case media for both DICOM and non-
DICOM patients to the DICOM server (if applicable), local drives, or
connected external drives.
5.9 Saving case media
If snapshots and/or images were recorded, ending the current case will
prompt users to save the media. The patient information can also be
updated at this time, even if the case was started with previously saved
information.
5.9.1 Save to default location
After selecting to end the case:
Fig.16
►Press “Yes” to continue saving the media information.
– or –
►Press “No” to permanently delete all case media (this will require con-
firmation).
– or –
►Press “Cancel” to return to the case.
Selecting “Yes” will allow the patient’s information to be added or
updated. Patient information saved prior to starting the case will be
retained at the end of the case.
Fig.17
►Enter a first and last name, then press Next button to continue, or
Cancel button to return to the “Save Recorded Media?” message.
►Press the pencil button to add or update “Optional Patient Data”.
This option is enabled once a first and last name have been entered.
►Press OK button when done editing to proceed.
Fig.18
From the “Media Information” screen, optionally keyword(s) can be
entered or the folder name changed.
►Press Back button to return to the previous screen or press OK
button to proceed.

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5.9.2 Copy media to drive
Fig.19
►To copy case media to an available local or externally connected drive,
select the drive letter from the drop-down list, then press “Yes”
– or –
►Press “No” to save to the default location only.
The save media screens will close and the application returns to the
home screen.
There will be progress messages for the copy in progress, as well as con-
firmation once it completes.
Note
The location where case media will be saved is F:\TVS\TrueVision\Sur-
geons\<SurgeonName>. Selecting an additional drive to copy to will be in
addition to the default location.
5.10 Removing the drape
At the end of the case or when the robotic arm drape needs to be removed:
►Ensure the area is clear of objects or people and move the robotic arm
into the “Drape” position, see Chapter 6.2.1.
►Release the stripes on the drape bag.
►Detach the adapter from the camera head.Invert and remove the drape
along the robotic arm.
►Dispose the sterile drape in compliance with medical waste regulations.
5.11 Shutdown procedure
For safety, it is important to follow proper shutdown procedure when the
DSM system is not in use. The software will need to be shut down, the
robotic arm will need to be moved into storage position, and the system
power should be turned off with the main power button.
5.11.1 Software shutdown and robotic arm storage
►After the drape has been removed from the robotic arm, press the Exit
button.
►Once the 3D display is cleared from the robotic arm movement path,
move the robotic arm to “Storage” position, see Chapter 6.2.1 or press
“Cancel” button (return to the application).
Once the robotic arm is fully in “Storage” position, the software will
automatically provide further options to “Shut Down”, or press “Can-
cel” button (return to the application).
Fig.20
5.12 Changing footswitch batteries
Battery type: 3 × IEC- LR14 (Type C – “Baby”)
►Shut down DSM, see Chapter 5.11.
►Open battery housing: Rotate both lockers near battery housing by 90°.
While doing so, lightly press down the battery cover.
►Lift the empty batteries by the ejector belt and remove them.
►Insert new batteries. Keep attention to the right polarity (see marking
on battery compartment bottom).
►Close battery housing: rotate both lockers back to original position.
6. Software
6.1 Home screen
The DSM software starts on the home screen on the touchscreen.
Fig.21
Symbols
Protective stop
As a risk control, the software has a protective stop button in
the unlikely scenario that the robotic arm moves in an unpre-
dictable way. The protective stop button halts all robotic arm
movement when pressed. The button is available in both the
home and live screens.
The button will change color from red to gray when engaged
(On, movement disabled).
Press the button again to remove the protective stop and allow
the robotic arm to move again. The button will change back to
red.
Eject drive
When an external USB drive is connected to the system, select
the Eject button to properly eject the drive. The software will
confirm the drive has been ejected and can be physically
removed.
TrueMedia application
Select the TrueMedia application playback button to view or
edit surgical content. The DSM software will need to close in
order to open TrueMedia.
