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I, Robot

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Santiago Horgan
Surgery, University of Illinois Medical Center at Chicago

Born in Buenos Aires, Santiago Horgan, 40, is the great-grandson of an Irishman who moved to Argentina in the 19th century to help build the railways there. Like his name, Horgan’s medical duties at UIC also have a kind of duality: he serves as director of both the Minimally Invasive Surgery and Robotic Surgery Department and the Minimally Invasive Bariatric Center, which offers surgical solutions to obesity.

Q. To battle obesity, you have recently begun using an alternative to gastric bypass, the Lap-Band Adjustable Gastric Banding System. What is that?
A. It is a ring that we place in the stomach in order to create an hourglass shape. The upper part [of the hourglass] is very tiny—the size of an egg—and the lower part is the rest of your stomach. What that band does is make you feel fuller quicker. It takes your hunger away.

Q. Unlike a gastric bypass, the Lap-Band can be adjusted following surgery. How does that work?
A. Inside that ring, there is a balloon that we can inflate slowly [by inserting a needle into a permanent portal in the abdomen]. That allows us to tailor how much the patient is eating based on his needs. That’s the beauty. We can make it tighter, or we can make it looser.

Q. You are also conducting trials to win approval from the FDA to perform this surgery on children. Why is that so important?
A. My main concern is that obesity is impacting kids, and these kids will be adults in 20 years. If we already have obese kids, this is going to be an obese society if we don’t stop it. We need to be more aggressive; we need to change dramatically the way we eat.

Q. How do you decide which obese patients might benefit from surgery?
We use BMI: body mass index. If your BMI is more than 40, you would benefit from an operation. If your BMI is more than 35 and you have diabetes, high blood pressure, coronary artery disease, or sleep apnea, you qualify for an operation.

Q. Since 2000, you have been employing the robotic da Vinci Surgical System at UIC. What are its advantages over standard laparoscopic surgery?
A. What the robot brings to the equation is the ability for the surgeon to operate away from the patient. In theory, in the future I could be operating [in Chicago], and the patient could be in New York. In addition, the camera has real 3-D, and the system has a wrist action, which is very unique. It is like I am operating with tiny hands inside the belly, so the things I do are much more accurate.

Q. Where does robotic surgery currently have the most promise?
We are trying to identify that [robotics] is not just a fancy tool. In kidney transplantation, we can clearly do the extraction of the kidney safer, quicker, and with fewer complications. With cancer of the esophagus, we can remove the esophagus with a tiny incision, without needing to open your chest or your belly. We couldn’t do that as well laparoscopically. Prostatectomy [surgical removal of the prostate gland] is becoming one of the leading operations to be treated by the robot because it diminishes the possible complication of impotence. You can see the nerves better and you don’t have tremor. It really improves patient care, which is what this is all about.


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