Robotic surgery to remove a gallbladder via a single port was performed for the first time in the Midwest recently by surgeons at the University of Illinois at Chicago.
Gallbladder surgery (a cholecystectomy) using this method involves a single incision instead of multiple cuts and less scarring, according to Dr. Enrico Benedetti, head of the department of surgery at UIC.
In robotic surgery, the surgeon sits at a console operating joysticks that control the robot while its arms perform the actual surgery. The doctor sees the patient and every step of the procedure on various screens and can intervene immediately if necessary.
Dr. Pier Giulianotti, the surgeon at UIC who performed the robotic gallbladder removal, first began practicing robotic surgeries in 1999 and has since done hundreds of them.
The robotic surgeries are done at the University of Illinois Health & Sciences System, the renamed medical center at 1740 W. Taylor St.
“From the beginning I understood that the future of medicine would be connected to computers and robots,” Giulianotti said.
Gallbladder removal “is a very common procedure, performed half a million times in the United States a year,” Benedetti said.
Many of those patients are women for whom a procedure that reduces scarring is important.
Gallbladder removal used to involve conventional, open cavity surgery and then, in the late 1980s, the procedure started to be performed with laparoscopy, according to Dr. Benedetti. Laparoscopy involves inserting a camera into small incisions and then inflating the area with carbon dioxide to get a better view and perform the removal.
Gallbladder removal can be a recommended form of treatment for many gallbladder problems, according to the National Institutes of Health. The gallbladder stores bile from the liver.
A multi-port laparoscopy was the initial method used, but the focus has been on performing the operation with only a single port to reduce scarring. This can prove problematic when using laparoscopy, since all of the instruments are entering through a single port in the belly button in a straight alignment. Performing the operation with the robot can give the surgeon a better view of what he or she is doing.
Dr. Sherry Wren, professor of surgery at Stanford University, said that the single port surgery allows patients to avoid the three extra incisions and the robotic version of the single port surgery is better because of “the better viewpoint, ability to do better retraction, the ability to have a camera that isn’t colliding with your other instruments. It really reestablishes the ability to work in the safest manner on the gallbladder.”
Wren is a consultant for Intuitive Surgical, the California company that makes the robot (the da Vinci surgical system) used in the gallbladder removal. The robot is also used for surgical procedures involving various kinds of cancer, obesity, kidney disorders and uterine fibroids.
Benedetti pointed to the increased visibility robotic surgery provides for the surgeon as well as the fact that the robot filters out human hand tremors.
Criticism of the robot has centered on the price and practicality of having it at a hospital. Benedetti mentioned that Intuitive Surgical is the only company currently making the surgical robots. As competitors arise, the cost could potentially go down. Additionally, as the people becoming doctors are increasingly tech-savvy individuals, robotic surgery could itself become part of medical school training.
Dr. Marie Crandall, associate professor of surgery at the Northwestern University Feinberg School of Medicine, said that one area the robot still can’t be used is in trauma surgeries and that it would not be a good choice “when you need quick access to the abdomen for things like bleeding or intestinal spillage”
“I think it has the potential to be very helpful in minimally invasive applications where you need tremendous control over your instruments,” Crandall said.
Giulianotti called planning for the operating room of the future his “obsession” and mentioned improved patient comfort and understanding, converting to wireless, a central role for computers and robots and having a constant interface with surgeons in other locations as important.
He went on to say he thought surgery today was at the end of a 19th century process and that it was time to start at ground zero to reimagine the operating room.
Asked whether we’d ever see a completely automated surgery, he said, “I think the difference between the human mind and a computer is that the human mind can make errors. You can learn more and you can achieve also another step of knowledge. If you’re always repeating what you think is true, you’ll always stay at the same level.”
But until artificial intelligence can mimic the kinds of fortunate mistakes that lead to new discoveries, humans will still be needed for the surgical process, he said.