Robotic surgery can be employed to treat different liver diseases that require surgery, including liver cancer, non-cancerous tumors (adenomas and hemangiomas), and resections of the liver. It allows the surgeon to perform the same type of surgery that would be performed with open technique but without the large incision that usually goes from one side of the abdomen to the other, called bilateral subcostal incision. This is an incredible advantage in the postoperative recovery period. When these surgeries are performed through the open technique, the access to the liver itself is intensive and requires cutting the muscles of the abdominal wall; the incision on the muscle may cause prolonged postoperative pain, and this has the potential to affect the respiratory performance in the first days after surgery. Dr. Giulianotti was the first surgeon worldwide to use a robotic technique to resect the liver using small incisions and has been performing and teaching this type of surgery for more than a decade.
Biliary and Gallbladder Surgery
Robotic surgery has recently revolutionized the removal of the gallbladder and the treatment of biliary diseases, including stone removal, resections, and strictures. A dedicated set of special instruments allows surgeons to remove the gallbladder through a single incision - 1.5-2 inches long - that is hidden in the navel to create a virtually scarless surgery. Surgery on bile ducts requiring resections and reconstructions traditionally has been performed using open surgery, but now the computer-enhanced technology allows us to approach most of those procedures with a minimally invasive technique.
Pancreatic surgery is considered to be among the most challenging type of abdomen procedures, as it usually requires a large incision that cuts all the abdominal wall muscles form one side to the other. Dr. Giulianotti has been a pioneer in the field of robotic pancreatic surgery and is currently one of the very few in the world able to use this approach. The advantages of using robotic procedures for pancreatectomies and pancreatic resections are faster recovery, less trauma, fewer wound complications, and, for cancer patients, there is a potential to start chemotherapy treatment earlier than following open surgery.
The robotic approach for gastric diseases involves treatment for a wide variety of conditions that include cancer and benign diseases. The robotic technique 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.
Small Bowel Surgery
Resection of the small bowel can be necessary to treat different types of cancers or inflammatory diseases of the bowel. These conditions can be treated using robot-assisted techniques with the advantage of smaller incisions and the potential for less adhesions and inflammatory responses inside the abdomen.
Several benign conditions - such as diverticula, inflammatory bowel diseases, and strictures - and cancers might require partial of complete removal of the colon. In most cases, a robotic approach is feasible with all the advantages of minimally invasive surgery and the increased dexterity of the da Vinci system. The high precision of the dissection allows accurate removal of lymph nodes and precise reconstruction of the bowel continuity, in addition to 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.