da Vinci OnSite Site Survey Questionnaire

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Survey Overview

This site survey questionnaire is used to request network information to configure your da Vinci® Surgical Sysytem(s) to support the da Vinci® OnSite upgrade that is provided free of charge as a part of your standard service warranty. This information will be used by Intuitive Surgical's Field Engineers to configure the network components in your da Vinci Surgical System(s) to enable OnSite (remote service diagnostics).

For any questions regarding this survey please contact the Intuitive Surgical Customer Service at 1(800) 876-1310 opt 2,2 or email ras@intusurg.com.

Hospital / System Information

IT Contacts

Please fill out IT contact information. The primary IT contact will be considered by Intuitive Surgical to be the customer's network point of contact.

IT Primary Contact

IT Secondary Contact

da Vinci OnSite Overview

OnSite remote diagnostics feature for the da Vinci Surgical System is designed to be both highly secure and firewall-friendly.  The da Vinci System negotiates outgoing TLS session based on PKI certificate authentication communication with the remote access servers at Intuitive Surgical to facilitate status updates, log uploads and remote access to the system.  The system does not communicate nor require access to any of the hospital's internal resources.  The critical OnSite networking component that is integrated into the da Vinci Surgical System is a firewall.  The requested network information you provide will be used to configure the firewall and your da Vinci Surgical System to access Intuitive Surgical OnSite servers. 


*da Vinci S Surgical systems are configured to encapsulate its TLS commuinication in an IPSec tunnel intitiated by its embedded firewall. 

Network/Firewall Requirements:

da Vinci Si and Xi Systems

10/100/1000 Mb Ethernet connection in the OR(s)

Allow TCP port 443 outbound to dvms-dv.intusurg.com ( and dvms-dv.davinci-onsite.com (

Allow TLS 1.2 cryptographic protocol


da Vinci S System

10/100/1000 Mb Ethernet connection in the OR(s)

Allow UDP communication on ports 500 and 4500 between the da Vinci and (ISI VPN Hub)

*If the da Vinci hopital provided IP is a public IP then additonal ESP port 50 bidirectional communication is required  


If a static IP is to be provided, please fill in the following information below:

**The robot is nat'd behind an integrated firewall on a  It is essential that the IP address provided will not be address.

Port Speed Settings

100M 10M Full Duplex Half Duplex
Data Jack Locations

OR: Data Port: Jack No.:

* Used to trouble shoot in bound traffic

Wireless Option

If wireless access is possible and or desireable, please complete all necessary fields below.


The wireless communication is facilitated by installing a wireless bridge operating in “bridge mode”, acting as a client to the hospital supplied Wireless Access Point transmitting data back and forth between the hospital network and the da Vinci Surgical System with OnSite.  The Wireless Connectivity Option utilizes the IEEE 802.11 wireless standard using either 802.11b or 802.11g.


Wireless Bridge

  • Wireless Access Point located within 75 feet of the da Vinci System
  • Maximum latency of 50 ms between the Wireless Bridge and the hospital supplied Wireless Access Point
  • Wireless Channel that has 20% or less utilization

Overall Network

  • Maximum end-to-end packet loss of less than 10%
  • Network latency should not exceed 300 ms


Once successfully installed and configured Intuitive Surgical field service personnel will conduct an end-to-end functional test to ensure that OnSite is functioning as expected.

Post-installation Intuitive Surgical recommends that the hospital routinely monitor to ensure that the Wireless Channel does not exceed 20% utilization, and the latency between the Wireless Access Point and the Wireless Bridge does not exceed 50 ms. If either of these exceeds the specified levels please contact Intuitive Surgical Customer Service.

Please provide the following information:

If static IP is preferred, please fill in the following information below:

Wireless Security Mode

If required, please provide the following information:

Authentication type:


Wep Key Length:


Key Index




Proxy Server

da Vinci OnSite supports transparent and most non-transparent proxies, provided user-authentication or user acceptance is not dynamically prompted via a web browser (the da Vinci surgical system or its user(s) have no means to access a web browser).

If “Yes” please provide the following information:
**da Vinci surgical system does not support/resolve proxy address domain names

*da Vinci Surgical System unable to resolve proxy host/domain names

If “Yes” please provide the following information:


By clicking “submit,” this Hospital/Organization warrants that the information provided above is accurate and grants permission to Intuitive Surgical to attach its da Vinci Surgical System(s) to its network as structured above for its intended purposes.  Given that the Hospital/Organization owns and manages its network infrastructure and configuration, Intuitive Surgical cannot be, and is not responsible for any network changes, disturbances, interruptions of service or suboptimal performance that may result from changes out of Intuitive Surgical’s control.

1da Vinci® Surgical System(s) shall mean any da Vinci Surgical System (past, present, or future models) you have obtained or purchased or will obtain or purchase from Intuitive Surgical, whether via upgrade, purchase, trade-ins, swap-outs, or otherwise.  References in this survey or related document to da Vinci, da Vinci System, da Vinci Surgical robot, da Vinci robot, robot, or System shall be deemed to refer to da Vinci Surgical System as defined here.

Intuitive Surgical and its affiliates within the Intuitive Surgical group of companies (collectively, “Intuitive”) may collect data relating to your use of Intuitive products (“Data”).  In some instances Data may be communicated via data gathering or transmission technology to Intuitive.  In other instances, Intuitive may require you to provide Data to Intuitive.  Such Data may be used for a variety of purposes, including, but not limited to (1) providing support and preventative maintenance of Intuitive products, (2) improving Intuitive products or services, (3) ensuring compliance with applicable laws and regulations, and (4) providing a general resource for Intuitive’s research and business development.  Intuitive does not intend to collect protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) or analogous foreign patient privacy laws or regulations, as may be amended from time to time.  In the event any Data communicated to Intuitive identifies an entity or individual, Intuitive will not share such Data with any third parties without the entity’s or individual’s consent, unless required by law or regulatory authorities.


Please enter the characters you see in this picture:


This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess. You will have another try in the next screen.
Can't see the image? Click here for an audible version in English.

Need assistance with this form?