"Imagine an alternative to open surgery that requires only a few small incisions, has you back on your feet within days and back home within days of that, minimal pain, fewer complications, quicker recovery time." - Pier Cristoforo Giulianotti, MD, FACS, Professor of Surgery
When Joseph Lindbloom told friends he needed a Whipple procedure to treat his pancreatic cancer, some of them became visibly upset.
“Anyone who knew anything about the procedure was a little shocked,” recalls Lindbloom, 62, a retired high school science teacher from suburban Homewood. “It became clear my condition was more serious than I realized.”
The Whipple, he learned, is among the most complex surgeries performed by general surgeons, calling for creation of a large abdominal opening to remove benign or cancerous tumors in the head of the pancreas, and in adjacent ducts and blood vessels. Patients are left with a long scar, a lengthy hospital stay, significant pain, months of recuperation and risk for infection. But Lindbloom was lucky. Not only was his cancer detected early, but it also was removed using a noninvasive robotic Whipple, a pioneering technology available at the University of Illinois Medical Center at Chicago.
Another piece of luck: His surgeon was Pier Cristoforo Giulianotti, MD, chief of the center’s division of general, minimally invasive and robotic surgery, who has performed more than 2,000 minimally invasive surgeries, including nearly 1,000 robotic procedures.
Giulianotti says the robotic Whipple requires about the same amount of time as traditional methods, though the result is less blood loss and pain, minimal scarring and shorter recovery time. It’s why Giulianotti, who hails from Pisa, Italy, joined UIC in 2007 as Lloyd M. Nyhus Professor of Surgery. “I felt, here was a place where I could make a contribution,” he recalls.
While robotic surgery is routine for certain conditions, Giulianotti, a general surgeon, has expanded its use to treat the lungs, esophagus, colon, stomach, liver, gall-bladder and kidney, in addition to the pancreas. The center, which performs more than 300 such procedures per year, is a world leader in robotic-assisted surgery.
Surgery performed by Giulianotti to remove a cancerous lung lobe illustrates why. Before he arrived, Fabio Sbrana, MD, and other team members prepped the patient by making four tiny incisions — three for inserting tiny robotic instruments to excise tissue and tie sutures. The fourth accommodated lighting implements and removal of excised tissue. Giulianotti, meantime, was seated at a console resembling those found in road race video games, his forehead pressed against the instrument so he could access a binocular viewer. Robotic arms translated his gestures via hand and foot controls.
“I can see the patient better than if I were at the operating table,” he says, noting that high-resolution, three-dimensional views are magnified nearly 30-fold.
Gripping the hand controls, he explains that the jointed-wrist instruments replicate the surgeon’s motions but allow 360-degree rotation, twice the range of the human hand.
To operate the third hand, Giulianotti removed his shoes to increase his sensitivity while pumping pedals.
As surgery proceeded, Giulianotti employed a cauterizing instrument to excise tissue, isolate the cancer and remove it. Once surgery was completed, the day’s schedule called for a robotic Whipple. Giulianotti says it’s not uncommon for UIC to perform one per day, as compared with one per month at other hospitals. Lindbloom underwent Whipple surgery in January 2009 and left the hospital just 10 days later. “By that point, patients who undergo a traditional Whipple only feel well enough to rise from bed,” he says.
Once home, Lindbloom resumed normal activity after two months, long before a traditional Whipple would have allowed.
“I really feel good,” he says, “and my prognosis is very good.”
Dr. Pier Giulianotti is Chief of the Division of General, Minimally Invasive and Robotic Surgery at the University of Illinois Chicago Medical Center and known world-wide for his pioneering techniques in treating cancer and other challenging ailments that other surgeons declared untreatable. As a preeminent surgeon in Italy, we are fortunate that Dr. Giulianotti came to Chicago to make it his new home and venue for training the next generation of surgeons; passing along his knowledge in the latest cutting edge techniques.
As both an educator and a highly skilled, world-renowned surgeon, Dr. Giulianotti is contributing to the fabric of Chicago by making these advances accessible to the disadvantaged, the next generation of surgeons and most importantly, patients previously told that their conditions were inoperable.
The Division has had a distinguished track record of "firsts", many of them by Pier:
- First robotic donor nephrectomy for living donor kidney transplant in the world (2000)
- First robotic hepatectomy in the US (2005)
- First robotic combined donor nephrectomy and pancreatectomy for living donor
- First robotic pancreatectomy with auto-islet transplant worldwide (2007)
- First robotic lung resection in the Midwest (2007)
- First robotic whipple procedure in the Midwest (2007)
- First robotic total gastrectomy in the Midwest (2008)
- First robotic renal artery aneurysm repair in the United States (2008)
- First robotic total colostomy with ileo-rectal anastomosis in the United States (2008)
- First robotic right hepatectomy for living donor liver transplant worldwide (2008)
- First robotic right hepatectomy with hepatico-jejunostomy worldwide (2008)
- First parathyroidectomy without neck incision in the United States (2008)
- First fully robotic kidney transplant in obese recipients
- First single port cholecystectomy in Midwest (2011)
- First parathyroid transplant (2011)
The benefits of robotic assisted surgery
Robotic assisted surgery, unlike conventional open surgery, requires only a few small incisions. As a result, patients experience reduced pain, minimal scarring and quicker recovery times, allowing patients to have significantly shorter hospital stays.
Robotic-assisted surgery may be the future of medicine, but its fundamentals are rooted in practices that have been in place for generations. Laparoscopic surgery is a technique requiring only small incisions to perform abdominal surgery. However, laparoscopic procedures have their limitations, including instruments with only a limited range of motion. In addition, the surgeon must look away from the instruments to view procedures on a 2-D video monitor.
By comparison, Robotic-assisted surgery provides surgeons with a greater range of motion and superior visualization. Surgery is directed from a console, where the surgeon controls a camera, vacuum pump, saline cleansing solution and cutting tools, each located in its own small incision site. During surgery, the surgeon peers through a binocular viewer while operating hand- and foot-held controls to manipulate the instruments. The instruments replicate the surgeon's motions, but with a range of 360 degrees – twice that of the human hand. Three-dimensional magnification provides the surgeon a true stereoscopic image, allowing for better views than if he were at the operating table. The result is superior staging and precision during surgery, in addition to reduced pain, less bleeding, and shorter recovery times.
The other advantages of robotic surgery are due to the small incisions required – each a mere 8 mm in length – thereby eliminating the long incisions and permanent scarring characteristic of open surgery. Patient benefits include minimal risk for wound infection, less postoperative pain and reduced need of pain medication.