Fullscreen view
Select the fullscreen button to enter fullscreen mode, which
displays the surgery view and contains active status messages
and the buttons for emergency stop, settings, and exit
fullscreen mode. The fullscreen view button is available in both
the home and live screens.
Select the close fullscreen button to exit fullscreen mode.

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6.2 DSM setup
The “Setup” panel in the home screen provides the following functions:
■Move the robotic arm to a preset position
■Rebalance the DSM
■Enter recovery state
■Reconfigure the coupler.
Note
Setup should always take place before surgery.
Fig.22
6.2.1 Preset positions
The available preset positions are:
■Drape
■Storage
Fig.23
Legend
aKeep this area clear vertically during position change
bKeep this area clear horizontally during position change
►Select a pre-configured position for the robotic arm in the “Position”
drop-down list.
►Press the “Press and Hold to auto-position” button until the robotic
arm movement fully stops in position.
6.2.2 Rebalance scope
Moving the robotic arm to its limits can affect the DSM’s balance. To cor-
rect the presence of any drift, the DSM can be rebalanced.
The DSM robotic arm is factory-calibrated. It is recommended to rebalance
the robotic arm once annually or as needed, especially if the robotic arm
feels unbalanced during movement with the handle brake-release buttons.
►Ensure the area of the robotic arm is clear.
►Press “Rebalance Scope” in the “Setup” tab.
In rare instances, some configurations can cause the robotic arm to lock
up when reaching the joint limits.
►If this occurs, move the robotic arm to a preset position.
Note
If proper rebalancing of the DSM still results in unsatisfactory balance, con-
tact Aesculap Technical Service for assistance, see Chapter 10.
6.2.3 Robot recovery
If communication is lost with the force-torque sensor or the coupler and
the robotic arm becomes difficult or impossible to move, the arm joints
need to be manually repositioned.
►Press and hold “Robot Recovery” in the “Setup” tab.
►Manually reposition of the arm joints.
6.3 Live screen
Selecting “Start Case” in the “Case” tab advances to the live screen,
intended for live surgery. The Live Screen shows controls for the DSM head,
robotic arm, recording, fluorescence, and access to settings.
Fig.24
6.3.1 Zoom, focus, and light controls
The “DSM” tab within the “DSM Control” panel shows controls for zoom,
focus, white light levels, and DUV light levels (if licensed). The DSM control
values can be adjusted by using the handles, footswitch, or the touch-
screen.
►Press anywhere on the value bar or press and drag the slider to change
the values.
►Select the or buttons for fine tuning.
WARNING
Risk of injury due to unintended movement of the
robotic arm!
►Make sure the area surrounding the robotic arm
is clear of objects or people.
►Watch the robotic arm while it is moving.
a = 450 mm
b = 1 240 mm
Setting Range
Zoom 1.00 × to 10.00 ×
Focus 200 mm to 450 mm
White Light 0 % to 100 %
DUV Light 0 % to 100 %

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6.4 Fluorescence controls
Note
Fluorescence module (DUV 400) requires a license for use with the DSM sys-
tem.
DUV 400: The integrated DUV 400 fluorescence module of the DSM is
used to visualize near-UV fluorescent areas in the surgical field. The mod-
ule has been designed for excitation in the wavelength range from 390 nm
to 420 nm and for fluorescence visualization in the wavelength range
greater than 510 nm. The module enables the surgeon to switch between
white light and blue-violet excitation light for fluorescence. In addition to
visualization, users can record fluorescent and auto-fluorescent light
emitted by tissue by enabling the “Overlay” feature.
Fluorescence controls can be adjusted by using the handles, footswitch, or
touchscreen.
Note
The “Autofocus” feature is disabled while fluorescence function DUV 400 is
enabled. Use the touchscreen, handles, or footswitch to manually refocus
the target image.
6.4.1 Function checks
►Before starting fluorescence visualization, always check the function-
ality of the integrated fluorescence module.
►Ensure that the DSM system is in a dark room, with no other illumina-
tion other than the DSM integrated lighting and the system displays.
►Place the reference card on a level surface.
►Set the focus to 325 mm and the zoom to 5 × on the touchscreen.
