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Ceccarelli G, Catena F, Avella P, Tian BW, Rondelli F, Guerra G, De Rosa M, Rocca A. Emergency robotic surgery: the experience of a single center and review of the literature. World J Emerg Surg 2024; 19:28. [PMID: 39154016 DOI: 10.1186/s13017-024-00555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUNDS Laparoscopic surgery is widely used in abdominal emergency surgery (AES), and the possibility of extending this approach to the more recent robotic surgery (RS) arouses great interest. The slow diffusion of robotic technology mainly due to high costs and the longer RS operative time when compared to laparoscopy may represent disincentives, especially in AES. This study aims to report our experience in the use of RS in AES assessing its safety and feasibility, with particular focus on intra- and post-operative complications, conversion rate, and surgical learning curve. Our data were also compared to other experiences though an extensive literature review. METHODS We retrospectively analysed a single surgeon series of the last 10 years. From January 2014 to December 2023, 36 patients underwent urgent or emergency RS. The robotic devices used were Da Vinci Si (15 cases) and Xi (21 cases). RESULTS 36 (4.3%) out of 834 robotic procedures were included in our analysis: 20 (56.56%) females. The mean age was 63 years and 30% of patients were ≥ 70 years. 2 (5.55%) procedures were performed at night. No conversions to open were reported in this series. According to the Clavien-Dindo classification, 2 (5.5%) major complications were collected. Intraoperative and 30-day mortality were 0%. CONCLUSIONS Our study demonstrates that RS may be a useful and reliable approach also to AES and intraoperative laparoscopic complications when performed in selected hemodynamically stable patients in very well-trained robotic centers. The technology may increase the minimally invasive use and conversion rate in emergent settings in a completely robotic or hybrid approach.
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Affiliation(s)
- Graziano Ceccarelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Fausto Catena
- Division of General Surgery, Bufalini Hospital, Cesena, Italy
| | - Pasquale Avella
- Department of General Surgery and Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Brian Wca Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fabio Rondelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Germano Guerra
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Michele De Rosa
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Aldo Rocca
- Department of General Surgery and Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
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Łajczak PM, Jóźwik K. Beyond the Band-Aid: Robot-Assisted Laparoscopy for Splenic Aneurysms. A Systematic Review. Ann Vasc Surg 2024:S0890-5096(24)00409-6. [PMID: 39009124 DOI: 10.1016/j.avsg.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/15/2024] [Accepted: 05/31/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION Splenic artery aneurysm (SAA) is characterized by a weakening and bulging of splenic artery. Robot-assisted laparoscopic surgery is a minimally invasive surgical technique. This systematic review aimed to assess the use of robot-assisted laparoscopic surgery to manage SAA. METHODOLOGY Five medical databases were used to identify studies that investigated the use of robotic devices in laparoscopic SAA management in humans. Original, peer-reviewed articles were included. Two authors independently screened articles and extracted data on factors including patient demographics, surgical procedures, and outcomes. RESULTS The PRISMA search identified seven studies with a total of 28 patients who underwent robot-assisted laparoscopic surgery for SAA. The studies reported successful surgeries using various techniques, including end-to-end anastomosis, ligation, and graft placement. 3D printed models were used in one study as an aid for pre-operative surgery planning. Mean operation time was 210 minutes, and three complications were reported (robotic arm failure during surgery and two conversions to open surgery). DISCUSSION AND FUTURE DIRECTIONS Robot-assisted laparoscopic surgery offers several advantages over traditional open surgery for SAA management. However, more research is needed to confirm these potential benefits and establish robot-assisted laparoscopic surgery as a standard treatment option for SAA. Future studies should involve larger patient groups, compare this method to traditional techniques, and evaluate its cost-effectiveness. Additionally, incorporating advancements like mixed reality for pre-operative planning and 3D printing to improve surgical planning and patient communication.
