Biliary and Gallbladder Surgery
Robotic surgery has recently revolutionized the removal of the gallbladder and other biliary diseases that can be surgically treated. A dedicated set of special instruments allows us to remove the gallbladder through a single incision, 1.5-2 inches long, which is hidden in the umbilicus to create a virtually scarless surgery. In addition, the use of special dyes to highlight the anatomy during surgery has the potential to reduce errors and safely shorten the length of time for the procedure. Surgery on bile ducts requiring resections and reconstructions has always been performed using open surgery, but now the computer-enhanced technology allows us to approach most of those procedures with a minimally invasive technique.
- Gallbladder removal
- Common bile duct stones removal
- Bile duct bypass
- Resection of common bile duct
- Resection of common bile duct cysts
- Common bile duct strictures
Several benign conditions (diverticula, inflammatory bowel diseases, strictures) and cancers might require the removal of part or all of the colon. In most cases a robotic approach is feasible and offers all the advantages of minimally invasive surgery and the increased dexterity of the da Vinci® system. The precision of the dissection allows accurate removal of lymph nodes and precise reconstruction of the bowel continuity, as well as increased capability to recognize and preserve nerves that are involved in sexual activity and urinary function. These surgeries are performed in collaboration with the division of Colorectal surgery.
- Right colectomy
- Left colectomy
- Rectal resections
Surgical access to the esophagus is always challenging. The esophagus connects the throat to the stomach and it runs in between the abdomen, the chest and the neck. Surgery on the esophagus often requires multiple incisions in those different regions in order to have good control and exposure of the anatomy. Access to the chest can be extremely traumatic because of the need to cut or fracture ribs. Robotic surgery allows for small incisions and an overall reduction in trauma associated with those incisions. For cancer patients, the removal of the lymph nodes draining the diseased area is very important and the computer-assisted technology can help enhance precision during those steps. For benign disease such as GERD and achalasia, robotic surgery offers an effective alternative as well, with increased precision, fast recovery and reduced postoperative pain.
- Hiatal hernia, GERD, Nissen Fundoplication
- Achalasia: Heller myotomy
- Esophageal Cancer: Radical esophagectomy
- Esophageal diverticula resection
Several types of hernias may occur. In many cases a minimally invasive repair can be indicated, and a mesh is generally used to close the defect. Because of the limitations of laparoscopic surgery, special clips are used to fix the mesh in place. In many cases robotic technology can reduce the use of those foreign bodies to fix the mesh allowing for a strong fixation. The repair of hernias can be fast and safe with just three small incisions. The increased precision of the computer-assisted instruments has potential for a more precise dissection and preservation of nerves, with expected lower postoperative pain and potential for lower incidence of chronic postoperative pain. Most of the surgeries are performed as outpatient procedures and patients usually go home the same day of surgery.
- Umbilical, Ventral, Incisional hernia repair
- Inguinal hernia repair
- Diaphragm hernias
- Crural, femoral, spigelian, parastomal hernias
Robotic surgery can be utilized to treat different diseases of the liver that require surgery. It allows surgeons to perform the same type of surgery that would be performed with open technique, but without a large incision that usually goes from one side of the abdomen to the other (bilateral subcostal incision). This is an incredible advantage in the postoperative recovery period. In this type of surgery, the access to the liver itself is a big procedure which requires cutting the muscles of the abdominal wall. This has several implications in the postoperative course as the wound is at risk of infections and hernias. The incision on the muscle may cause prolonged postoperative pain and may affect the respiratory performance in the first days after surgery. Dr. Giulianotti was the first surgeon worldwide to use a robot to resect the liver using small incisions; he has been performing and teaching this type of surgery for more than 14 years.
- Liver cancer, metastases to the liver form other cancers, Adenomas, Hemangiomas: Major hepatectomy (left, right), Hepatic segmentectomy, Hepatic wedge resections
Pancreatic surgery is considered among the most challenging type of procedures that can be performed in the abdomen. It usually requires a large incision that cuts all the abdominal wall muscles form one side to the other. Dr. Giulianotti is a pioneer in the field of robotic pancreatic surgery and is currently one of very few surgeons in the world able to use this approach. Since 2001, he has been routinely performing this surgery using small incisions and the robotic technology. The advantages are: faster recovery, less trauma, fewer wound complications, reduced blood losses, and for cancer patients, there is a potential to start chemotherapy treatment earlier.
- Resection of the head of the pancreas (Whipple procedure)
- Central pancreatectomy
- Distal pancreatectomy with preservation of the spleen
- Distal spleno-pancreatectomy
- Total pancreatectomy
- Treatment of pancreatic pseudocysts
Robotic approach for gastric disease involves a wide variety of procedures that include cancer and benign diseases. The robot allows for a precise and less traumatic removal of the organ, together with all the lymph nodes that can be potentially involved in the disease.
- Total and subtotal gastric resection for cancer
- Gastric resection for benign disease
- Partial/wedge resections
- Gastric by-pass
Several conditions might require a total or partial removal of the spleen. With the assistance of the robot, it is possible to perform most of those surgeries with few small incisions, allowing for reduced postoperative pain and faster recovery.
- Total or partial removal of the spleen for: Lymphoma, Hematologic diseases, Cancer.
Small bowel Surgery
Resection of the small bowel can be necessary to treat different types of cancer or inflammatory diseases of the bowel. The conditions can be treated using robotic-assisted techniques with the advantage of smaller incisions and the potential for fewer adhesions and inflammatory responses inside the abdomen.
- Small bowel cancer
- Crohn’s disease