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Sutter W, Alsac JM, Ben Abdallah I, Michel C, Julia P, Empana JP, El Batti S. Treatment of Aortoiliac Occlusive Lesions by Aortic Robotic Surgery: Learning Curve and Midterm Outcome. Ann Vasc Surg 2024; 104:258-267. [PMID: 38593921 DOI: 10.1016/j.avsg.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUD The learning curve and midterm results of aortoiliac occlusive disease (AIOD) revascularization by robot-assisted laparoscopic (RAL) surgery may be known. METHODS A prospective single-center study was conducted in the vascular surgery department of Georges Pompidou European Hospital (Paris, France). Patients with AIOD treated by RAL from February 2014 to February 2019 were included. Demographic characteristics, past medical history, Trans-Atlantic Inter-Society Consensus (TASC) lesions classifications, mortality, primary and secondary patency, as well as complication rates were collected. Safety was analyzed by the cumulative sum control chart method with a conversion rate of 10%, operative time by cumulative average-time model, and primary and secondary patency by the Kaplan-Meier method. RESULTS Seventy patients were included, 18 (25.7%) with TASC C lesions and 52 (74.3%) with TASC D lesions. Before discharge, 14 (24.3%) patients had surgical complications. Among them, 10 (14.3%) required at least one reintervention. One (1.4%) patient died during the hospitalization. The learning curve in terms of safety (conversion rate) was 13 cases with an operating time of 220 minutes after 35 patients. During follow-up (median 37 months [21; 49]), 63 patients (91.3%) improved their symptoms, 53 (76.8%) became asymptomatic, and 3 graft limb occlusions occurred. The primary patency at 12, 24, 36, and 48 months was 94%, 92%, 92%, and 92%, respectively, while the secondary patency for the same intervals was 100%, 98.1%, 98.1%, and 98.1%, respectively. CONCLUSIONS Robotic surgery in AIOD revascularization seems safe and effective; allowing to treat patients with few comorbidities and severe lesions, in a dedicated center experienced in RAL, with excellent patency. Prospective clinical trials should be performed to confirm safety.
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Affiliation(s)
- Willy Sutter
- Integrative Epidemiology of Cardiovascular Diseases Team, Paris Cardiovascular Research Center- INSERM UMR-S 970, Paris, France; Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Jean-Marc Alsac
- Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Iannis Ben Abdallah
- Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR-S 1140, Laboratoire de recherches Biochirurgicales de la Fondation Carpentier, Université de Paris-Cité, Paris, France
| | - Cassandre Michel
- Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Julia
- Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Empana
- Integrative Epidemiology of Cardiovascular Diseases Team, Paris Cardiovascular Research Center- INSERM UMR-S 970, Paris, France
| | - Salma El Batti
- Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR-S 1140, Laboratoire de recherches Biochirurgicales de la Fondation Carpentier, Université de Paris-Cité, Paris, France
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Artificial Intelligence-Empowered 3D and 4D Printing Technologies toward Smarter Biomedical Materials and Approaches. Polymers (Basel) 2022; 14:polym14142794. [PMID: 35890571 PMCID: PMC9319487 DOI: 10.3390/polym14142794] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 12/17/2022] Open
Abstract
In the last decades, 3D printing has played a crucial role as an innovative technology for tissue and organ fabrication, patient-specific orthoses, drug delivery, and surgical planning. However, biomedical materials used for 3D printing are usually static and unable to dynamically respond or transform within the internal environment of the body. These materials are fabricated ex situ, which involves first printing on a planar substrate and then deploying it to the target surface, thus resulting in a possible mismatch between the printed part and the target surfaces. The emergence of 4D printing addresses some of these drawbacks, opening an attractive path for the biomedical sector. By preprogramming smart materials, 4D printing is able to manufacture structures that dynamically respond to external stimuli. Despite these potentials, 4D printed dynamic materials are still in their infancy of development. The rise of artificial intelligence (AI) could push these technologies forward enlarging their applicability, boosting the design space of smart materials by selecting promising ones with desired architectures, properties, and functions, reducing the time to manufacturing, and allowing the in situ printing directly on target surfaces achieving high-fidelity of human body micro-structures. In this review, an overview of 4D printing as a fascinating tool for designing advanced smart materials is provided. Then will be discussed the recent progress in AI-empowered 3D and 4D printing with open-loop and closed-loop methods, in particular regarding shape-morphing 4D-responsive materials, printing on moving targets, and surgical robots for in situ printing. Lastly, an outlook on 5D printing is given as an advanced future technique, in which AI will assume the role of the fifth dimension to empower the effectiveness of 3D and 4D printing for developing intelligent systems in the biomedical sector and beyond.