►Refocus the image by moving the DSM head upwards or downwards
using assisted drive.
►Activate the fluorescence function by selecting the “DUV 400 On” but-
ton on the touchscreen or the corresponding handle or footswitch but-
ton.
►In the live image, check the following:
–DUV 400: There is distinct contrast (orange/pink) between the DUV
400 reactive compound and the reference card (green/white).
– The reactive compound must be clearly distinguishable and the live
image should not be washed out. Slight deviations in color and
brightness are acceptable.
6.4.2 DUV 400 imaging
The following factors influence the visualization of the fluorescence sig-
nal:
■Fluorescence medium and its concentration in the tissue
■Illumination intensity of the light source in the defined wavelength
range (both blue and white light)
■Transmission of the optical system
■Working distance and the illuminated field diameter
■DSM white light level
►Activate the fluorescence function by selecting the “DUV 400 On” but-
ton on the touchscreen or the corresponding handle or footswitch but-
ton.
The “DSM Control” panel will still be available and – additionally – the
“DUV Light Level” value bar can be adjusted while DUV 400 is on.
►Select “Overlay” to show an overlay of captured fluorescence in the live
view.
►Select “FL Off” to turn off near-ultraviolet light and return to white
light only.
6.5 Touchscreen robot control
Fig.25
The robotic arm pan and rotation movements can be controlled from the
“Robot” tab in the “DSM Control” panel in precise, single-axis movements.
Each arrow (Forward, Back, Left, Right, Up, and Down) corresponds to a
directional movement in relation to the DSM head.
Holding down one of the directional arrow buttons moves the robotic arm
until a joint limit is reached. Directional movements can also be employed
by configuring the corresponding commands to the handle buttons (see
Chapter 6.8.10) or footswitch buttons (see Chapter 6.8.11).
6.5.1 Lock On Target
The “Lock On Target” function locks the DSM onto a selected focal target
in the live image. When enabled, directional movement will rotate around
the focal target instead of moving linearly. Up and Down directional
movement remains unchanged while “Lock On Target” is enabled.
“Lock On Target” does not apply when moving the DSM by using the han-
dle brake-release buttons, even when enabled. After such a movement,
Lock On Target movement will resume as long as it is enabled.
►Press the “Lock On Target” button to activate/deactivate the function.
6.5.2 Robot Speed
If the slider position is closer to “Min” (minimum), the robotic arm move-
ment will be slower, and if the slider position is closer to “Max” (maxi-
mum), the robotic arm movement will be faster.
►Change the speed of the robotic arm movement by clicking anywhere
on the “Robot Speed” bar or by clicking and dragging the slider.
6.6 Quick Access Bar (QAB)
The Quick Access Bar (QAB) can be configured to show the top four most-
used available functions in the home and live screens, as well as while in
fullscreen.
Fig.26
►Edit the QAB by selecting the pencil button and toggling on or off
the available functions.
Selected QAB functions are highlighted in green and are added to the
bar by order of selection.
WARNING
The fluorescence reference card and the touch-
screen are not sterile!
►Perform fluorescence functional tests before
surgery.

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The following QAB functions are available:
Note
If “Auto-focus After Move” in the “Camera” settings panel is disabled, the
focal target will not be reassessed after manual movement while “Lock On
Target” is enabled. To refocus image manually, use the touchscreen, han-
dles, or footswitch.
6.7 Robotic arm state indicators
The robotic arm has defined force, speed, and geometric limits for safety.
As the arm approaches a limit, the indicator shown in the lower right of
the live screen will change its icon and color.
The Indicator states are pictured and described in the table below:
Note
In the unlikely event that the robotic arm becomes difficult to move near a
geometric limit, it is recommended to move the robotic arm back to a preset
position (e.g. Drape).
6.8 Software settings
►Select the Settings button to open system settings panels.
The “Camera” settings panel will open by default the first time the set-
tings are accessed.
After that, the last used panel will be opened in subsequent accesses.
Selecting a different Settings button will automatically save any
changes made and switch panel.
