Intuitive Surgical, Inc.: The da Vinci Xi and X surgical systems (IS4000 and IS4200) each consist of three main components: the Surgeon Console (SC), the Vision Cart (VC), and the Patient Cart (PC). The Patient Cart is the operative component of the system and its primary function is to support the instrument arms and camera arm. The X/Xi Instrument Arm Drape is intended to be used with the instrument arms of the PC as a sterile barrier during clinical procedures, and makes the instrument arms sterile and suitable for surgery. X/Xi Instrument Arm Drapes are sterile unless the package is opened or damaged, and are indicated for a single use. The drapes are placed onto the instrument arms by two users (one sterile and one non-sterile)in tandem, with the non-sterile user leading the placement via drape cuff pockets.

Recall number

Z-0275-2022

Recalling firm

Intuitive Surgical, Inc.

Product

The da Vinci Xi and X surgical systems (IS4000 and IS4200) each consist of three main components: the Surgeon Console (SC), the Vision Cart (VC), and the Patient Cart (PC). The Patient Cart is the operative component of the system and its primary function is to support the instrument arms and camera arm. The X/Xi Instrument Arm Drape is intended to be used with the instrument arms of the PC as a sterile barrier during clinical procedures, and makes the instrument arms sterile and suitable for surgery. X/Xi Instrument Arm Drapes are sterile unless the package is opened or damaged, and are indicated for a single use. The drapes are placed onto the instrument arms by two users (one sterile and one non-sterile)in tandem, with the non-sterile user leading the placement via drape cuff pockets.

Status

Terminated

Initiated

2021-09-21

Posted

not on file

Terminated

2024-01-25

Reason

Incorrect expiration date on its package labeling (shipper box and inner carton label).

Root cause

Labeling Change Control

Action

On September 21, "Urgent Medical Device Recall"-customer letter was sent out to the affected sites, via FedEx and an updated letter with legible print of labels on October 21 to non-responder customers for incorrect expiration date on the package labeling (shipper box and inner carton) label. Both shipper and carton label had expiration date as 11/30/2023 instead of 01/31/2023. The Affected product is being requested to be returned per attached field safety notice (5556010-01 Rev A). The customers had been requested to fax or E-mail the acknowledgement form to, Attn: REGULATORY COMPLIANCE FIELD ACTIONS; Subject line for email: ISIFA2021-05-R Xi Drape Expiration Date U.S. Fax +1(408) 523-0619, or Scan and Email: Recalls@intusurg.com. The firm expects customers to call or email the firm with the unused quantities to receive the replacement or credit to return the affected devices, if customers call or send an E-mail. The firm will provide RMA when customers call the firm. Customers are advised to take actions as: Inform necessary hospital personnel about this issue. 2. Locate all affected products at their site and return to the firm via the standard RMA process. 3. Inform affected personnel when the requested actions have been completed. 4. Complete the attached Acknowledgement Form immediately and return to the firm via fax or email as instructed on the form. 5. Please retain a copy of this letter and the acknowledgement form for customer's files. Replacements will be provided against returned affected product. Customers are provided contact information as: Customers Clinical Sales Representative or contact at the numbers listed below: " North America: (800) 876-1310, Option 3 (4 AM to 5 PM PST) or mail: customerservice@intusurg.com. " South Korea: 02-3271-3200 (9 AM to 6 PM KSTJ)

Quantity

1,740 drapes (87 bobes)

Distribution

Worldwide distribution - U.S. Nationwide distribution in the states of AL, CA, GA, IL, FL, CO, TX, MO, OH, MA, WI, NC, LA, UT and the country of South Korea.

Lot, serial or model codes

Part number: 470015-07; Lot number: DM4210309; REF: 470015; UDI # 00886874112199.

510(k) numbers

["K131861"]

PMA numbers

not on file

Product code

NAY

Firm FEI

3001675293

Firm city

Sunnyvale

Firm state

CA

Firm country

not on file

Cite as

FDA Medical Device Recalls (openFDA) (U.S. Food and Drug Administration (openFDA)), device-recall-0001-of-0001.json.zip, sha256 b87518bfe2e8, published 2026-09-28

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