"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
Joseph Lindbloom's Pancreatic Cancer Story
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.”
Division of General, Minimally Invasive and Robotic Surgery at the University of Illinois Chicago Medical Center
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 Dr. Giulianotti:
- 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
According to Pier Cristoforo Giulianotti, the advantages of robotic surgery include:
- Small incisions. Incisions to accommodate a surgeon’s hands are far larger than those required for robotic tools.
- Reduced blood loss. Small incisions eliminate transfusions that can spread infections and stress the immune system.
- Reduced pain. Tiny instruments minimize surgically related pain.
- Shorter hospital stays. Patients are on their feet faster.
- Minimal scarring. Patients avoid large, open incisions.
- Fewer post-operative complications, including risk for infection.
- Faster resumption of daily activities. Less trauma cuts recovery time from weeks to days.
About Dr. Pier Cristoforo Giulianotti
Prof. Giulianotti received his M.D. degree from La Scuola Normale of Pisa University, Italy. Beside a formal General Surgery Residency at University of Pisa, he has completed two additional Residencies: Digestive and Vascular Surgery. For 10 years he has been Faculty Surgeon at Pisa University. In 1998, he became Director of the General and Minimally Invasive Surgery Division at Misericordia Hospital in Grosseto, Tuscany (Italy) and, after 5 years, Head of the Department of General Surgery at the same Hospital. In 2000, he pioneered the new robotic technology, performing complex procedures such as formal hepatic resection, lung resection and pancreatico-duodenectomy. In the last 7 years he has developed one of the largest programs worldwide for Robotic Surgery: the Special School ACOI of Robotic Surgery of which, Prof. Giulianotti is the Director. He is also a faculty member of the Minimally Invasive Training program at the European Surgical Institute, Ethicon Endo-Surgery Norderstedt (Hamburg , Germany) and invited professor at the Institut de Recherché contre les Cancers de l'Appareil Digestif (IRCAD), Strasburg France. Since 1979, he has published over 250 papers in scientific publications on several topics such as pancreatic, vascular, transplant, oncologic, digestive and robotic surgery. Recently, Prof. Giulianotti has been awarded with the prestigious Lloyd M. Nyhus Endowed Chair in Surgery at University of Illinois at Chicago and has been appointed Chief of the Division of General, Minimally Invasive and Robotic Surgery.