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It’s Time For Surgery’s Future To Go Under The Knife

Fri, 03/05/2010 - 11:52am
Pier Giulianotti, M.D. University of Illinois at Chicago

It’s not enough to have mere awareness in robotic surgery; the imperative lies in applying it—and differently.

March 8, 2010

Pier Giulianotti, M.D.

Pier Giulianotti, M.D.

Recently, I consulted with a leading medical manufacturer about a new surgical tool in development which would expand the depth and scope of robotic surgeries presently available to the medical community. Throughout those conversations, I kept on thinking about how far the world of surgery has come—and how much further we have to go.

As surgeons—as with any doctor—we are charged with doing everything possible to help make patients’ lives better. Yet it almost seems counterintuitive to think that a large incision in a person’s chest to resect a lung or to transplant a liver is a positive action. As my colleagues and I have found, robotic surgery has done wonders to improve patients’ lives by minimizing incisions and blood loss while decreasing recovery time. 

Yet, these positives are just the beginning; as we look ahead to how the surgical world will evolve, patients are certainly the ones who will benefit from our changes.

New surgeries, new possibilities. To be sure, I am happy to see that more hospitals and medical centers across the globe are embracing the possibilities of robotic surgery. One might argue that the money spent on robotic technology could, instead, be used to help fund administrative functions or bolster balance sheets. At UIC, we have found that investing in the future of our field has unleashed a whole new spectrum of research such that we are doing more to save lives today. 

Just recently, our team performed the first parathyroidectomy in the Midwest using robotic surgery, making a few small incisions under a man’s underarms as opposed to making a large incision along his neckline. We have also performed the first robotic thyroidectomy in the region in an Illinois woman. Some of the advances we have found have nothing to do with medicine and everything to do with psychology. The woman in the aforementioned thyroidectomy was scared that she would not be able to go out in public without having to wear a high-necked blouse or sweater—she didn’t want to face the psychological scars of people asking her, “What happened to you?” Imagine how this woman reacted when we told her that she would have a renewed sense of confidence after the surgery because there would be no visible marks unless she showed people. 

At UIC, this is what we believe cases like these are merely the tip of a very large iceberg. Exploring the ways that robotic surgery can improve all of a hospital’s and patient’s influencers will only increase the usage and possibilities of surgical innovations.

Incorporating robotics into surgery requires a shift in learning and teaching.  Those surgeons who have been at the forefront of minimally invasive surgery understand and appreciate that the traditional surgical “model” is getting a facelift as a result of robotic advances. Change can be a good thing—especially when you can communicate the benefits of change to those who want to learn how to make their practices stronger.

At UIC, my colleagues and I have been hosting a series of sessions with surgeons from across the globe who want to learn about how robotic surgery can be further integrated into their cases. What’s more, the manufacturers of these robotic devices have embraced and supported our initiatives to the point that they have become active partners in our programming.  While the manufacturers are the ones making the tools, the best teachers are those who are actively engaged in using the tools.

It also bears notice that robotic surgical advances will inevitably shape how colleges and universities teach the art and science of surgery.  UIC has taken the first of many steps in creating a robotic surgery specialty for future generations of surgeons. 

In March of last year, we became one of the first centers in the world to officially unveil a robotic training lab for surgical residents to practice using robotics ahead of their peers who, otherwise, would not get hands-on experience until later in their careers. This is one of many steps the University is taking in developing a robotic surgery certification program. 

Our programming also includes internal training for attending physicians (allowing the development of robotic skills necessary for adequate patient care) in addition to national and international training for surgeons being initiated in robotic surgery or wishing to gain more practice with it. As a part of both of these initiatives, ongoing research will contribute to advance robotic technology’s practice, usage and learning for all involved with surgeries.

There is so much more we can accomplish. With increased innovation in telematics and wireless communications, the dreams I have of performing robotic surgeries while I am here in Chicago and a patient is in another part of the world is not too far from becoming reality. Several manufacturers envision future iterations of their devices to accommodate the already minute lag time that currently exists in robotic surgery. Because UIC has amassed the talent it has with robotic surgery, we see a vast opportunity working with these device companies to make this vision real. 

Some critics of robotic surgery have thrown caution to the wind, noting that robotic surgery allows for more to go wrong in a surgery.  In fact, robotic systems alleviate the worry of the traditional quivering associated with human hands and traditional surgeries. Plus, future robotic systems are being built into robots such that they will warn surgeons if they are about to make a mistake. This sort of alarm system will be a tremendous asset, as surgeons will have the ability to rehearse complex and complicated procedures with potential warning signs and alarms before actual intervention. In challenging cases, a robot could create a sophisticated virtual surgery experience based on past procedures in an operating room—benefitting both new and veteran surgeons.

For those worried about the connectivity between a surgeon and patient, i.e., how a robot can ‘feel’ what a patient’s organs feel like, future systems will have increased tactile feedback without touching human organs. 

To that end, we envision a day that robotic systems will work on surgeries not related to organs.  Repairing damaged nerves is but one area where there is great potential for robotic surgical procedures to grow.

I firmly believe that robotic surgery will revolutionize how medicine is performed—once the technology gets into the hands of more people to use it, and once more patients can share their experiences on how they benefitted from it.  Just as Beethoven needed inspiration to create symphonies and Michelangelo sought a vision before creating works of art that millions have appreciated, those schooled in robotic surgery have the foresight to know that there is so much more that can—and will—be accomplished in the world of medicine. 

Pier Giulianotti, M.D. is Chief, Division of General Minimally Invasive & Robotic Surgery at the University of Illinois Medical Center. Recognized in many circles as the world’s leading robotic surgeon, Dr. Giulianotti has been at the forefront of using new technology to change the way surgical procedures are performed.  The director of the National School of Robotic Surgery and one of the founders of the Clinical Robotic Surgery Association, Dr. Giulianotti has performed more than 1,000 minimally invasive robotic surgical procedures.  Contact Dr. Giulianotti at piercg@uic.edu.

 

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