The da Vinci® Surgical System is a sophisticated robotic platform designed to enable complex surgery using a minimally invasive approach. The da Vinci System consists of an ergonomic surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance tridimensional vision system and proprietary EndoWrist® instruments that reproduce the movements of the fingers and wrist of the surgeon’s hand inside the abdomen. Powered by state-of-the-art robotic technology, the da Vinci System is designed to scale, filter and seamlessly translate the surgeon’s hand movements into more precise movements of the EndoWrist instruments inside the abdominal cavity. The net result is an intuitive interface with breakthrough surgical capabilities.
The da Vinci® System’s high-resolution 3D stereo viewer is designed to provide surgeons with an immersive experience. Unlike conventional approaches, the target anatomy appears at high magnification, in brilliant color and with natural depth of field. To perform a procedure, the surgeon uses the console’s master controls to maneuver the patient-side cart’s four robotic arms, which securely hold the surgical instruments and high-magnification endoscopic camera. The instruments’ jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon’s hand movements. A final hallmark of the da Vinci System is its fail-safe design, incorporating multiple, redundant safety features designed to minimize opportunities for human error when compared with traditional surgical approaches.
The da Vinci® System is a remarkable improvement over conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments, to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on his/her patient-side assistant to position the camera correctly. In contrast, the da Vinci System’s ergonomic design allows the surgeon to operate from a comfortable, seated position at the console, with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands.
By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci® Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. This ultimately raises the standard of care for complex surgeries, translating into numerous potential patient benefits.
The advantages of robotic surgery are:
- Small incisions. The size of the incision made to fit the surgeon’s hand is much bigger compared to the one made to fit the surgical tools used with robotic surgery and this means that only small incisions are made.
- Reduced blood loss, no need for transfusion. Increased dexterity and better vision translates into a potential for reduced blood loss, the immune system does not suffer, and this type of surgery could be an option for people whose religious beliefs do not approve transfusions.
- Reduced post-operative pain. Because of the tiny incisions and the small surgical tools, surgery is overall less traumatic and more selective. The pain related to the surgery is far less than that associated with traditional surgery.
- Shorter hospital stays. The overall surgical trauma is reduced, consequentially the recovery is faster than that of traditional surgery.
- Minimal scarring. Small incisions translate into minimal scarring.
- Fewer post-operative complications, including reduced risk of infection. A large wound has an increased risk of developing infections and hernias, and the rate of complications increase with the size of the wound. Because of the small surgical tools and the small incisions, the incidence of wound infections and hernias are dramatically reduced compared to traditional surgery.
- Return to daily activities much faster – day instead of weeks. With the less traumatic surgery experience, you can return to your daily activities sooner.
- Faster chemotherapy. Because of the faster recovery and the reduced risk of developing wound complication, we have observed that patients who need further cancer treatments, such as chemotherapy, have more opportunities to start those treatments earlier.
- Safer Surgery. The new robotic devices incorporate a sophisticated system of infrared cameras, called firefly, that allows surgeons to identify in real-time important anatomical structures such as vessels, biliary ducts, lymph nodes and cancer tissue. This enables the surgeon to interact using information that increases the effectiveness and safety of surgery.
- Single incision technology. The da Vinci® system allows surgeons to perform selected surgeries, such as gallbladder removal, through one single incision 1.5 inches long, that is hidden in the umbilicus, with excellent cosmetic results and increased safety compared to the traditional minimally invasive options.
The University of Illinois Hospital & Health Sciences System is internationally renowned for being home to the most advanced robotic-assisted general surgery program. Under the leadership of Dr. Giulianotti a wide array of procedures are offered routinely.
Adrenal Gland Surgery
Robotic adrenalectomy is a minimally invasive alternative to traditional laparoscopic adrenalectomy and open surgery. The adrenal gland can be removed with two different approaches using the robotic system. The traditional approach requires 3 or 4 small incisions and is performed inside the abdominal cavity; the second approach, available for selected diseases, is performed through 3 incisions in the back without entering the abdominal cavity. This option provides potential for even faster recovery and faster return of bowel function. These approaches have the advantage of better cosmesis, reduced pain and blood losses with a faster recovery compared to open surgery.
- Robotic Adrenalectomy for Adenoma
- Robotic Adrenalectomy for Pheochromocytoma
Robotic surgery represents a very interesting alternative to the traditional removal of the thyroid gland. This thyroid gland is conventionally removed through an incision in the neck, which leaves a visible scar. In select cases, with the assistance of the robotic system, it is possible to perform the same surgery through an incision that is hidden under the arm.
- Partial thyroidectomy
- Total thyroidectomy
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
These surgeries are performed in collaboration with the division of Cardiothoracic surgery. Surgery in this part of the body requires opening the chest and spreading or breaking the ribs just to gain access to the anatomical structures that need to be removed. The trauma on the ribs is usually accompanied by postoperative pain that may last for several weeks. The same procedures can be performed with small incisions and no trauma to the ribs using the robotic technology.
- Lung resections for benign conditions
- Lung resections for cancer with lymphadenectomy (lobectomy, Pneumonectomy)
For some diseases, the removal of the thymus can be indicated. This type of surgery generally requires a large incision in the chest and opening of the sternum. Robotic surgery has revolutionized this approach, allowing access to the thymus through 3-4 small incisions, with a faster recovery and reduced postoperative pain and complications connected to the surgical access.
- Robotic thymectomy for Myasthenia
- Robotic thymectomy for Thymoma
These surgeries are performed in collaboration with the division of Vascular surgery. Thanks to the enhanced dexterity and unique suturing capabilities of the robot, it is possible to intervene on vessels using small incisions with enhanced precision and accuracy when compared to open surgery. The computer-enhanced movements of the instruments together with improved and magnified visualization of the anatomical structures, make this approach an alternative to open surgery for selected cases. For some diseases it is possible to repair defects of vessels that otherwise would require the complete removal of the organ or permanent closure of the vessel involved.
- Visceral aneurysm resection with reconstruction (e.g. renal and splenic artery)
- Vascular by-pass