Dualto is a sneak peek inside Ottava
- Steve Bell
- May 8
- 18 min read
Updated: Aug 30
From design cues - to operating principles - to user interaction to UX - to operating room flow. Dualto indicates to me an inside look into the thinking and design behind Ottava.
And - well it looks intriguing.
The Design cues from Dualto to Ottava
First let us start with the design cues. I will say from an industrial design point of view both Dualto and Ottava have similar styling from plastics to design grills, to corner radius. And they look good. Sleek modern, functional.
Often when companies have multiple major ongoing programs - being able to raid the parts bins and have shared components, processes makes more sense. So in 2025 I would be very surprised if the two R&D teams have not tried to use as much of each other’s learnings as possible.
I think there will be a lot of durable materials overlap. Also manufacturing methods such as magnesium injection moulding process called thixomolding. I do believe that many manufacturing, moulding, extrusion processes. Connector type, connector halo lights etc etc. will all come from the same parts bin. I see a lot in the close ups of Dualto that I think I see in Ottava (but don’t hold me to that until I see them close up and for real.)
Let’s also start with just with the Chasis designs - the idea and theme from both systems is “reduced OR footprint.” 46% claimed for Dualto (need to see the way they measured that) but I guess if you take two generators and stack em you maybe get a near 50% reduction. And that is a consistent theme. And by “combining” modules in the same form factor, that firstly reduces footprint - but interestingly also starts to give dual (hmm Dualto) user operation. And this one grabbed my attention.
So at the bedside it allows two surgeons - one on either side of the patient to use independent energy from the same electrosurgery units. This is sort of new but not totally unique. There are ways that this can be done with other systems - but it looks like Dualto has made this simpler and out of the box.
The Ottava question for me is interesting - as when this is paired up with Ottava - technically you could have the Ottava user activate from the control console - whilst a bedside could actually work bedside and assist - even with energy. Hmmm.
That would start to open up some more forms of “hybrid” and cooperative surgery set ups.
Now yes.. you could do that today with da Vinci. Using the tower from the console - and a second energy system from the bedside. BUT monopolar becomes challenging… return pads - pathways etc. And you need a second generator or control box on a stand in the OR = more floor space. It all gets crowded and a bit ugly. Dualto is elegant by doing it this way.
The Dualto approach when combined with Ottava could give some unique advantages. Plus you could start to see blended modality usage at the same time across dual users?
Now how often you would want that is debatable. How often you have two major teams working at once is rare. But having this capability inherent in the design opens up some interesting options. And with a very reduced footprint. Smells of ASC for footprint… clearly… but main Hospitals for major complexity needing two operating surgeons. So I need to see how that really plays out. But it’s a great marketing message. That is a Unique Selling Proposition right there.
Getting Dualto and Ottava into the ASC
Now — on “floor space reduction”: a statement for the company, and they did start to mention ASCs. Again this is interesting as just going after the ASC with energy devices - interesting - but not a complete picture.
JNJ is not stupid - and they know that the push and future direction of delivering surgery lies in the ASC for many patients. Many specialties. And if the price is right, workflow is right.. robotics.
So Dualto through design - smaller footprint - and modularity helps in those aspects. I think the modularity is more important than many people think - as it allows “fleet shared” components. You won’t need full sets of dual systems for dual operating that much, not all the time. So if you can stack single units that become dual units you can share fleet for it and when it is needed. Less components but full coverage.
So what do I think in relation to Ottava. Again just wild speculation - but ASCs are not lost on the Ottava team. The integrated bed arms are a clever way to reduce footprint dramatically - both in use - but importantly in “storage.”
You can’t have massive robotic systems filling the ASC OR when they are not in use. Ottava packs away - under the table. Of course there is still the console — but the tower…. Hmm wait.
Oh let me come to that.