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Robot-assisted techniques in vascular and endovascular surgery. Langenbecks Arch Surg 2022; 407:1789-1795. [PMID: 35226179 PMCID: PMC8884093 DOI: 10.1007/s00423-022-02465-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/09/2022] [Indexed: 01/21/2023]
Abstract
For thousands of years, robots have inspired the imagination of humans, but it was only about 35 years ago that a robot was used for the first time in medicine. Since then, robot-assisted procedures have become increasingly popular in urology, general surgical specialties, and gynecology. Robot-assisted vascular surgery was first introduced in 2002 and was thought to overcome the limitations of laparoscopy. However, it did not gain widespread popularity, and its usage is still limited to a few centers worldwide. Robot-assisted endovascular procedures, on the other hand, while still in its infancy, have become a promising alternative to existing techniques. The improvements of the robotic systems promote better surgical performance and reduce occupational hazards for vascular and endovascular surgeons. A comprehensive review of literature was performed using the search terms “robotic,” “robot assisted,” “vascular surgery,” and “aortic” for surgical procedures or “robotic,” “robot assisted,” and “endovascular” for endovascular procedures. Full text articles that were published between January 1990 and March 2021 were included. This review summarizes the development of the techniques for robot-assisted vascular and endovascular surgery in recent years, its outcomes, advantages, disadvantages, and perspectives.
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Štádler P, Dorosh J, Dvořáček L, Vitásek P, Matouš P, Lin JC. Review and current update of robotic-assisted laparoscopic vascular surgery. Semin Vasc Surg 2021; 34:225-232. [PMID: 34911628 DOI: 10.1053/j.semvascsurg.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 11/11/2022]
Abstract
The field of vascular surgery is constantly evolving and is unsurpassed in its innovation and adoption of new technologies. Endovascular therapy has fundamentally changed the treatment paradigms for aneurysm and occlusive disease. As we continue to make advances in not only endovascular therapy, but also robotic surgery, artificial intelligence, and minimally invasive surgery, it is important that the vascular community stay at the forefront. Topics include the advantages of laparoscopic and robotic surgery over open surgery for aortic procedures, robotic versus laparoscopic aortic surgery, patient candidacy for robotic-assisted aortic surgery, and how to increase training and adoption of robotic-assisted laparoscopic aortic surgery. Future growth includes the development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics in vascular surgery.
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Affiliation(s)
- Petr Štádler
- Na Homolce Hospital, Department of Vascular Surgery, Prague, Czech Republic
| | | | - Libor Dvořáček
- Na Homolce Hospital, Department of Vascular Surgery, Prague, Czech Republic
| | - Petro Vitásek
- Na Homolce Hospital, Department of Vascular Surgery, Prague, Czech Republic
| | - Pavel Matouš
- Na Homolce Hospital, Department of Vascular Surgery, Prague, Czech Republic
| | - Judith C Lin
- Michigan State University College of Human Medicine, 4660 S. Hagadorn Road, Suite 600, East Lansing, MI 48823.
