Advancements in RAS (robotic-assisted surgery) systems have led to a small robot that allows surgeons to obtain full multi-quadrant access without the need for docking and redocking a large, cumbersome external platform. (Credit: Virtual Incision)

The advancements in the design of robotic-assisted surgery (RAS) systems continue to aim toward enabling operations to be performed through small incisions. This is done by providing the surgeon the ability to control robotic arms and cameras with precision. The goal of RAS is to help surgeons perform procedures reproducibly in a minimally invasive manner, which, in turn, can lead to advantages such as reduced pain and shorter hospital stays.

As demand for RAS continues to grow, facilities are seeking ways to accelerate the expansion of their programs. The goal of Virtual Incision (Lincoln, NE) is to offer a way for facilities to add systems and improve their efficiency without disrupting their existing infrastructure. To do this, the company designed and manufactured MIRA, the world’s first miniaturized RAS platform that aims to be easily transported and set up in any operating room. The system is made up of MIRA, a surgeon console that provides complete control of the MIRA instrument arms and endoscopic vision of the anatomy in real-time, and a companion cart to easily transport equipment (see Figure 1). Setup is designed to be straightforward. The goal is to enable the 90 percent of operating rooms that do not currently have access to an RAS system to now have access so that an increased number of patients can be served.

Fig. 1 - MIRA’s three components are easy to set up quickly, enabling any operating room to be used regardless of its size. As of the time of this publication, MIRA is an investigational device not available for sale in the US. (Credit: Virtual Incision)

During the design phase of MIRA, Virtual Incision found that the major engineering challenge was to create something small, portable, and easy to use while maintaining the strength to perform challenging operations — such as bowel resection surgery — for which the device was successfully used in an IDE study to support its FDA market authorization. In addition, the company wanted to design the device in such a way that it would be easy to clean and sterilize between cases. This feature would eliminate the need for draping that most present systems on the market require. Draping ultimately adds time between procedures, potentially reducing the number of patients who can be treated.

MIRA is a highly differentiated solution in comparison to the boom or pedestal-based systems (the mainframes) that require a large footprint and are less portable. Such systems are limited for use with spacious operating rooms, which may impede workflow in the OR by requiring more cumbersome setup as well as blocking the vision and movement of support staff.

The Motion Components

Fig. 2 - maxon designs and manufactures a complete line of motors, gearboxes, and accessories for a wide variety of motion system applications, which enabled a rapid iterative process in the design of MIRA that would meet demanding high speed and torque requirements. (Credit: maxon)

Virtual Incision chose to work with maxon during the design of MIRA, along with the first-ever integrated articulating camera to be used in an RAS system. The system has demanding requirements due to high speeds and torques. maxon was in a unique position to support Virtual Incision’s rapid iterative “make and improve” design process because of its complete line of motors (see Figure 2) and world-renowned expertise. Testing and qualification activities are also supported to ensure reliability and consistency of the subassemblies going into the MIRA system. maxon’s team of engineers was helpful from conception and design to manufacturing of the subsystems. Virtual Incision developed all of the accompanying hardware, firmware, and software in-house to optimize miniaturization and device performance characteristics.

The team was able to increase the efficiency of the system and maximize the deliverable output power for each joint. This design feature is what makes MIRA very strong for its size, delivering up to two pounds of output force anywhere in the workspace while maintaining speed and agility.

A Unique Approach

Fig. 3 - The rigid arms with the motors mounted inside provide strength while fully enabling triangulation of the camera and instruments.

The mainframe type RAS systems incorporate motors located outside of the body, placed on booms or pedestals in order to give the device enough strength. MIRA gains its strength in a small size by placing the motors inside the body. The rigid (non-snake-like) arms with the motors mounted inside deliver the needed strength while also enabling triangulation of the camera and instruments (see Figure 3). The device has been used clinically for bowel resection procedures, and this is the first time the motors for an RAS device have ever actually operated inside the human body.

The requirements of surgery demand both strength and speed. Through the use of high-efficiency, top-of-the-line motors, MIRA has been designed specifically to manipulate large and heavy organs such as the colon. The RAS must be able to mimic the real time motions of the surgeon in order for it to provide quick responses when required.

In addition to strength, colorectal procedures often require the RAS system to reach into multiple quadrants of the abdomen — sometimes all four. Multi-port mainframe systems require careful port placement and procedure choreography to avoid external arm collisions. MIRA’s miniaturized, self-contained design enables full anatomical access without the concern of external arm collisions.

Additionally, the articulated camera design ensures proper triangulation between the instruments and camera in all operating scenarios. As a medical device, special considerations including sterilization, biocompatibility, electrical safety, and delivery of electrocautery were all part of the MIRA design.


Virtual Incision believes that the best and most productive approach to innovation is through doing. The company designs products by creating something, testing it profusely, and learning everything possible from the experience. This make-and-improve approach has enabled the company to implement iterations in minimal time, allowing them to push the boundaries of the technology — in this case, making smaller RAS devices. As a partner, maxon has provided the technical expertise as well as the willingness to try variations to Virtual Incision’s innovations.

In the end, MIRA is the smallest RAS on the market. It offers significant strength for its size and enables quick setup in any operating room. This includes outer space, as a version of MIRA has been tested on the International Space Station in 2024 where surgeons on Earth remotely controlled the device from a console to simulate activities performed in surgery, including cutting simulated tissue and manipulating small objects.

This article was written by Peter van Beek, Business Development Manager, maxon medical, Taunton, MA. For more information about maxon, contact This email address is being protected from spambots. You need JavaScript enabled to view it. or visit here . For more information on Virtual Incision, visit here .