The Surgical Robot Built Into the Operating Table
How does a robotic surgical system with four arms integrated directly into the operating table expand access to robotic surgery in rooms previously considered too small?
Photo source:
Ottava-robotic
Why OTTAVA Matters
Demand for robotic-assisted surgery is growing,
but many hospitals struggle to scale their robotic surgical volumes.
Traditional robotic systems require large external carts or ceiling-mounted
booms that take up significant operating room space, limit how many rooms can
accommodate robotic procedures, and add complexity to setup and breakdown
between cases. Smaller operating rooms are often excluded from robotic surgery
entirely because the equipment simply does not fit alongside the surgical team
and patient. Johnson & Johnson MedTech developed the OTTAVA Robotic
Surgical System to address those constraints. It is the world's first soft
tissue robotic surgical system with the robotic arms fully integrated into the
operating table itself.
The FDA granted De Novo authorization for
OTTAVA, clearing it for multiple procedures in general surgery, including
Roux-en-Y gastric bypass, gastrectomy, cholecystectomy, splenectomy, gastric
sleeve, small bowel resection, appendectomy, lysis of adhesions,
fundoplication, and hiatal hernia repair. During the FORTE clinical trial, the
system was installed and used successfully across six US hospital sites.
Operating room sizes in that trial ranged from approximately 243 to 694 square
feet, and in five of the six sites, procedures were performed in rooms that had
never previously been used for robotic surgery due to space constraints.
How This Table-Integrated Surgical Robot Works
OTTAVA features four low-profile robotic arms
built directly into a standard-size surgical table. When not in use, the arms
stow underneath the table, making the system virtually invisible in the room.
This eliminates the need to transport, store, or maneuver separate robotic
carts or ceiling booms before, during, or after a procedure. According to
Johnson & Johnson, the system occupies 30 to 50% less space than
traditional boom- and cart-mounted robotic systems, and 34% less space than Da
Vinci 5 specifically.
Sophisticated software controls coordinate the
four arms and enable automated, pre-defined procedural poses. These poses
simplify both setup and breakdown by positioning the arms for specific surgical
steps without requiring manual adjustment. A feature called Twin Motion
synchronizes the movement of the table and the robotic arms together, allowing
the surgical team to reposition the patient during a procedure while
maintaining multi-quadrant access to the anatomy without the need to undock and
redock the system. The unified architecture also supports robotic,
laparoscopic, hybrid, and open surgery within the same operating room.
Exploring the Practical Benefits of Using OTTAVA
The console where the surgeon controls the
robotic arms is designed around ergonomics. Surgeons sit upright while
maintaining access to the full surgical workspace, a posture intended to
minimize the eye and neck strain associated with prolonged procedures. Each
surgeon can save personalized settings to a profile that loads automatically
the next time they log in, reducing the setup time between different operators
using the same system. The controls are designed to capture and convey natural
surgical movement, translating the surgeon's hand motions into precise
instrument actions inside the patient.
OTTAVA exclusively features Ethicon
instrumentation, drawing on Johnson & Johnson's portfolio of surgical tools
developed over more than a century. The instruments are designed specifically
for robotic use, built to deliver a consistent experience between traditional
minimally invasive surgery and robotic-assisted procedures. This means surgeons
transitioning from laparoscopic to robotic workflows encounter familiar
instrument behavior rather than an entirely new set of tools.
Digital Platform and Ongoing Support
Alongside the physical system, Johnson &
Johnson developed Polyphonic for OTTAVA, a secure digital platform that
supports surgical teams throughout the OTTAVA experience. Polyphonic brings
together learning resources, surgical media, and data-driven insights in a
single environment connected to the robotic system. This is intended to help
teams track performance, access training materials, and make data-informed
decisions about their surgical program.
The service and support infrastructure includes
multi-tier plans that hospitals can choose based on their needs and budgets,
with the flexibility to upgrade or downgrade as requirements change. Coverage
includes the integrated table and the uninterrupted power supply system under a
single payment. Remote diagnostics enable faster issue identification, and the
digital solutions connect systems and people to keep actionable information up
to date. Johnson & Johnson describes the goal as maximizing system uptime
and protecting case schedules from disruptions caused by equipment downtime.
Where Table-Integrated Robotics Fits in Surgical Innovation
Robotic-assisted surgery has grown
significantly over the past two decades, but adoption remains uneven. Many
hospitals that would benefit from robotic capabilities have not adopted them
because of the infrastructure required. Traditional systems demand dedicated
operating rooms large enough to accommodate bulky external hardware, and the
time needed to set up and break down between cases can limit how many robotic
procedures a room can handle in a single day.
By integrating the robotic arms into the table
itself, OTTAVA changes the infrastructure equation. Rooms that were previously
too small or too difficult to configure for robotic surgery can now potentially
accommodate it. The clinical trial demonstrated this directly, with five of six
participating hospitals performing robotic procedures in operating rooms that
had never been used for robotic surgery before. Whether this architectural
approach drives meaningful increases in robotic surgical adoption will depend
on how effectively the system performs across a broader range of procedures and
institutions, and whether the reduction in space requirements translates to
measurable gains in operating room throughput and scheduling flexibility.
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