Illinois Medicine

D I DOUBLE CARE A MATCHING GIFT IS HELPING UIC TO RAISE $1.5 MILLION FOR DUAL-CONTROL TEACHING ROBOT LLINOIS MEDICINE IS WORKING TO ACQUIRE high-end, dual-control robotic equipment that will enable the department of surgery to train residents in even more complex robotic tech- niques, further preparing them for an emerging field in 21st cen- tury medicine. Adding another robotic operating system would also increase the overall number of robotic procedures performed at the medical center. "Right now the residents do a fair number of robotic cases, but not the more complex cases, because there's no way for the attend- ing surgeon to maintain control and guide them in the way he would in a conventional surgery," explains Gary Merlotti, MD, director of the surgical residency program. "Getting the teaching console is a critical step that opens up a huge vista of complex surgery that the resident will be able to do." The dual-control system's $1.5 million price tag is daunting, but the initiative has received a major boost from an anonymous donor, a grateful surgery patient who has pledged to match any gifts for the acquisition of the system dollar for dollar until all the needed funds are raised, which will include more than another million dollars to install and maintain the equipment. "Obviously, it's an enormous help," Merlotti says. "We hope it will encourage our past residents and other friends of the program to make contributions." To make a donation or for more information, please contact Stephanie Hilbert in the Office of Medical Advancement at (312) 996-8769 or shilbert@uic.edu. URING ROBOTIC PROCEDURES, A SURGEON manually makes dime-sized incisions in the patient and passes a 3-D camera and robotic instruments through them. With the robot arms hanging over the operating table like tree branches, the surgeon guides and views the instruments from the console. "One of the biggest adjustments from conventional surgery is that you have no tactile sensation," Grubb says. "But you very quickly realize you don't need it, because the view is enough." In fact, the clarity and vividness of the magnified 3-D imaging puts Avatar to shame. Robotic surgery offers patients the advantages of other minimally invasive surgical procedures such as laparoscopy—including reduced blood loss, pain, recovery time, scarring and risk of infection—and has some unique additional advantages. While laparoscopic instruments have immovable straight arms, which Grubb compares to operating with chop- sticks, the instruments at the end of robotic arms rotate with the move- ments of the surgeon's wrist's, allowing for far more intricate surgery. Furthermore, because the instruments are remote controlled, robotic surgery eliminates the hand tremors that accompany even lapa- roscopic surgery. The combination of the tiny instruments' flexibility and steadiness makes it possible to use robotic techniques for complex procedures that, until just a few years ago, always required open surgeries with major incisions. Robots were first incorporated into surgery in 1985 to increase the precision of neurosurgical biopsies. That innovation led to the first lapa- roscopy using a robotic system, performed in 1987. It wasn't until 2000, though, that the da Vinci robotic surgery system—which is used at the medical center—became the first complete robotic system of surgical and imaging instruments to receive approval from the U.S. Food and Drug Administration for general laparoscopic surgery. Since then, robotic surgery has become increasingly common, par- ticularly for prostate cancer, its primary clinical application. Citing data from Intuitive Surgical, the da Vinci system's manufacturer, The New York Times recently reported that 73,000 out of the 85,000 men who had pros- tate cancer operations in America last year had robotic prostate surgery. With more than 1,000 robotic procedures to his credit, Giulianotti has been a pioneer in expanding robotic surgery's scope. He performed a number of the first surgeries in the world with the robot, including the first major right hepatectomy, renal aneurysm, pneumonectomy and Whipple surgery (a treatment for tumors of the head of the pancreas that entails removal of the gallbladder, bile duct and parts of the pancreas, stomach and duodenum). Giulianotti has performed more than 80 ro- botic Whipple procedures, along with 150 robotic pancreatectomies and more than 80 hepatectomies (partial or complete removal of the pancreas and liver, respectively). Giulianotti came to Illinois Medicine in the spring of 2007 from Misericordia Hospital in Grosseto, Italy, where he was head of surgery. "The robotic surgery project here was bigger," he says. "You have more opportunities in research, training, teaching and clinical work to have a complete validation of the technique." The robotic surgery program at the medical center has grown considerably in the last three years. The year prior to Giulianotti's arrival, 156 robotic surgeries took place at the medical center. By last year, that number had grown to 492 procedures—178 of them led by Giulianotti himself. Giulianotti and his Illinois Medicine colleagues have performed the world's first robotic liver resection for transplant from a living donor, the first robotic thyroid removal in the U.S., the Midwest's first fully robotic kidney transplant and the first robotic Whipple procedure in the Midwest. Giulianotti and the other surgeons in the division of general, minimally invasive and robotic surgery now employ robotic techniques in more than 90 percent of their cases. His colleagues in other divisions within the department of surgery are following his lead, working with him to expand the range of procedures they can conduct robotically. "The 34 | SPRING 2 010

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