The power of the tower
Without a doubt Ottava will need to have a lap tower - not just robotic tower (no it is not exactly the same but it sort of it.). And very interesting to see the stackability of these units. Because they are vertically connected - even with the touch screen interface (which may even be walkable around the OR for use to not be tethered to the tower?)
But I look closely at the connectors in the video - and well they start to make me think - yes you can stack two Dualto systems - together. But I think a Dualto style Light box - a Dualto style high flow insufflator with gas evacuation - image box (easily upgradable for different image modalities) - all modular. (There’s a reason they bothered to pad print Energy in the top left hand corner ya know.)
This would speak to JNJs heritage in open - lap and robotic - where instead of a single robotic tower that does lap. Instead we have a fleet of components that all stack up - talk to each other and all use a common iPad style interface that can be slotted onto a comms module.
Imagine a store room full of components that you can pick n mix from - stack as you want and have a cart for open - and then a configuration for lap - and then one for robotic. You can decide if you want a normal flow insufflator off the shelf - or go get a modular JNJ insufflator to stack n match… depending on the case.
And again - this is very cute for the ASCs and the hospitals - but makes it super convenient for dominating ASCs. It’s allowing choice from basic to high end - all depending on the modules you have and the modules you stack. You can cater for the wide range of case acuity without having to commit to high end stacks everywhere. Ideal for the ASC - and high end for the hopsital.
It would also allow a true “fleet” approach. Because you don’t need every component for every OR. You need a central store you can pick from. Hell even shared across sites. (Is that why they want such tough case work??)
I do believe robots will be around the power of the tower (like the DV5 tower below), and I think that Dualto gives a little design peak into what I believe will be their ultimate strategy on Ottava.
I also want to add one more small thing here that could be a big thing. Power. So as I can see the energy unit (written energy so you don’t confuse it with light, insufflation later - just saying.) Has no AC power inlet. And that is fascinating. It is the controller box above that has the power - and that power is passed through the vertical connectors as far as I can see.
Don’t want to imagine the 60601 nightmares they might have had. BUT if they have cracked that, and you can power two generators, a harmonic, an Enseal, data coms and control all from one plug in the wall. Hmm.
That is an OR game changer right there just from ease of plugging in, avoiding trip wires and decluttering the OR. Again ASCs will win the most. People hate wires - hate wires - hate wires.
Now a massive advantage of Ottava and a bed design is one cable to the console. De wire my friends - go wireless my friends if you can.
But (in my speculation) there is a box with light written on it, Imaging on it (okay yes if they are combining then that will be a Vision box with light and imaging in one maybe) then if that too can be powered from that one plug etc etc. I will doff my cap to the engineers for thinking of it, designing it, and actually passing it through type testing.
It;s very different to having a power strip on a tower. Way more elegant and clever.
The True towers - one plug to rule them all. (You saw what I did there I hope FFS.)
The user interface on Dualto and Ottava
One of the biggest clues I have is the user interface shown in the stills and video. It’s a software driven interface - and I believe that depending on the units you stack the UX will allow you to open the controls of any part of the stack. The Energy module, the insufflation module - the light module and the “OR” all via that vertical integration.
Work flow and “more human” are the themes from the management. Well set up and adjustments will be able to be done from these tablets - and potentially anywhere in the OR. It makes me wonder if that interface will be available inside the console view - or if the idea is to bring the exact tablet and connect it to the console… so the console surgeon can control everything as a wing mirror? Or both as a choice?
Today DV5 has it all inside the HUD of the cockpit for the surgeon - but maybe some usability showed that touch screens are faster and more Intuitive. And if you do it all from that touch screen the UX for the tower - the UX for the console are the same - so reduces load on updates and deploying it. Because it is the same device. You can just update the room component and stack screen and not have to update the actual console. Maybe?
If they did, it would make software drops way faster and less complicated. Keep the peripheral control off the robot? I would have done it that way. Make updates as modular as possible.
I’m also scanning every detail of the actual user interface and the few buttons and RFIDs / NFCs next to the screen.