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Segers B, Solari L, Ferrera J, Sosnowski M, Wautrecht JC, Donckier V. Is Endovascular Retroperitoneoscopic Aortobifemoral Bypass a Reasonable Alternative to Transperitoneal Open Surgery for Treatment of Severe Aorto-Iliac Occlusive Lesions? A Retrospective Comparative Analysis. Eur J Vasc Endovasc Surg 2021; 62:489-490. [PMID: 34187729 DOI: 10.1016/j.ejvs.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/28/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Bernard Segers
- Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium.
| | - Livio Solari
- Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
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Krog AH, Sahba M, Pettersen EM, Wisløff T, Sundhagen JO, Kazmi SSH. Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery. Vasc Health Risk Manag 2017; 13:217-224. [PMID: 28670132 PMCID: PMC5482399 DOI: 10.2147/vhrm.s138516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Laparoscopic aortobifemoral bypass has become an established treatment option for symptomatic aortoiliac obstructive disease at dedicated centers. Minimally invasive surgical techniques like laparoscopic surgery have often been shown to reduce expenses and increase patients' health-related quality of life. The main objective of our study was to measure quality-adjusted life years (QALYs) and costs after totally laparoscopic and open aortobifemoral bypass. PATIENTS AND METHODS This was a within trial analysis in a larger ongoing randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial. Fifty consecutive patients suffering from symptomatic aortoiliac occlusive disease suitable for aortobifemoral bypass surgery were randomized to either totally laparoscopic (n=25) or open surgical procedure (n=25). One patient dropped out of the study before surgery. We measured health-related quality of life using the EuroQol (EQ-5D-5L) questionnaire at 4 different time points, before surgery and for 6 months during follow-up. We calculated the QALYs gained by using the area under the curve for both groups. Costs were calculated based on prices for surgical equipment, vascular prosthesis and hospital stay. RESULTS We found a significantly higher increase in QALYs after laparoscopic vs open aortobifemoral bypass surgery, with a difference of 0.07 QALYs, (p=0.001) in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 €) was less than open surgery (17,260 €), (p=0.001). CONCLUSION Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs.
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Affiliation(s)
- Anne Helene Krog
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo
| | - Mehdi Sahba
- Department of Vascular Surgery, Østfold Central Hospital, Kalnes
| | - Erik M Pettersen
- Department of Vascular Surgery, Sørlandet Hospital HF, Kristiansand
| | - Torbjørn Wisløff
- Department of Health Management and Health Economics, University of Oslo
- Norwegian Institute of Public Health, Oslo, Norway
| | - Jon O Sundhagen
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo
| | - Syed SH Kazmi
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo
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Helgetveit I, Krog AH. Totally laparoscopic aortobifemoral bypass surgery in the treatment of aortoiliac occlusive disease or abdominal aortic aneurysms - a systematic review and critical appraisal of literature. Vasc Health Risk Manag 2017; 13:187-199. [PMID: 28572732 PMCID: PMC5441676 DOI: 10.2147/vhrm.s130707] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This systematic review aims to evaluate the published literature regarding totally laparoscopic aortobifemoral bypass (LABF) surgery in the treatment of aortoiliac occlusive disease (AIOD) or abdominal aortic aneurysms (AAA), compared with open aortobifemoral bypass surgery. MATERIALS AND METHODS A systematic review of the medical literature between 1990 and 2016 was performed, searching the medical databases Cochrane Library, OVID Medline, Embase and PubMed. Studies concerning totally LABF with or without control group and containing more than 10 patients were included in the analysis. Operative and aortic cross-clamping times, blood loss, rate of conversion to open surgery, mortality and morbidity within the first 30 postoperative days, hospital stay and primary and secondary patency of the graft were extracted and compared with open surgery when possible. RESULTS Sixty-six studies were deemed eligible for inclusion in this review, 16 of them matched the inclusion criteria for quantitative synthesis. The patient material consisted of 588 patients undergoing totally LABF, 22 due to AAA, and the remaining 566 for AIOD. Five comparative studies regarding AIOD compared 211 totally LABF procedures with 246 open procedures. Only one study concerning AAA was eligible for inclusion, and this study did not provide a comparison against an open group. The operating and aortic cross-clamping times were shorter in the open group. Conversion rates ranged from 0% to 27%. There was no statistically significant difference in mortality between the two groups (p=0.64). Hospital stays ranged from 4.0 to 12.1 and 5.0 to 12.8 days in the laparoscopic group and open group, respectively. Most of the studies provided low levels of evidence, mainly due to lack of blinding, randomization and correction of bias. CONCLUSION Totally laparoscopic aortoiliac surgery seems to be a feasible technique with unaffected mortality and trend toward benefits in hospital stay and possibly also in complication rates. The literature published this far is sparse and with inconsistent results. More randomized controlled trials are required before this method can be widely implemented.
