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P. Giulianotti - Robotics in General Surgery: State of Art and future perspectives

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P. Giulianotti - Robotics in General Surgery: State of Art and future perspectives

  1. 1. PC GIULIANOTTI, MD,FACS Distinguished Lloyd M Nyhus Chair in Surgery Professor and Chief Division of General, Minimally Invasive and Robotic Surgery University of Illinois at Chicago Robotics in General Surgery: State of Art and Future Perspectives
  2. 2. Robotic Surgery? Robotic Surgery ?
  3. 3. The Future of Surgery HAS SURGERY A ROLE IN THE FUTURE? Selective Cosmetic Minimal Trauma Nanocellular From distant location (Space)
  4. 4. The Future of Surgery Which kind of surgery ? Overcome limits of human hand Overcome limits of human mind ERA OF VIRTUALITY ROBOTICS
  5. 5. The Future of Surgery Decision making process Human Mind Acquisition of data , images, informations Surgical operations Computer Computer
  6. 6. ROBOTIC SURGERY What is it?
  7. 7. ROBOTIC SURGERY <ul><li>WHAT DOES IT MEANS ROBOTIC SURGERY ? </li></ul><ul><li>Better quality microdissection </li></ul><ul><li>Virtuality </li></ul>
  8. 8. <ul><li>BETTER QUALITY MICRODISSECTION </li></ul>ROBOTIC SURGERY 3D-HD Vision Motion scaling Endowrist
  9. 9. MINIMALLY INVASIVE SURGERY <ul><li>BETTER QUALITY MICRODISSECTION </li></ul>Ergonomic Intuitive control Multiple instruments The Robotic Surgical System
  10. 10. ROBOTIC SURGERY
  11. 11. <ul><li>Digital images manipulation </li></ul><ul><li>Digital reality augumentation </li></ul>VIRTUALITY ROBOTIC SURGERY
  12. 12. Simulation ROBOTIC SURGERY
  13. 13. <ul><li>WARNINGS IN REAL TIME </li></ul>ROBOTIC SURGERY Warning
  14. 14. MEMORY ROBOTIC SURGERY
  15. 15. Miniaturization ROBOTIC SURGERY
  16. 16. TELEPRESENCE - NETWORK ROBOTIC SURGERY
  17. 17. LUNG ESOPHAGUS STOMACH LIVER BILIARY SYSTEM PANCREAS KIDNEY SMALL BOWEL COLON THYROID SPLEEN ADRENAL GLAND ARTERIES MULTIORGAN CARDIO GYNECOLOGY UROLOGY Indications ROBOTIC SURGERY
  18. 18. Personal Experience 1045 procedures Gastrectomies 94 Pulmonary resections 42 Oesophagectomy 19 Pancreatoduodenectomy 77 Distal pancreatectomy 52 Other pancreatectomy 23 Hepatic procedures 84 CBD procedures 42 Colo-rectal resections 70 Splenic artery aneurismectomy 9 Renal artery aneurismectomy 5 Thymectomy 5 Iliac-fem by-pass 1 Splenectomy 21 Nephrectomy 28 Adrenalectomy 33 Fundoplication 181 Heller myotomies 29 Other oesophageal procedures 8 Cystojejunostomy 5 Cystogastrostomy 12 Cholecystectomy 162 Other procedures 30 ROBOTIC SURGERY
  19. 19. OUR EXPERIENCE <ul><li>ADVANTAGES </li></ul><ul><li>Hylar dissection </li></ul><ul><li>Selective vascular pedicle contol (NO Pringle) </li></ul><ul><li>Caval isolation with suprahepatic veins transect </li></ul><ul><li>Parenchimal section </li></ul><ul><li>Haemostatic and biliary leakage control </li></ul>Hepatectomies PARAMETERS Conv. rate: 6.3%. Mean op. time: Major Resections 340 min (220-480) - Minor Resections 206 min (90-459). Transfusion: 14%. Mortality: NONE. Morbidity: 21%. P.O. stay: 7 days (3-23). 79 Resections ROBOTIC SURGERY LIVER
  20. 20. <ul><li>ADVANTAGES </li></ul><ul><li>Hepatoduodenal ligament lymph. </li></ul><ul><li>Portal-mesenteric preparation </li></ul><ul><li>Uncinate process dissection </li></ul><ul><li>SMA Lymphadenectomy </li></ul><ul><li>Reconstruction </li></ul>PARAMETERS Conv. rate: 14.3% Mean op. time: 417 min (240-660) Transfusion: 11.6% Mortality: 3.8% Morbidity: 34% Lenght of stay: Italy 15 day, US 10 days OUR EXPERIENCE ROBOTIC SURGERY PANCREAS PANCREATICODUODENECTOMY 77 Pancreaticoduodenectomies
  21. 21. Expanding the indications of minimally invasive surgery Robotic living donor right hepatectomy Few Blood losses CLINICAL ADVANTAGES Robotic multiorgan resection ROBOTIC SURGERY
  22. 22. TRAINING OR FUTURE COSTS BIOETHICS CHALLENGES ROBOTIC SURGERY FUTURE CHALLENGES
  23. 23. Robotic surgery The Robotic Training Lab
  24. 24. 6 5 1 21 5 6 97 Surgeons 151 Students Med-Eng 225 Visitors 6 Robotic training Lab at University of Illinois at Chicago The Live connections Visiting surgeons 5
  25. 25. INSTITUTE ADVANCED ROBOTIC SURGERY Robotic Surgery
  26. 26. Robotic Surgery
  27. 27. OR of the Present
  28. 28. <ul><li>New technologies </li></ul><ul><li>New energies ( monpolar, bipolar, radiofrequency, harmonic, ) </li></ul><ul><li>New diagnostic tools ( US, Xray, NMR ) </li></ul><ul><li>New equipments ( laparoscopy, Robotics ) </li></ul><ul><li>New operations </li></ul>OR of the Present
  29. 29. OR of the Present
  30. 30. OR of the Present
  31. 31. <ul><li>Adaptation of the container </li></ul><ul><li>Addition of technologies </li></ul><ul><li>Addition devices </li></ul><ul><li>Addition personnel </li></ul><ul><li>Addition screens, visualization systems </li></ul><ul><li>Addition of energies </li></ul><ul><li>Addition of cables </li></ul>OR of the Present
  32. 32. <ul><li>Imaging based </li></ul><ul><li>Connectivity </li></ul><ul><li>Wireless </li></ul><ul><li>Robotics </li></ul><ul><li>Computer controlled </li></ul><ul><li>Integration of technologies </li></ul><ul><li>Integration of diagnostic tools </li></ul><ul><li>Decrease personnel </li></ul><ul><li>Increase patient safety and comfort </li></ul>Needs OR of the Future
  33. 33. Needs OR of the Future
  34. 34. Economical Limits Direct costs Indirect costs Direct benefits Indirect benefits COSTS
  35. 35. Still we need to take advantage of benefit of extended indications of minimally invasive surgery Very fast track techniques COSTS
  36. 36. BIOETHICS New Responsibilities Telepresence Role of Robot Teleproctoring BIOETHICS
  37. 37. Thank you

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