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Affiliation(s)
- Paweł Marek Łajczak
- Prof. Zbigniew Religa Student Scientific Club at Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, 40-043 Zabrze.
| | - Kamil Jóźwik
- Prof. Zbigniew Religa Student Scientific Club at Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Jordana 18, 40-043 Zabrze
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Rinaldi LF, Brioschi C, Marone EM. Robotic Surgery for Elective Repair of Visceral and Renal Artery Aneurysms: A Systematic Review. J Clin Med 2024; 13:3385. [PMID: 38929914 PMCID: PMC11203936 DOI: 10.3390/jcm13123385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/27/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The treatment choice of visceral artery aneurysms in an elective setting is debated. The durability and the risk of reintervention with endovascular treatment are still reasons for concern, whereas open surgery is invasive and burdened by major complications. In anecdotal reports and isolated studies, robotic-assisted surgery seems to provide the possibility of a minimally invasive treatment and the durability of traditional open surgery, but the literature supporting this view is scarce. This review aims to collect the results of robotic-assisted surgery in the treatment of visceral artery aneurysms. Methods: A systematic search of the main research databases was performed: the study endpoints were mortality and conversion rates, perioperative morbidity, and freedom from late complications and reinterventions. Results: We identified 16 studies on 53 patients. All cases underwent successful resection, with three conversions to laparoscopy. Perioperative and aneurysm-related mortality were nil. Over a median follow-up of 9 months, two reinterventions were reported (3.6%). Conclusion: The robotic technique is safe and effective in treating splenic and renal artery aneurysms, and it should be considered as a valuable alternative to endovascular and open repair, although larger sample sizes and a longer-term follow-up are necessary to confirm such results.
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Affiliation(s)
- Luigi Federico Rinaldi
- Vascular Surgery, Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, 16132 Genoa, Italy
- Hospital Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
| | - Chiara Brioschi
- Hospital Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
| | - Enrico Maria Marone
- Hospital Policlinico di Monza, 20900 Monza, Italy; (C.B.); (E.M.M.)
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Troisi N, Bertagna G, Tomei F, Adami D, Cioni R, Perrone O, Juszczak M, Berchiolli R. Long-term Outcome Comparison of 2 Techniques for Embolization of Splenic Artery Aneurysms. J Endovasc Ther 2024:15266028241255531. [PMID: 38813950 DOI: 10.1177/15266028241255531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE The aim of the study is to analyze our single-center experience in endovascular treatment of splenic artery aneurysms (SAAs) with transcatheter coil embolization, comparing long-term outcomes of packing and sandwich techniques. MATERIALS AND METHODS Between January 2010 and December 2021, 28 patients with certain diagnosis of non-ruptured asymptomatic SAA were treated with 2 different embolization techniques (packing, n=10, and sandwich, n=18). Early outcomes assessed were technical success, overall mortality, mean hospital stay, post-embolization syndrome rate, and freedom from splenectomy rate. Estimated 5-year outcomes in terms of freedom from sac reperfusion, and freedom from reintervention were evaluated and compared between the 2 different embolization techniques. RESULTS The mean SAA diameter was 2.8±0.8 cm. Overall technical success rate was 100%. Intraoperative and 30-day mortality rates were 0 in both groups. One patient in the sandwich group required a postoperative splenectomy. The mean follow-up period was 58.3±44.5 months. Estimated overall 5-year survival was 86.7%. Five-year freedom from sac reperfusion was 100% in the sandwich group, and 85.7% in the packing group, with no difference between the 2 groups (p=0.131), whereas freedom from reintervention was 100% in the sandwich group, and 75% in the packing group with a statistically significant difference (p=0.049; log-rank=3.750). CONCLUSIONS Embolization of SAAs seemed to be safe and effective with 100% of technical success rate and good perioperative results. Both sandwich and packing techniques yielded promising results also in the long-term period. CLINICAL IMPACT Transcatheter coil embolization of splenic artery aneurysms seems to be a safe and effective procedure with a 100% technical success and satisfactory perioperative outcomes. Sandwich and packing techniques offer good results in the long-term period. Freedom from reintervention seems to be optimal and comparable between the 2 techniques.