One thing I think is that the surgeon or “user” could have a tag on a keychain - tap the small RFID and the set up (be it lap, robotic, open) will be understood by how the boxes are stacked - and will then do the set up for them as they like it. Or in a phone pre set up prior to surgery…. Later.
Today starting with monopolar and bipolar - and advanced energy. Tomorrow insufflation - light etc etc. makes initial “Tap n Go” easier. And completely competitive with Intuitive.
I do believe Ottava will have that same “tap n go” as it will all be connected. You either tap at the console of you tap at the tower - but it will also then (when all connected) set up the robot to your liking, the room, the energy settings etc
A smart OR from the tower. And the top box - looking at the rear connectors (or one similar) will be the comms unit to talk between all the boxes, Ottava and then via the LAN will parse all that data up to Polyphonic.
So clues in the software interface?
Let me dig a bit deeper into this as I see a few things in the way they have done this.
First the screen with Software updates was not put on the website by mistake. Over the air software updates here we come.
And looking at the granularity - I’m going to suspect they can update individual components. (Which can be named, traced, tracked etc to help JNJ and the biomedical engineers / estates managers.) And I’m going to even wager firmware updates of hand pieces and connectors. All over the air via this comms box.
IF this is correct, then logically Ottava will follow thew same design philosophy (if they are smart) and it will have over the air push of software updates - down to individual parts. It means they have really thought of the two way connectivity of the design of Dualto (and the boxes of the future) plus hopefully the Ottava. I am speculating - but the software and architecture points me that way.
Then what I notice is that within that interface there are the controls which I’ll come to - but also looking at the top bar we can see “Double mastectomy” and the name of the surgeons etc. And ability to STAR it.
That leads me to the procedural ecosystem cues that today is Dualto (for settings and recording all that lovely data and activations - settings etc). But once you get the other modules on - that procedure will span across all of the data windows of energy, insufflation, imaging etc etc. And Ottava data will all pair up - and all of that will get scooped up to Polyphonic. You will get rich data on open cases, lap cases and robotic cases. And that gives you dominance and optionality.
It also means fleet tracking right down to the hardware, servicing, and Inventory (consumables) management.
And if you've got a wifi signal between a smart hand held stapler and say the system - hmmmm interesting - but maybe for another day. Okay - it’s coming in my mind.
Let me dig a little deeper into the actual software. Nice. Very modern - Apple-esque and actually quite da Vinci 5 esque. I feel that all the usability and UX houses are all on a road to convergence. Which - actually it would be bloody nice for a change to see our industry standardise a bit.
The software has some lovely “drag to assign” features and that will be needed to assign different pedals to different functions. Especially as I note some oddities with the pedals.
They are multi function pedals. So I hope they have done LOTS of usability on that. We have double pedals that do cut, coag - but also MAX / MIN for Harmonic. And even a single pedal that will do Bipolar coag and Enseal activation. That does overcome one of the issues with pedal activated systems like an OTTAVA - in that you end up with fewer “energy pedals”: as I imagine they have replicated that to their console pedal deck. The benefit is that you do some clever selection and assignment and use the same pedals - depending what arm is holding what instrument. So if you have in the right hand a Harmonic and the left a bipolar. You can select the assignment to correspond to the pedals. All speculation and I’m just imagining those pedals on an Ottava. But it indicated to me “multi function pedals” which may come with staplers as well. Activation of the staplers via an electrosurgery pedal? Maybe not.
Screen is large - clear - high res - bright. Nice Icon interface - drag n drop assign and ability to do numeric data entry for settings and QWERTY entry. All in software - all upgradable - expandable. They talk about making it human and easy - I think it looks like they nailed it with this interface. For me my two year old could use an iPad - so it means it’s easy and natural. Well done.
