The New Yorker - USA (2019-09-30)

26 THENEWYORKER,SEPTEMBER30, 2019

Surgical robots have thin rods instead of bulky hands, and the rods never tremble.

ANNALS OFMEDICINE

DR. ROBOT

An Italian surgeon prefers to do his cutting by remote control.

BY D.T. MAX

ILLUSTRATION BY ELENA XAUSA

W

hen Pier Giulianotti was a medi­
cal student, he hated the sight of
blood. In the mid­seventies, he travelled
from his native Italy to Spain, on a fel­
lowship, and watched a lung resection.
“I nearly fainted,” he recalled recently.
“I had to sit down in the corner.” The
next day, he attended a plastic­surgery
procedure. “Something more gentle,”
he told himself. “This will be for me!”
The patient had a burn scar on her face.
First, the surgeons removed the damaged
skin. “You’ve seen the movie ‘Termina­
tor’?” Giulianotti said. “I was trembling
on my legs, but I was trying to resist.”
After the surgeons prepared a graft by
slicing healthy skin from the woman’s

thigh—“Swoosh swoosh swoosh, like cut­

ting a piece of salami!”—he went woozy.

Again he was led to the chair of shame.

Giulianotti considered quitting medi­

cine, but he loved helping patients. He

got over his squeamishness and decided

to specialize in surgery, but kept won­

dering if the practice could be refined.

“I am Tuscan—anatomy is painting,”

he said to himself. “Surely there is a

more artistic way to interact with the

human body.”

He finished his medical studies and

did surgical residencies at the Univer­

sity of Pisa and the University of Milan,

which are among Italy’s best medical

faculties. In the mid­eighties, he be­

came an expert in laparoscopic surgery,

in which a doctor inserts a camera in­

side a small incision and then uses the

video to guide surgical tools that have

been inserted into the body through

other incisions. Minimally invasive sur­

gery speeds recovery and reduces the

length of hospital stays. But he found

that laparoscopic equipment was dis­

orienting to use—among other prob­

lems, depending on the position of the

probe inside the body, the image that

the surgeon sees can be backward.

In 1999, Giulianotti remembers, he

attended a conference in Germany, spon­

sored by Johnson & Johnson, where the

company demonstrated a prototype of

a robotic arm for use in performing sur­

gery. The response was tepid—the sur­

geons present said that they just wanted

better laparoscopic tools. Johnson &

Johnson shelved the project, but Giu­

lianotti was galvanized by the concept.

“Ninety per cent of the surgeons said

bullshit,” he said. “But I knew.”

On a recent morning in Chicago,

Giulianotti, who looks a little like Ar­

nold Schwarzenegger with white hair,

put on a sterile gown and cap, covered

his craggy face with a surgeon’s mask,

and entered an operating room. Giu­

lianotti is now a professor of surgery at

the University of Illinois College of

Medicine, where he runs a program in

robotic­assisted surgery. At the age of

sixty­six, he has now performed roughly

three thousand procedures with the aid

of a robot, and has helped train nearly

two thousand surgeons in the art. Farid

Gharagozloo, a professor at the Univer­

sity of Central Florida and a surgeon at

the Global Robotics Institute, said of

Giulianotti, “He single­handedly started

the area of general surgery in robotics,

and I don’t think that’s an overstate­

ment. No matter what the field, there’s

a certain panache and sort of genetic

makeup that makes people the lead­

ers—makes them do things that no one

else wants—and Pier has that.” Ghara­

gozloo said that, when he watched vid­

eos of Giulianotti’s surgeries, he was left

“in awe.” Giulianotti was the first sur­

geon to perform more than a dozen ro­

botic procedures, ranging from kidney

transplants to lung resections. In the

operating room, he relies on one robot:

a multi­armed, one­and­a­half­ million­

dollar device named the da Vinci.