Selecting the More Settings button reveals additional settings panels.
Function Description
Viewport Configure the format for multiple inputs on screen.
Select between primary input, secondary input, split
screen, or picture-in-picture. Configure a second video
source in the input settings.
Swap Sources Switch between the primary and secondary input in the
main view.
Orientation Toggle the orientation of the primary input between
standard and inverted 180 degrees.
Digital Aper-
ture
Toggle a digital aperture that blocks out the periphery
of the image. Adjust the size and transparency in the
“Digital Aperture” settings, see Chapter 6.8.3.
Autofocus Select to automatically focus the object in the center of
the DSM image.Start the autofocus by:
■Pressing an appropriately configured handle button,
see Chapter 6.8.10
■Pressing an appropriately configured footswitch
button, see Chapter 6.8.11
Specification Limit
Force 250 N
Speed 1 m/s
State Icon Description
Initializing State Displayed during initial power ON, or
when arm is initializing
Ready State Displayed when arm is ready for
movement
Emergency Stop State Displayed when Emergency Stop
button is engaged
Protective Stop State Displayed when the robot is in a pro-
tective stop state after the arm
movement is interrupted
Soft Stop State Displayed when soft stop state is
selected
Footswitch Directional
Move with No Restric-
tions
Displayed when moving the arm
with the footswitch and there are no
movement restrictions
Footswitch Directional
Move Approaching
Restrictions
Displayed when moving the arm
with the footswitch and arm
approaches a directional limit
Footswitch Directional
Move with Restrictions
Displayed when moving the arm
with the footswitch and arm reaches
a directional limit
Handle Directional Move
with No Restrictions
Displayed when moving the arm
with the handle buttons and there
are no movement restrictions
Handle Directional Move
Approaching Restric-
tions
Displayed when moving the arm
with the handle buttons and arm
approaches directional limit
Free Drive State Displayed when robot arm is in “Free
Drive State”
Pre-Programmed Posi-
tion Move
Displayed when arm is moving to a
pre-programmed position
Assisted Drive Move
with No Restrictions
Displayed when moving the arm
with the handles and there are no
movement restrictions
Assisted Drive Move
Approaching Restric-
tions
Displayed when moving the arm
with the handles and arm
approaches directional limit
Assisted Drive Move
with Restrictions
Displayed when moving the arm
with the handles and arm reaches a
directional limit
Uncalibrated State Displayed when arm hasn’t been cal-
ibrated
Handle Directional Move
with Restrictions
Displayed when moving the arm
with the handles buttons and arm
reaches a directional limit
GUI Directional Move
with No Restrictions
Displayed when moving the arm
from the user interface and there are
no movement restrictions
GUI Directional Move
Approaching Restric-
tions
Displayed when moving the arm
from the user interface and arm
approaches a directional limit
GUI Directional Move
with Restrictions
Displayed when moving the arm
from the user interface and arm
reaches a directional limit
Failure State Displayed during a hardware mal-
function
Coupler in Unlocked
Position
Displayed when coupler in Unlocked
position and while changing coupler
orientation
State Icon Description

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Commonly found buttons in the settings panels include:
6.8.1 Camera settings
In the Camera settings panel the following settings of the DSM camera
can be modified:
■Orientation
■Auto-exposure
■Auto-focus After Move
Orientation
The Orientation drop-down menu has the following options:
■Standard (default, used for most configurations of the DSM head to
match the surgeon’s view)
■Rotated (180° view from Standard orientation)
The orientation applies to all connected monitors, unless “Assistant” view
is being used; see Chapter 6.8.7 for more information on “Assistant” view
settings.
Note
The DSM handle button layout will rotate if the view is set to "Rotated" in
software settings.
Auto-exposure
When “Auto-exposure” is enabled, the live view automatically adjusts for
changing lighting conditions and is especially effective in reducing red
color saturation.
When “Auto-exposure” is disabled, no adjustments to the live image will
be made.
►Press the “Auto-exposure” toggle to disable (default) or enable the fea-
ture.