What I’m going to say (suspect) is that the same UX design team have done the Ottava HUD as well. So expect it to look almost identical - and flow with design cues to what you see on the Dualto screen. And I suspect that the assignment of arms and functions in Ottava will also be drag n drop. I imagine you drag an arm Icon and drag it over to left or right arm to assign. Rather than a select as such. Now that may be use the hand controller of the robot to pinch grab an icon and drag it - then release. Would be the logical way.
I also see the way other items are dragged into place, and suspect that method of additions to the user will also be incorporated - and if it is controlled (perhaps by the touch screen or the console HUD) - maybe) I think it will feel very similar to what you see here on Dualto.
Plus the design cues fall neatly to the insert plug Halos - which are nice, and the keen eye would see a little unusual as you get 4 X monopolar (but with a little odd colour assignment of Cut and Coag. The blue is on the lower Monopolar 1 is … strange.) two return plates. That will have been fun for the engineers - and will be fun for the OR teams finding two area to place return pads on the patient. Unless they have been able to do a return split and one pad can feed two return cables?…. Hmm.
And the advanced interface is probably a universal connector for Enseal and for Harmonic - and software switches function when it detects the connector. So in theory you could have quite a selection of energy devices split across two users. And lots of room for expansion in the future as new modalities like Microwave come.
Hang on… Rendezvous for the future? - Just being speculative… But it would allow energy in Rendezvous - notes to self (now if you didn’t see what I did with notes there… oh forget it.)
The OS seems snappy - fast - accurate touch response - that you would expect in 2025. But they didn’t show the boot to screen just the “Good Morning.” I’ll give the benefit of the doubt and think it is a fast boot. (Take a look here)
Why do I care about that. The software here will be indicative of the software on Ottava. And you need fast boots and shutoffs to not be an issue with a robot. You cannot wait for 15 minute boot times. Self tests - zeroing etc etc. So seeing pretty snappy processing power here is encouraging from start to boot screen. But would love to see boot screen to user interface times. Which they edited out of the video.
I also look at the “hot cabling / connecting”: ie plugging things in and out when the software is running. Standard fare today but you would be surprised how many system have not done that in a smooth and fast way. Hope for Dualto and hope for Ottava. Looks clean - quality and snappy.
Other small things - are an eye to ample energy modes for all the different surgeries. Hope it comes with a lot of presets - that help the user choose the mode easily - and that AUTO is really an auto catch all. Otherwise we end up with 40/40. I’ve seen users get choice fatigue too many times. The downside of physical buttons is less choice. The downside of software buttons is too much choice. The usability teams hopefully reigned in the design teams.
It's all about better communication and connection
Sort of come back to this. But the info console at the top is loaded with ports on the back. Good to have lots of USB ports - bad from a cyber security point of view. 510K so I don’t know how much scrutiny FDA will have given that. But for Ottava - is that a route into the system? I’m sure they have it nailed - but a de Novo is a level up from 510K. But I’m sure they have worked out all the Cyber Security in details.
So clearly the design thesis is a connected system. As I’ve already said - fleet management - surgical data - telemetric data and more. And all of this screams that this is the design philosophy of Ottava. That would be super welcome.
And all of that data will get piped up to Polyphonic - and there is will be stored - sorted - analysed and generate the insights to the connected app.
Which - I’m going to suspect is the same design house that did the tablet - or maybe the same design cues. So expect the JNJ Polyphonic app for Ottava to have the look and feel of the software you see on Dualto. Well they should - let’s hope.
But what it means is that I am suspecting that it is a different “modular” tower approach vs Intuitive. But a very much data connected approach like Intuitive. And that means all the tower modules and peripherals will be throwing off data that will all connect up. Much like Intuitive.
I mean come on it’s 2025 - you have to.
I’m wondering if the tap n go could potentially be done from a smart phone NFC to do the set up? Hmm perhaps, set up the operating list on your phone with your settings - case data (EHR maybe) and then just tap to transfer or “unlock” the data piped from the EHR. Anyhow I digress. Smart phones are part of this somewhere. If not - it would be super odd and a missed opportunity.
