1) Robotic surgery allows for better quality microdissection through 3D-HD vision, motion scaling, and wrist-like movements of surgical instruments. 2) The surgeon's experience includes over 1,000 robotic procedures across various specialties like liver, pancreatic, and colorectal surgery. 3) Future challenges for robotic surgery include training costs, assessing clinical and economic costs/benefits, and addressing bioethical issues from new technologies like telepresence and virtual reality simulations.

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. Robotic Surgery? Robotic Surgery ?

3. The Future of Surgery HAS SURGERY A ROLE IN THE FUTURE? Selective Cosmetic Minimal Trauma Nanocellular From distant location (Space)

4. The Future of Surgery Which kind of surgery ? Overcome limits of human hand Overcome limits of human mind ERA OF VIRTUALITY ROBOTICS

5. The Future of Surgery Decision making process Human Mind Acquisition of data , images, informations Surgical operations Computer Computer

6. ROBOTIC SURGERY What is it?

7. ROBOTIC SURGERY WHAT DOES IT MEANS ROBOTIC SURGERY ? Better quality microdissection Virtuality

8. BETTER QUALITY MICRODISSECTION ROBOTIC SURGERY 3D-HD Vision Motion scaling Endowrist

9. MINIMALLY INVASIVE SURGERY BETTER QUALITY MICRODISSECTION Ergonomic Intuitive control Multiple instruments The Robotic Surgical System

10. ROBOTIC SURGERY

11. Digital images manipulation Digital reality augumentation VIRTUALITY ROBOTIC SURGERY

12. Simulation ROBOTIC SURGERY

13. WARNINGS IN REAL TIME ROBOTIC SURGERY Warning

14. MEMORY ROBOTIC SURGERY

15. Miniaturization ROBOTIC SURGERY

16. TELEPRESENCE - NETWORK ROBOTIC SURGERY

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. 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. OUR EXPERIENCE ADVANTAGES Hylar dissection Selective vascular pedicle contol (NO Pringle) Caval isolation with suprahepatic veins transect Parenchimal section Haemostatic and biliary leakage control 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. ADVANTAGES Hepatoduodenal ligament lymph. Portal-mesenteric preparation Uncinate process dissection SMA Lymphadenectomy Reconstruction 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. Expanding the indications of minimally invasive surgery Robotic living donor right hepatectomy Few Blood losses CLINICAL ADVANTAGES Robotic multiorgan resection ROBOTIC SURGERY

22. TRAINING OR FUTURE COSTS BIOETHICS CHALLENGES ROBOTIC SURGERY FUTURE CHALLENGES

23. Robotic surgery The Robotic Training Lab

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. INSTITUTE ADVANCED ROBOTIC SURGERY Robotic Surgery

26. Robotic Surgery

27. OR of the Present

28. New technologies New energies ( monpolar, bipolar, radiofrequency, harmonic, ) New diagnostic tools ( US, Xray, NMR ) New equipments ( laparoscopy, Robotics ) New operations OR of the Present

29. OR of the Present

30. OR of the Present

31. Adaptation of the container Addition of technologies Addition devices Addition personnel Addition screens, visualization systems Addition of energies Addition of cables OR of the Present

32. Imaging based Connectivity Wireless Robotics Computer controlled Integration of technologies Integration of diagnostic tools Decrease personnel Increase patient safety and comfort Needs OR of the Future

33. Needs OR of the Future

34. Economical Limits Direct costs Indirect costs Direct benefits Indirect benefits COSTS

35. Still we need to take advantage of benefit of extended indications of minimally invasive surgery Very fast track techniques COSTS

36. BIOETHICS New Responsibilities Telepresence Role of Robot Teleproctoring BIOETHICS

37. Thank you