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Affiliation(s)
- Nicola Troisi
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giulia Bertagna
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Tomei
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Cioni
- Department of Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Orsola Perrone
- Department of Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Maciej Juszczak
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Raffaella Berchiolli
- Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Pavone M, Seeliger B, Teodorico E, Goglia M, Taliento C, Bizzarri N, Lecointre L, Akladios C, Forgione A, Scambia G, Marescaux J, Testa AC, Querleu D. Ultrasound-guided robotic surgical procedures: a systematic review. Surg Endosc 2024; 38:2359-2370. [PMID: 38512350 PMCID: PMC11078854 DOI: 10.1007/s00464-024-10772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Ultrasound has been nicknamed "the surgeon's stethoscope". The advantages of laparoscopic ultrasound beyond a substitute for the sense of touch are considerable, especially for robotic surgery. Being able to see through parenchyma and into vascular structures enables to avoid unnecessary dissection by providing a thorough assessment at every stage without the need for contrast media or ionising radiation. The limitations of restricted angulation and access within the abdominal cavity during laparoscopy can be overcome by robotic handling of miniaturised ultrasound probes and the use of various and specific frequencies will meet tissue- and organ-specific characteristics. The aim of this systematic review was to assess the reported applications of intraoperative ultrasound-guided robotic surgery and to outline future perspectives. METHODS The study adhered to the PRISMA guidelines. PubMed, Google Scholar, ScienceDirect and ClinicalTrials.gov were searched up to October 2023. Manuscripts reporting data on ultrasound-guided robotic procedures were included in the qualitative analysis. RESULTS 20 studies met the inclusion criteria. The majority (53%) were related to the field of general surgery during liver, pancreas, spleen, gallbladder/bile duct, vascular and rectal surgery. This was followed by other fields of oncological surgery (42%) including urology, lung surgery, and retroperitoneal lymphadenectomy for metastases. Among the studies, ten (53%) focused on locating tumoral lesions and defining resection margins, four (15%) were designed to test the feasibility of robotic ultrasound-guided surgery, while two (10.5%) aimed to compare robotic and laparoscopic ultrasound probes. Additionally two studies (10.5%) evaluated the robotic drop-in probe one (5%) assessed the hepatic tissue consistency and another one (5%) aimed to visualize the blood flow in the splenic artery. CONCLUSION The advantages of robotic instrumentation, including ergonomics, dexterity, and precision of movements, are of relevance for robotic intraoperative ultrasound (RIOUS). The present systematic review demonstrates the virtue of RIOUS to support surgeons and potentially reduce minimally invasive procedure times.
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Affiliation(s)
- Matteo Pavone
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France.
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France.
