Robotic surgery makes Dr. Giulianotti think about art

Source:Global Times Published: 2010-7-19 9:03:00

Dr. Pier Cristoforo Giulianotti has completed more than 1,000 successful major procedures without laying a finger on a patient. Using hand controllers, foot pedals, and 3-D visualization, he performs complex surgeries sitting just a few meters away from the operating table.

It happens that the sophisticated surgical system, consisting of three to four robotic arms and a remote console, is nicknamed after one of the Italian surgeon's most famous hometown visionaries -- Leonardo da Vinci.

"At the beginning, even I did not understand the revolution behind robotics because I was appreciating only the aspects of mechanical improvements," said Dr. Giulianotti, chief of the Division of General, Minimally Invasive and Robotic Surgery at the University of Illinois-Chicago. "But actually, in robotics there is a charming revolution I can summarize paradoxically: You are modifying reality using virtuality. You are using a virtual environment to interact with reality; the only limit is your mind. "

As the president of the Clinical Robotic Surgery Association, an organization of robotic surgeons worldwide formed last year, 57- year-old Dr. Giulianotti is leading the reimagining of surgical operations. There are three "da Vinci" systems housed within his university department, each with a price tag upwards of 1 million U.S. dollars. Intuitive Surgical, Inc., the sole manufacturer of the surgical systems, have installed 1,482 around the world as of March, according to the company's 2010 SEC filings.

Modern robotic surgery technology originated in the 1980's with a NASA research project on telemedicine, or the capability to utilize virtual reality to connect physicians to patients and use robotics for treatment. The project was heavily funded by the U.S. Army, but the patents were later sold to Intuitive Surgical, Inc. in the 1990's.

"Using the computer and electronic instruments you can achieve better movements," said Dr. Giulianotti in an interview with Xinhua. He cited enhancement of sight through an endoscopic camera with a high-resolution zoom function and 3-D visualization, stabilization of instrument movements, as well as sole control over the navigation of the surgery by negating an assistant's role. "My capability is expanded; I'm using three hands instead of two."

The method has been successfully used for pancreas, lung, esophagus, colon, stomach, liver, gall bladder and kidney procedures, and has proven especially superior for treating prostate cancer. "You can preserve the physiology much better," he said. "The incidence of potency is much higher than in an open procedure."

The aesthetic results of robotic surgery are another advantage - - Dr. Giulianotti remembers robotically operating on a young female patient from Florida with thyroid cancer. "We were able to remove the thyroid and the cancer avoiding any incision in the neck, just using small holes in the axilla (armpit). I received a call from the family yesterday saying how grateful they are, that she is so happy with no scar."

As a medical student in Tuscany, Giulianotti remembers watching an open chest procedure that he found "too violent with too much blood." Since then, his advocacy of refined robotic operations has connected him to international programs around the world. He has performed live teaching surgeries and lectured at PLA General Hospital in Beijing and Ruijin Hospital in Shanghai, sits as director of the robotic surgery division of the Misericordia Hospital in Tuscany, and served as a surgical professor in Germany and France.

Like da Vinci, he envisions technology transforming contemporary methods. "We are working in the same square room of 200 hundred years ago," he said. "Now it is so crowded and difficult even to clean." He is spearheading a multimillion-dollar project to redesign the operating room, leaving space for only a bed and the robotic surgical system, as well as a computer that surrounds the patient with projections of calming images. The surgeon would sit in a different room, remotely maneuvering the robotic arms holding the necessary tools.

"To me, a big operation is like making a painting; like sculpturing anatomy when anatomy is not clear; drawing tissue when tissue is destroyed; restoring physiology when it is lost," Giulianotti said. "I don't think about surgery in terms of blood or organs. I am thinking about art."

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