Auto-focus After Move
If “Auto-focus After Move” is enabled and the DSM is moved via any
method, once the DSM stops movement the software will automatically
refocus on the current focal point.
When this feature is disabled, manual adjustment to achieve ideal focus
will be required (using the handles, footswitch, or touchscreen).
►Select the “Auto-focus After Move” toggle to enable (default) or dis-
able the feature.
6.8.2 Screen Layout
In the Screen Layout settings panel the following settings of the DSM
camera can be modified:
■Picture in Picture (PiP) Location
■DSM Settings
Picture in Picture (PiP) Location
The “PiP Location” drop-down menu has the following options:
■Bottom Right (default)
■Top Left
■Top Right
■Bottom Left
DSM Settings
The “DSM Settings” drop-down list has the following options:
6.8.3 Digital Aperture
The Digital Aperture feature enables a digital overlay where the live
image can be restricted to a circle in the center of the screen, with a dark
mask covering the rest of the image.
►Press the toggle button to disable (default) or enable the feature.
Diameter
►Use the “Diameter” bar to select or slide the value anywhere between
0.05 (smallest diameter) and 1.00 (largest diameter).
The default Diameter is 0.75.
Opacity
►Use the “Opacity” bar to select or slide the value anywhere between
0.05 (most transparent mask) and 1.00 (most opaque mask).
The default Opacity is 0.50.
6.8.4 DUV 400 (Fluorescence)
In the DUV 400 panel the following settings for the DUV 400’s overlay
can be modified:
■Hue: can be adjusted on a range of yellow to blue (default: green)
■Opacity: can be adjusted from 0 to 100 (default: 100)
■“Auto-Overlay”
“Auto-Overlay”, when enabled, transitions from DUV 400 to Overlay after
a set amount of time. “Overlay Mode Timer” can be adjusted from 1 to 60
seconds. By default, “Auto-Overlay” is disabled and “Overlay Mode Timer”
is set to 30 seconds.
6.8.5 Color
In the Color panel the following settings can be modified:
■Gain: can be adjusted from 0 to 80 (default: 0)
■Picture: adjust Brightness, Contrast, Gamma, Hue and Saturation
■White Balance
Picture
Note
These are advanced settings. It is not recommended to change these set-
tings.
►Select the desired quality setting by pressing or pressing and dragging
the slider on any of these settings:
– Brightness: determines the intensity of the color in the live image
(range: 20 to 80, default: 48)
– Contrast: difference between the lightest and darkest regions of the
live image (range: 20 to 80, default: 55)
– Gamma: non-linear operation used to encode and decode lumi-
nance of the live image (range: 0.50 to 5.00, default: 1.20)
– Hue the degree to which a stimulus can be described as similar to
or different from stimuli that are described as red, green, blue, and
yellow (range: -180 to 180, default: 2)
– Saturation: the amount of white mixed into the hue (range: 0 to
300, default: 90)
►To return to the original settings, press the “Default” button.
Icon Description
Exit panel without saving changes made to current panel.
Reset the current panel to its default settings.
(Not present for DICOM or Input panels.)
Save changes and close panel.
Option Description
Auto-Hide
(default)
The DSM control values (Zoom, Focus, and White Light)
will be displayed over the live surgery screen for ~5 sec-
onds and then hidden after adjusting the values.
Show The DSM control values will always been shown on the
surgery screen(s).
Hide The DSM control values will never be shown on the sur-
gery screen(s).

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White Balance
Every DSM is shipped with pre-configured white balance settings.
Note
These settings may not be optimal for the specific lighting conditions.
►To reset the white balance to the factory settings, press “Reset to Fac-
tory WB” button.
For the best image, the DSM should be white-balanced.
►Set the DSM light to the surgeon’s normal working conditions.
►Place the white balance card PV030 under the light. Ensure that the
entirety of the live view is filled by the card. Never use gauze, tape,
sheets, or other fabrics which may have been bleached.
►Tilt the card and move it either closer or farther from the light as the
software instructs.
►Select White Balance button to perform white balance and follow
the on-screen instructions to complete the white balance process.