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Barbara Seeliger
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
- Department of Digestive and Endocrine Surgery, University Hospitals of Strasbourg, Strasbourg, France
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
| | - Elena Teodorico
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Marta Goglia
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Cristina Taliento
- Department of Obstetrics and Gynecology, University Hospital Ferrara, Ferrara, Italy
- Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000, Leuven, Belgium
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Lise Lecointre
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- ICube, UMR 7357 CNRS, University of Strasbourg, Strasbourg, France
- Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | - Cherif Akladios
- Department of Gynecologic Surgery, University Hospitals of Strasbourg, Strasbourg, France
| | | | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Jacques Marescaux
- Research Institute Against Digestive Cancer, IRCAD, Strasbourg, France
| | - Antonia C Testa
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Denis Querleu
- Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
- UOC Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Ciocan RA, Graur F, Ciocan A, Cismaru CA, Pintilie SR, Berindan-Neagoe I, Hajjar NA, Gherman CD. Robot-Guided Ultrasonography in Surgical Interventions. Diagnostics (Basel) 2023; 13:2456. [PMID: 37510199 PMCID: PMC10378616 DOI: 10.3390/diagnostics13142456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The introduction of robotic-guided procedures in surgical techniques has brought an increase in the accuracy and control of resections. Surgery has evolved as a technique since the development of laparoscopy, which has added to the visualisation of the peritoneal cavity from a different perspective. Multi-armed robot associated with real-time intraoperative imaging devices brings important manoeuvrability and dexterity improvements in certain surgical fields. MATERIALS AND METHODS The present study is designed to synthesise the development of imaging techniques with a focus on ultrasonography in robotic surgery in the last ten years regarding abdominal surgical interventions. RESULTS All studies involved abdominal surgery. Out of the seven studies, two were performed in clinical trials. The other five studies were performed on organs or simulators and attempted to develop a hybrid surgical technique using ultrasonography and robotic surgery. Most studies aim to surgically identify both blood vessels and nerve structures through this combined technique (surgery and imaging). CONCLUSIONS Ultrasonography is often used in minimally invasive surgical techniques. This adds to the visualisation of blood vessels, the correct identification of tumour margins, and the location of surgical instruments in the tissue. The development of ultrasound technology from 2D to 3D and 4D has brought improvements in minimally invasive and robotic surgical techniques, and it should be further studied to bring surgery to a higher level.
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Affiliation(s)
- Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
| | - Florin Graur
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Andra Ciocan
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Cosmin Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Sebastian Romeo Pintilie
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Claudia Diana Gherman
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
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Silvestri V, Pontecorvi E, Filotico M, Coppola A, Lauria F, Bracale U, Corcione F. Laparoscopic splenic artery aneurysmectomy with ICG guided partial splenectomy: alternative approach. MINIM INVASIV THER 2021; 31:810-814. [PMID: 34694196 DOI: 10.1080/13645706.2021.1994420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We herein report the case of a voluminous splenic artery aneurysm (SAA) diagnosed in a 48 year-old Caucasian male patient. After endovascular treatment failure, considering the volumetric aneurysm increase and recurrent symptoms, a laparoscopic splenic artery aneurysmectomy with partial splenectomy guided by indocyanine green fluorescence (ICG) was performed. This conservative strategy leads to save a spleen volume of about 10 cm3 to avoid postsplenectomy thrombocytosis and infections, potential immunodeficiency and overwhelming postsplenectomy infection syndrome (OPSS) and to preserve pancreatic vascularization preventing distal pancreas injuries.
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Affiliation(s)
- Vania Silvestri
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Emanuele Pontecorvi
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Marcello Filotico
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Andrea Coppola
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Federica Lauria
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Umberto Bracale
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Francesco Corcione
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
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Laparoscopic and Robotic Surgery for Splenic Artery Aneurysm: A Systematic Review. Ann Vasc Surg 2020; 68:527-535. [DOI: 10.1016/j.avsg.2020.05.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/27/2023]
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9
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The use of robot-assisted surgery for visceral abdominal aneurysms treatment. J Robot Surg 2020; 15:153-154. [PMID: 32909109 DOI: 10.1007/s11701-020-01122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
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10
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Tijani Y, Belmir H, Zahdi O, Khalki L, El Khloufi S, Sefiani Y, Elmesnaoui A, Lekehal B. Giant anevrisms of the splenic artery about six cases. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:248-253. [PMID: 32862981 DOI: 10.1016/j.jdmv.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 07/04/2020] [Indexed: 11/25/2022]
Abstract
Splenic artery aneurysms are rare. Giant aneurysms more than 2,5cm are extremely rare. The splenic artery is the third site after the aorta and iliac arteries, and the first location for aneurysmal lesion of the visceral arteries. The etiology of splenic artery aneurysms is not yet well established, however, fibromuscular dysplasia, non-cirrhotic portal hypertension and pregnancy seem to contribute to the emergence and evolution of arterial lesions. The majority of splenic artery aneurysms are asymptomatic. However, epigastric or left hypochondrial pain may occur. Doppler ultrasound, computed tomography angiography or magnetic resonance imaging are usually performed in the diagnostic workup. Treatment procedure, surgical or endovascular, depends on the aneurysmal site (proximal or distal) and the type of elective or urgent intervention. The present study reports six cases of splenic artery aneurysm, with a diameter greater than 50mm, treated successfully with surgery.
