30 THENEWYORKER,SEPTEMBER30, 2019
all, because of the risk of leaving can-
cerous lymph nodes behind. “Let’s com-
plete the job,” he said. He went back
to the console, and the robot began
methodically cutting the blood vessels
that bonded the stomach to the spleen.
Throughout the operation, the
da Vinci displayed morsels of digital in-
telligence. Whenever Giulianotti wanted
to cut something, the robot first mea-
sured the tissue’s impedance—or resis-
tance to an electrical current—and, thus,
the extent to which blood had been
stanched. If the da Vinci judged that it
was O.K. to proceed, it gave an encour-
aging beep. The robot had a stapler, but
it would not use it if the tissue that it
was supposed to tack down was too thick.
(It reminded me of a remark that Moll,
Intuitive Surgical’s co-founder, had made
to the Times, in 2008. He said that a key
function of robots in an operating room
was to constrain bad surgeons: “Robots
are good at going where they are sup-
posed to, remembering where they are
and stopping when required.”)
At eight-forty-five, the tumor paled,
its blood supply having been cut off.
Giulianotti cut loose a section of the
pancreas near the tumor and then sep-
arated the spleen, and its suspect lymph
nodes, from the stomach wall. If there
had been no evidence of cancer, Giu-
lianotti could have chopped up the
tumor and brought it out through the
existing tiny holes in the patient’s belly.
But this was impossible where there
was a risk of malignant cells spreading,
so a nurse sent a specimen bag through
the cannula. Giulianotti used his ro-
botic grasper to put the loose organ and
the tumor inside the bag.
The elegance that Giulianotti so
prized had evaporated. He got up from
his seat and went over to the operating
table. The chief resident made a three-
inch incision in the patient’s abdomen.
Giulianotti put a laparoscopic camera
through one of the cannulas and, while
watching the screen, used forceps to
push the bag toward the incision. He
then squeezed the contents until they
fit through the slit.
At 9:42 a.m., he pulled out the bag
with the severed spleen and the tumor.
The specimen emerged through the in-
cision with a plop. Giulianotti looked
up like a boy with mixed feelings about
having caught a fish. “We lost more
blood from this stupid maneuver than
from the entire robotic operation,” he
groused. But there was compensation.
“We finished before the Bach partitas
did,” he noted.
Afterward, Giulianotti and I went
to a small room outside the O.R., where
various physicians were typing into ter-
minals. He said, “Some people—even
my colleagues—when speaking about
the robot they are saying, ‘Oh, it’s a bet-
ter tool.’No. It’s not a better tool! It’s
a complete”—he searched for the end
of the thought—“philosophical con-
cept. We are for the first time in the
history of humanity using a world that
doesn’t exist—virtuality—to be able to
change reality.”
Later that day, we went across the
street, where the university is building
a new robotic-surgery center. (The most
generous private donor is a satisfied for-
mer patient of Giulianotti’s.) The new
lab, which is set to open next year, will
be underground, and when Giulianotti
first saw the bunkerlike space he found
it too gloomy. So he lifted the auda-
cious concept behind I. M. Pei’s addi-
tion to the Louvre, and added skylights,
in the shape of glass pyramids, to var-ious courtyards. Giulianotti told me that
he had originally come to Chicago for
a one-year sabbatical but had grown
to like the city. “It is one of only three
American cities acceptable to Europe-
ans,” he declared.
To get to the new lab, Giulianotti
took me beneath the university’s neuro-
psychiatric institute, whizzing past an
“Authorized Personnel Only” sign. He
has the mind-set, common to many sur-
geons, that he can do pretty much what-
ever he wants. At one point, when a pub-
licist from the hospital told him that she
was obligated to be at his side whenever
I was present, he refused, informing her
that he didn’t live in the Soviet Union.
Arriving at the new lab space, most
of which was still under construction,
Giulianotti showed me where seminar
rooms and training facilities would go.
He was particularly eager to try out an
operation on patients who suffered from
gastric reflux; if the technique worked
as well as he hoped, the patients might
emerge fully cured—and could stop tak-
ing medication like Prilosec. He swore
me to secrecy on the new procedure,
saying, “If they knew that I’m working
on this project they could kill me, be-THE CLIMATE
It was like watching a wave approach
from a great distance, so greatthat at first it is not a wave at all, but
a mere horizon, static and singular,so that one, it being possible, presumably,
to avail oneself of the diversionsof the beach, might turn one’s back
on the ocean altogether, might turn insteadto the sand, heaped and tunnelled,
the sunscreened hand that fumblesfor a book, indeed, the book,
the sentence, the syntax, the sunblanching the page, stained, perhaps,
with sweat, the creamy pleasureof not-laboring, when one would otherwise
labor, the pleasure of wasting