►Test the colors by viewing your hand under the DSM. Repeat the pro-
cess if the colors look incorrect.
6.8.6 Recording
In the Recording panel the following settings can be modified:
■Movie or snapshot file formats
■Auto-record
■Fullscreen recording
■Frame rate
■Movie quality
■DICOM 3D recording
Note
Recording settings cannot be changed while recording a case.
Basic settings
Note
Fullscreen recording is not recommended due to possible delays in the
image.
►Select the desired recording settings:
– Movie format: Press the radial button of either “AVI” or “MOV”
(default: MOV).
– Auto-Record: check the checkbox to have the software start record-
ing as soon as “Start Case” is selected (default: unchecked).
– Fullscreen: Check the checkbox to record the surgery screen with all
annotations and overlays. If unchecked, the software will only
record the raw DSM input (default: unchecked).
– Snapshot format: Press the radial button of either “JPEG” or “PNG”
(default: JPEG).
Advanced settings
Note
Increases or decreases to frame rate and quality can be expected to have
relative increases or decreases to file size.
►Select the desired advanced recording settings:
– Frame rate: frames per second that will be captured during a
recording. Select the desired frame rate by pressing or pressing and
dragging the slider from any value between 30 fps and 58 fps
(default: 45 fps).
– Quality: can be adjusted from 0 to 10, resulting in respective
changes to recording quality. Notably, minimizing the slider can
introduce compression elements such as haloing or blurry frames to
the recording with the benefit of reducing file size. Select the
desired quality setting by pressing or pressing and dragging the
slider from any value between 1 and 10 to change the quality for
recordings (default: 5).
– Squeezed SxS (side by side): checking the checkbox reduces resolu-
tion of saved media to 1920 × 1080 (default: unchecked). Select
this option when smaller file sizes and/or the ability to edit with 3rd
party editing software are required.
– DICOM Record 3D: when a DICOM patient is selected at the start of
a case, all media recordings will be in 2D by default. Check the
checkbox to record all DICOM case media in 3D. Uncheck the check-
box to record in 2D again.
Note
Non-DICOM patient case media are in 3D by default, therefore the “DICOM
Record 3D” feature is disabled when a non-DICOM patient is selected.
6.8.7 Display
In the Display panel certain display settings can be modified, including
the view type, 3D format, and polarity of connected monitors (see
Chapter 3.3.3 for a list of compatible displays).
Identification information (numeric identifier, model number, 3D format,
polarity, resolution, and view type) will automatically appear on the live
image of each connected monitor while the Display settings panel is open.
Note
For displays intended for use (see Chapter 3.3.3), the 3D format and polarity
(“Swap 3D”) are automatically detected and set to their ideal pre-configu-
rations, as long as “Detect” remains enabled with the default panel settings.
►To return to the ideal pre-configuration after making changes, select
“return to defaults” button, then ensure “Detect” is enabled.
Detect
►Press the “Detect” button to turn this feature on or off.
Detect is set to “Off” by default to allow the software to automatically
configure the connected displays to their saved settings.
Display List
►To view or manually modify settings for a specific display, select the
corresponding numeric identifier for that display from the “Display”
drop-down list.
View
►Press the “View” drop-down list to assign a view type to the selected
display.
The available view types are:
■Control
■Surgery
■Assistant 180
■Assistant 90 CW
■Assistant 90 CCW
“Surgery” view is a non-interactive secondary view with the primary func-
tion of displaying the live image. “Surgery” view will display relevant noti-
fications as they appear on the “Control” view.
“Assistant 180", “Assistant 90 CW” (clockwise), and “Assistant 90 CCW”
(counter-clockwise), are “Surgery” views that are rotated as indicated.
Note
At least one display must be assigned a “Control” view type. The touch-
screen display is assigned as the “Control” view by default.
3D Format
►When “Detect” is set to “Off”, press the “3D Format” drop-down list to
change the 3D format for the selected display from the following avail-
able options:
– Monoscopic
– Row-Interleaved
– Side-by-Side
– Top-Bottom
–Dimenco