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Affiliation(s)
- Y Tijani
- Department of vascular and endovascular surgery, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco.
| | - H Belmir
- Department of vascular and endovascular surgery, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - O Zahdi
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
| | - L Khalki
- Department of vascular and endovascular surgery, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - S El Khloufi
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
| | - Y Sefiani
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
| | - A Elmesnaoui
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
| | - B Lekehal
- Department of vascular and endovascular surgery, Mohammed V University of Rabat, Rabat, Morocco
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11
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Marone EM, Peri A, Argenti F, Pugliese L, Rinaldi LF, Pietrabissa A. Robotic Treatment of Complex Splenic Artery Aneurysms with Deep Hilar Location: Technical Insights and Midterm Results. Ann Vasc Surg 2020; 68:50-56. [PMID: 32283302 DOI: 10.1016/j.avsg.2020.03.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Splenic artery aneurysms are rare, but their occurrence is burdened by considerable mortality and morbidity rates. Although the indications to treatment are quite clear-cut, there is still debate on the first-choice technique of treatment (endovascular, open, or laparoscopic surgery). Recently, robotic surgery has been proposed as an alternative option in patients at high surgical risk. The present case series aims to assess the value of robotic treatment of splenic artery aneurysms in patients unfit for surgery. METHODS All cases of splenic artery aneurysms treated by robotic surgery at our center between 2014 and 2018 were retrospectively reviewed. Primary endpoints were clinical and technical success and disease-free survival. RESULTS Robotic surgery was used to treat four patients affected by splenic artery aneurysms, with the guidance of 3D printed patient-specific models. All patients, after aneurysm excision, received reconstruction of the splenic artery by direct anastomosis. All cases were treated successfully without mortality. Reintervention-free survival at 24-month mean follow-up is 100%, and no systemic complication of clinical relevance was reported. The mean time of organ ischemia was 45 min. CONCLUSIONS Robotic surgery is a safe and effective option in treating visceral aneurysms, providing the possibility to reconstruct the splenic artery after aneurysm excision.
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Affiliation(s)
- Enrico Maria Marone
- Vascular Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Andrea Peri
- General Surgery, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Argenti
- General Surgery, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigi Pugliese
- General Surgery, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigi Federico Rinaldi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Pietrabissa
- General Surgery, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Lozano Sánchez FS, García-Alonso J, Torres JA, Velasco L, Salvador R, Peña R, González-Porras JR. Decision-making and therapeutic options in intact splenic artery aneurysms: single-center experience and literature review. INT ANGIOL 2020; 39:241-251. [PMID: 32057214 DOI: 10.23736/s0392-9590.20.04304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Splenic artery aneurysms are rare, potentially serious, and usually asymptomatic. Several methods are currently available to treat them, each with their own advantages and drawbacks. Therefore, its therapeutic paradigm has changed. METHODS We review our database of splenic aneurysms (2009-2019) and undertake an exhaustive literature review. Demographic, clinical, diagnostic, therapeutic, early and follow-up outcome data were examined. Our experience comprised: 15 patients with 19 splenic aneurysms. 11 women (average age, 59.4 years) and 4 men (average age, 61.7 years). All asymptomatic. RESULTS At diagnosis, aneurysms had a mean cross-sectional diameter of 3.4 cm (3.2 and 3.9 for women and men, respectively), the largest measuring 8.5 cm. Two independent aneurysms were detected in four patients. Diagnoses were always incidental to a CT scan. Treatments consisted of open surgery (2 patients), endovascular surgery (10 patients: 7 embolizations, 3 covered stent) and observation/follow-up (3 patients). The cases of open surgery (with splenectomy) were carried out without postoperative morbidity. One embolization failed (requiring subsequent open surgery) and two suffered localized splenic infarction, but without further complications. In patients treated with a covered stent, the aneurysm was always excluded, without complications. There was no 30-day or follow-up (average 26.2 months) mortality. Splenic aneurysms are diagnosed more frequently and earlier (in the asymptomatic phase), albeit incidentally, than in the past. CONCLUSIONS The correct indication (identifying patients at risk) and individualization of treatment, in which endovascular techniques are the first-line option, have significantly improved morbidity and mortality outcomes in our hospital.