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Affiliation(s)
| | - Anne H Krog
- Institute of Clinical Medicine, University of Oslo
- Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
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A systematic review and meta-analysis of the risk for development of varicose veins in women with a history of pregnancy. J Vasc Surg Venous Lymphat Disord 2016; 4:518-524.e1. [PMID: 27639009 DOI: 10.1016/j.jvsv.2016.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/03/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The association between pregnancy and the development of varicose veins is uncertain. We aimed to determine whether a history of pregnancy is associated with the development of varicose veins. METHODS We performed a systematic literature search using the databases of PubMed, Embase, Robert Koch-Institut, and Cochrane Central and the references of included papers. Eligible studies were all epidemiologic observational studies in which the outcome "varicose veins" and pregnancy history were assessed. The quality of each study was evaluated on the basis of the Dutch Cochrane review checklist and by the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. For our meta-analysis, a random effects model was applied to pool odds ratios and 95% confidence intervals across studies. RESULTS We found nine eligible studies enrolling 17,109 women. Pregnancy was associated with a significant risk increase in developing varicose veins. The results of our meta-analysis suggest that the odds for women with a history of pregnancy in developing varicose veins significantly increases by 82% (odds ratio, 1.82; 95% CI, 1.43-2.33) compared with women with no history of pregnancy. As expected for epidemiologic observational studies, the heterogeneity was considerably high (I(2) = 81%). CONCLUSIONS Our meta-analysis strongly supports the hypothesis that there is a significant and strong association between a history of pregnancy and varicose veins. However, qualitative and quantitative differences among studies were evident and were also reflected in a considerably high heterogeneity.
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Ricco JB, Cau J, Biancari F, Desvergnes M, Lefort N, Belmonte R, Schneider F. Outcome After Open and Laparoscopic Aortic Surgery in Matched Cohorts Using Propensity Score Matching. Eur J Vasc Endovasc Surg 2016; 52:179-88. [DOI: 10.1016/j.ejvs.2016.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
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Long-term Results of Totally Laparoscopic Aortobifemoral Bypass. Eur J Vasc Endovasc Surg 2016; 52:581-587. [PMID: 27346447 DOI: 10.1016/j.ejvs.2016.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/06/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim was to estimate the long-term results and patency rates of totally laparoscopic aortobifemoral bypass in aorto-iliac occlusive disease (AIOD). METHODS All 87 patients who received a laparoscopic aortobifemoral bypass for AIOD on an intention to treat basis between October 2003 and October 2013 were identified. All operations were performed by the same surgical team using a totally laparoscopic technique. Demographic, pre-operative, peri-operative, and follow up variables were collected and analyzed. Patients were followed up at 1 month post-operatively and annually thereafter. Patency rates were calculated in accordance with published patency reporting standards. RESULTS The median age was 57 years (range 40-78 years). The conversion rate was 20.6% overall. The thirty-day post-operative mortality was 1.1%. Six patients required early re-intervention. There were no graft infections. The median length hospital stay was 6 days (range 4-39 days). The mean follow up was 58.0 months (range 1-133 months). Graft limb based primary, primary assisted, and secondary patency rates were respectively 96.1%, 98.1% and 99.4% at 1 year, and 83.0%, 92.0% and 97.0% at 5 years. CONCLUSION Totally laparoscopic aortobifemoral bypass is a safe alternative to open surgery in selected patients, with excellent long-term patency rates, albeit at the cost of a steep learning curve.