So we will have in all of this the fleet data for servicing, predictive maintenance, and hospital dashboards. I think it will go to inventory management and a few other things. And that will start with Dualto - (great simple test bed for Ottava and more.)
I think it will then get to a Full lap tower “Dualto”… and then Ottava.
(I think Velys and Monarch are already there on Polyphonic? Someone correct me please.) But all this data will be sucked up and parsed out to who wants it - needs it - and to the granularity they care about. For a Hospital manager it may be 30,000ft across all connected devices. For a surgeon - cases - video and kinematics with insights.
Short story - Dualto is connected - Ottava is (surely) connected. Polyphonic is the aggregation and management system.
Summary
I like it. I like it a lot. And it shows something that is critical. The team at Ethicon is thinking about the tower and not just the robot - and that is super encouraging. Even if it just the electrosurgery of the tower - which would be such a missed opportunity if they didn't use this design to build a vertically connected tower.
This could be a clear challenge to Medtronic and Valleylab - but an even bigger challenge to Intuitive and their tower.
And let's not think about Olympus and Storz - how this will hurt them.
The fact Ethicon has open and lap - and that they are making multi procedure systems from the off means that the “tower is power” of the DV5 will be one of many options now. Not a “it’s the only one.” Dualto may be their answer to the tower.
The focus on footprint reduction (Dualto and Ottava) screams ASC. Watch out Stryker… they are coming to your ASC soon. And it could make the Ottava and Ottava tower (Dualto and more speculation) a very attractive proposition. If it can maintain that use across the procedures, stackability for less costs by needing less stack parts for every OR (get as many as you need) - less power cables - and 46% footprint reduction.
I am speculating a lot here - but to me it is obvious - that if they want the ASC they need differentiation - and who the hell doesn’t want the ASC and be able to get a robot in. And that means smart design choices and owning the tower. No ASC is having multiple towers in the OR anymore. They can’t.
There is one other key thing that I think is super smart if applied. Upgradability. Wait - the upgrade of Dualto tower is later. I mean - that if they have made this a stack system that you can add what you want when you want - you get around one of the biggest lock ins from historic tower companies.
As certain items get obsolete or break - start with just an electrosurgery generator. unlike Intuitive you don’t have to take all components at once. You can say, add just the Lightbox later… no sweat. You can add the new insufflator later when you need one… no worries. If your one works today - good. But at upgrade time - we can just add it into then ever growing connected tower.
And that single touch screen and electronic "gubbings" in that top box may mean lots of cost savings in the functional part of the box below. (No screen, comms, power convertors) - the top box deals with all that. You don't repeat it in all other components.
It allows a modular buying strategy instead of an all our nothing. But encourages you to get their system at upgrade time as “look at all that lovely data.” And - it all fits on one stack. I think it will be a slow but steady move over to Dualto systems once the first parts are in. It breaks the need to wait for tower replacement cycles.
And - wild wild guess. Let’s say I get my tower in for open and lap. And I have my modules for energy, and imaging, and gas. And now I want to introduce Ottava… what do I need?
Erm just a bed with arms (Oh I get a new bed as well) and a console. The tower is already in doing its job — just connect it up. That could make the Ottava feel less expensive and leverages assets you already own.
Likewise…. Ottava goes in with its tower. Maybe add a few more modules and you now have kitted out the OR for robotic, lap, open… other endoscopy (wink wink).
And it is a connected smart system that adds even more value to the robot. Adds even more “one supplier” makes sense.
Yes I know I am well off ranch - but that is my job - to speculate. It's just a Valleylab replacement... sure... right? Your job is to convince me different. Or if you are in JNJ and none of that is true - there’s some ideas for you - hahahahaha. Cos I think the idea is smart !
Either way - Dualto very cool, and I feel a strong sneak peak into Ottava.
These are wild speculations and assumptions by the author based on public information. So don’t hold me to it.
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