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Affiliation(s)
- Francisco S Lozano Sánchez
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain -
| | - Jesus García-Alonso
- Unit of Interventional Radiology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - José A Torres
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Luis Velasco
- Unit of Interventional Radiology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Roberto Salvador
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - Ruben Peña
- Unit of Angiology and Vascular Surgery, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
| | - José R González-Porras
- Unit of Thromobosis and Hemostasis, Department of Hematology, University Hospital of Salamanca, Salamanca Biomedical Research Institute, Salamanca, Spain
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Ceccarelli G, Gusai G, Rondelli F, Balestra F, De Rosa M. Video-robotic aneurysmectomy for splenic artery aneurysm: case report and literature review. MINIM INVASIV THER 2019; 29:244-249. [PMID: 31250696 DOI: 10.1080/13645706.2019.1623819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We herein report the case of a symptomatic splenic artery aneurysm (SAA) diagnosed in a 65-year-old woman. Endoluminal exclusion was considered as first option, but the potential risk of postoperative splenic infarction, postsplenectomy thrombocytosis and immunodeficiency in an otherwise healthy patient raised the possibility to carry out a surgical procedure of vascular reconstruction using the robotic device Da Vinci® Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). We performed the resection of the aneurysm and the continuity of the splenic artery was restored by end-to-end anastomosis.
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Affiliation(s)
- Graziano Ceccarelli
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
| | - Giampietro Gusai
- Department of General Surgery, San Francesco Hospital, Nuoro, Italy
| | - Fabio Rondelli
- Department of General Surgery, San Francesco Hospital, Nuoro, Italy
| | | | - Michele De Rosa
- Department of General Surgery, San Giovanni Battista Hospital, Foligno, Italy
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Endovascular and Surgical Management of Intact Splenic Artery Aneurysm. Ann Vasc Surg 2019; 57:75-82. [DOI: 10.1016/j.avsg.2018.08.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/04/2018] [Accepted: 08/08/2018] [Indexed: 12/19/2022]
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15
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Antico M, Sasazawa F, Wu L, Jaiprakash A, Roberts J, Crawford R, Pandey AK, Fontanarosa D. Ultrasound guidance in minimally invasive robotic procedures. Med Image Anal 2019; 54:149-167. [DOI: 10.1016/j.media.2019.01.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/01/2019] [Accepted: 01/09/2019] [Indexed: 12/20/2022]
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16
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Nasser HA, Kansoun AH, Sleiman YA, Mendes VM, Van Vyve E, Kachi A, Berjawi T, Hamdan WS, El Nakadi I. Different laparoscopic treatment modalities for splenic artery aneurysms: about 3 cases with review of the literature. Acta Chir Belg 2018; 118:212-218. [PMID: 29631508 DOI: 10.1080/00015458.2018.1459363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The first laparoscopic treatment of splenic artery aneurysm (SAA) was performed in 1993. Since then, many papers have been published mentioning different laparoscopic treatment modalities, including splenectomy, aneurysmectomy, ligation or even occlusion. PATIENTS AND METHODS An updated literature review of the English medical literature using the following MeSH, 'Lapaorscopic splenic artery aneurysm', 'laparoscopic aneurysectomy', 'Laparoscopic Splenic artery Aneurysm Ligation' and 'Laparoscopic Splenic artery aneurysm excision' was done. Also three cases performed at our institutions are discussed, in terms of techniques, morbidity, mortality and postoperative outcomes. RESULTS About eight case series and 16 case reports were retrieved from the literature. Different techniques were described by the authors, including splenectomy, aneurysmectomy, splenic aneurysm ligation or even occlusion. Few morbidity cases were reported and none of the authors has mentioned a single mortality case. In our three cases, the postoperative course was uneventful, with good long-term results. CONCLUSIONS Despite the variations in the adopted operative techniques, the laparoscopic approach seems to be harmless. However, no treatment algorithm or consensus has been published.