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Kazmi SSH, Jørgensen JJ, Sundhagen JO, Krog AH, Flørenes TL, Kollerøs D, Abdelnoor M. A comparative cohort study of totally laparoscopic and open aortobifemoral bypass for the treatment of advanced atherosclerosis. Vasc Health Risk Manag 2015; 11:541-7. [PMID: 26425098 PMCID: PMC4583109 DOI: 10.2147/vhrm.s92671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Totally laparoscopic aortobifemoral bypass (LABF) procedure has been shown to be feasible for the treatment of advanced aortoiliac occlusive disease (AIOD). This study compares the LABF with the open aortobifemoral bypass (OABF) operation. Methods In this prospective comparative cohort study, 50 consecutive patients with type D atherosclerotic lesions in the aortoiliac segment were treated with an LABF operation. The group was compared with 30 patients who were operated on with the OABF procedure for the same disease and time period. We had an explanatory strategy, and our research hypothesis was to compare the two surgical procedures based on a composite event (all-cause mortality, graft occlusion, and systemic morbidity). Stratification analysis was performed by using the Mantel–Haenszel method with the patient–time model. Cox multivariate regression method was used to adjust for confounding effect after considering the proportional hazard assumption. Cox proportional cause-specific hazard regression model was used for competing risk endpoint. Results There was a higher frequency of comorbidity in the OABF group. A significant reduction of composite event, 82% (hazard ratio 0.18; 95% CI 0.08–0.42, P=0.0001) was found in the LABF group when compared with OABF group, during a median follow-up time period of 4.12 years (range from 1 day to 9.32 years). In addition, less operative bleeding and shorter length of hospital stay were observed in the LABF group when compared with the OABF group. All components of the composite event showed the same positive effect in favor of LABF procedure. Conclusion LABF for the treatment of AIOD, Trans-Atlantic Inter-Society Consensus II type D lesions, seems to result in a less composite event when compared with the OABF procedure. To conclude, our results need to be replicated by a randomized clinical trial.
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Affiliation(s)
- Syed S H Kazmi
- Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway
| | - Jørgen Junkichi Jørgensen
- Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway ; Faculty of Medicine, Oslo University, Oslo, Norway
| | - Jon Otto Sundhagen
- Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway
| | - Anne Helene Krog
- Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway ; Faculty of Medicine, Oslo University, Oslo, Norway
| | - Tor L Flørenes
- Department of Vascular Surgery, Heart, Lung and Vascular Disease Clinic, Oslo University Hospital, Oslo, Norway
| | - Dagfinn Kollerøs
- Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway
| | - Michael Abdelnoor
- Faculty of Medicine, Oslo University, Oslo, Norway ; Unit of Epidemiology and Biological Statistics, Faculty of Medicine, Oslo University, Oslo, Norway ; Centre for Clinical Heart Research, Faculty of Medicine, Oslo University, Oslo, Norway
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Howard AQ, Bennett PC, Ahmad I, Choksy SA, Mackenzie SIP, Backhouse CM. Introduction of laparoscopic abdominal aortic aneurysm repair. Br J Surg 2015; 102:368-74. [PMID: 25689292 DOI: 10.1002/bjs.9714] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/08/2014] [Accepted: 10/20/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim was to review a consecutive series of patients treated with laparoscopic abdominal aortic aneurysm (AAA) repair. These patients were compared with patients having elective open AAA repair. METHODS Demographic and operative details were collected prospectively and outcomes recorded for all patients undergoing laparoscopic or open AAA repair. RESULTS A total of 316 patients underwent laparoscopic (51), open (53) or endovascular (EVAR; 212) AAA repair between 2007 and 2013. The median age of patients who had laparoscopic or open repair was 72 (i.q.r. 66-75) years, and 92·3 per cent were men. There was no significant difference in sex distribution, age or V-POSSUM physiology score between laparoscopic and open repair. Of the 51 laparoscopic procedures, six were totally laparoscopic, 43 were laparoscopically assisted and two were converted to open repair. Pain scores were similar on days 1 and 3 after laparoscopic and open repair, even though epidurals were used in the open group, and were lower on days 5 and 7 after laparoscopic procedures. Patients who had laparoscopic repair had significantly fewer postoperative cardiorespiratory and renal complications (P = 0·017), and were discharged from hospital sooner (median 5 (i.q.r. 3-7) versus 8 (6-11) days; P = 0 ·001). CONCLUSION Laparoscopic AAA repair was performed safely, and with at least equivalent outcomes to open repair, in patients unfavourable for EVAR.