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Affiliation(s)
- Haydar A. Nasser
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alaa H. Kansoun
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Youssef A. Sleiman
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Vanessa Marron Mendes
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Etienne Van Vyve
- Department of General and Digestive Surgery, Clinique Saint-Jean, Brussels, Belgium
| | - Antoine Kachi
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Tarek Berjawi
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Wajdi S. Hamdan
- Faculty of Medical Sciences, Department of General and Digestive Surgery, Lebanese University, Beirut, Lebanon
| | - Issam El Nakadi
- Department of General and Digestive Surgery, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Brizzi V, Déglise S, Dubuisson V, Midy D, Ducasse E, Berard X. Laparoscopic Resection of a Middle Colic Artery Aneurysm. Ann Vasc Surg 2018; 48:253.e1-253.e3. [PMID: 29421421 DOI: 10.1016/j.avsg.2017.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/15/2017] [Accepted: 10/24/2017] [Indexed: 12/30/2022]
Abstract
We report herein the successful laparoscopic resection of an asymptomatic 3-cm middle colic artery aneurysm in a young woman. Endovascular treatment represents nowadays the first-line option facing visceral artery aneurysm, but in this case, embolization was excluded because of hostile anatomy. Advantages of laparoscopic approach were the safe resection of the aneurysm with immediate evaluation of the bowel tolerance and the possibility of a histological examination of the arterial wall, without the disadvantages of laparotomy.
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Affiliation(s)
- Vincenzo Brizzi
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France.
| | - Sebastien Déglise
- Vascular Surgery Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dubuisson
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - Dominique Midy
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Eric Ducasse
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Xavier Berard
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
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Partial splenectomy in the era of minimally invasive surgery: the current laparoscopic and robotic experiences. Surg Endosc 2015; 29:3618-27. [PMID: 25740639 DOI: 10.1007/s00464-015-4118-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/13/2015] [Indexed: 12/13/2022]
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19
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Robotic resection of a common hepatic artery aneurysm. J Robot Surg 2014; 8:295-7. [DOI: 10.1007/s11701-013-0445-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/19/2013] [Indexed: 11/25/2022]
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20
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Lin JC. The Role of Robotic Surgical System in the Management of Vascular Disease. Ann Vasc Surg 2013; 27:976-83. [DOI: 10.1016/j.avsg.2013.02.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/09/2012] [Accepted: 02/06/2013] [Indexed: 10/26/2022]
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21
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Impact of robotic general surgery course on participants' surgical practice. Surg Endosc 2013; 27:1968-72. [PMID: 23292560 DOI: 10.1007/s00464-012-2695-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/25/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Courses, including lectures, live surgery, and hands-on session, are part of the recommended curriculum for robotic surgery. However, for general surgery, this approach is poorly reported. The study purpose was to evaluate the impact of robotic general surgery course on the practice of participants. METHODS Between 2007 and 2011, 101 participants attended the Geneva International Robotic Surgery Course, held at the University Hospital of Geneva, Switzerland. This 2-day course included theory lectures, dry lab, live surgery, and hands-on session on cadavers. After a mean of 30.1 months (range, 2-48), a retrospective review of the participants' surgical practice was performed using online research and surveys. RESULTS Among the 101 participants, there was a majority of general (58.4 %) and colorectal surgeons (10.9 %). Other specialties included urologists (7.9 %), gynecologists (6.9 %), pediatric surgeons (2 %), surgical oncologists (1 %), engineers (6.9 %), and others (5.9 %). Data were fully recorded in 99 % of cases; 46 % of participants started to perform robotic procedures after the course, whereas only 6.9 % were already familiar with the system before the course. In addition, 53 % of the attendees worked at an institution where a robotic system was already available. All (100 %) of participants who started a robotic program after the course had an available robotic system at their institution. CONCLUSIONS A course that includes lectures, live surgery, and hands-on session with cadavers is an effective educational method for spreading robotic skills. However, this is especially true for participants whose institution already has a robotic system available.
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Tiberio GAM, Bonardelli S, Gheza F, Arru L, Cervi E, Giulini SM. Prospective randomized comparison of open versus laparoscopic management of splenic artery aneurysms: a 10-year study. Surg Endosc 2012. [PMID: 22752279 DOI: 10.1007/s00464-012-2413-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 05/21/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND: The literature does not support the choice between open and laparoscopic management of splenic artery aneurysms (SAA). METHODS: We designed a prospective, randomized comparison between open and laparoscopic surgery for SAA. Primary end points were types of surgical procedures performed and clinical outcomes. Analysis was developed on an intention-to-treat basis. RESULTS: Fourteen patients were allocated to laparotomy (group A) and 15 to laparoscopy (group B). Groups displayed similar patient- and aneurysm-related characteristics. The conversion rate to open surgery was 13.3 %. The type of surgical procedure performed on the splenic artery was similar in the two groups: aneurysmectomy with splenic artery ligature or direct anastomosis was performed in 51 % and 21 % of patients in group A and in 60 % and 20 % in group B, respectively. The splenectomy rate was similar (14 % vs. 20 %). Postoperative splenic infarction was observed in one case in each group. Laparoscopy was associated with shorter procedures (p = 0.0003) and lower morbidity (25 % vs. 64 %, p = 0.045). Major morbidity requiring interventional procedures and blood transfusion was observed only in group A. Laparoscopy was associated with quicker resumption of oral diet (p < 0.001), earlier drain removal (p = 0.046), and shorter hospital stay (p < 0.01). During a mean follow-up of 50 months, two patients in group A required hospital readmission. In group B, two patients developed a late thrombosis of arterial anastomoses. CONCLUSIONS: Our study demonstrates that laparoscopy permits multiple technical options, does not increase the splenectomy rate, and reduces postoperative complications. It confirms the supposed clinical benefits of laparoscopy when ablative procedures are required but laparoscopic anastomoses show poor long-term results.
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Affiliation(s)
- Guido A M Tiberio
- General Surgery, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy,
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Moriyama H, Ishikawa N, Kawaguchi M, Inaki N, Watanabe G. Laparoscopic approaches for splenic artery aneurysms. MINIM INVASIV THER 2011; 21:362-5. [PMID: 22098441 DOI: 10.3109/13645706.2011.636051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Therapeutic options for splenic artery aneurysm include endovascular management, laparoscopic surgery, and open surgery, although their indications and applications as standard therapy remain controversial. METHODS Between August 2009 and March 2011, three patients with splenic artery aneurysm were treated at our institution. All patients underwent laparoscopic surgery. RESULTS There was no conversion to open surgery. The mean operative time was 204.7 min (range: 147-265 min) and the mean intraoperative blood loss was 30 mL (range: 0-90 mL). There was no mortality or morbidity. CONCLUSIONS The laparoscopic approaches for splenic artery aneurysm were safe procedures.
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Affiliation(s)
- Hideki Moriyama
- Department of General and Cardiothoracic Surgery, Kanazawa University Kanazawa, Japan.
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