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Affiliation(s)
- A Q Howard
- Department of Vascular Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK; Iceni Centre, Colchester Hospital University NHS Foundation Trust, Colchester, UK
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Ghammad K, Dupuis A, Amond L, D'Hont C, Wijtenburg E, Piette P, Remy P. Total laparoscopic bypass is safe and effective for aortoiliac occlusive disease. J Vasc Surg 2015; 61:698-702. [DOI: 10.1016/j.jvs.2014.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 10/13/2014] [Indexed: 11/28/2022]
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Cirugía aórtica por laparoscopia: resultados a largo plazo. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Segers B, Van Den Broeck V, Roman A, Horn D. Complications of Laparoscopic Retroperitoneal Sutureless and Clampless Aortobifemoral Bypass. EJVES Short Rep 2015. [DOI: 10.1016/j.ejvssr.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Successful laparoscopic repair of refractory type Ia endoleak after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2015; 61:275-9. [DOI: 10.1016/j.jvs.2014.08.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022]
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Bujak M, Gamberdella J, Mena C. Management of Atherosclerotic Aortoiliac Occlusive Disease. Interv Cardiol Clin 2014; 3:531-543. [PMID: 28582078 DOI: 10.1016/j.iccl.2014.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Development of aortoiliac occlusive disease (AIOD) is associated with classic risk factors for atherosclerotic disease such as hyperlipidemia, hypertension, diabetes, or smoking. Risk factor modification, smoking cessation, and prevention of cardiovascular events remain the cornerstones of AIOD management. Symptom improvement and limb loss prevention are considered secondary goals of therapy. Continuous technological advances, new devices, as well as new revascularization techniques are constantly changing the landscape of AIOD management. Surgical interventions, which were considered a gold standard therapy for nearly 50 years, currently give way to newer and less invasive endovascular techniques.
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Affiliation(s)
- Marcin Bujak
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, DANA3 Cardiology, New Haven, CT 06510, USA
| | - Jacqueline Gamberdella
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, DANA3 Cardiology, New Haven, CT 06510, USA
| | - Carlos Mena
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, DANA3 Cardiology, New Haven, CT 06510, USA.
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Preliminary results from a prospective study of laparoscopic aortobifemoral bypass using a clampless and sutureless aortic anastomotic technique. Eur J Vasc Endovasc Surg 2014; 48:400-6. [PMID: 25065340 DOI: 10.1016/j.ejvs.2014.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 06/09/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This prospective study describes the feasibility and safety of a new clampless and sutureless aortic anastomotic technique used during retroperitoneal laparoscopic aortobifemoral bypass in extensive aortoiliac occlusive lesions. This is a case series of a previously published technique, demonstrating wider applicability of the technique. MATERIALS AND METHODS Twelve patients underwent a clampless and sutureless laparoscopic bypass for TASC D aortoiliac occlusive lesions using the EndoVascular REtroperitoneoScopic Technique (EVREST). Dissection of the retroperitoneal space and the infrarenal aorta was performed laparoscopically. A bifurcated graft was inserted into the retroperitoneal space. The main body of the graft was connected on the left side of the aorta by an intra- and extra-aortic covered stent-graft. An aortic clamp was used temporarily on four patients because of excessive bleeding when the connector was deployed. The femoral anastomoses were performed by classic open surgery. Initial technical success, complications, and bypass patency were assessed. RESULTS Median follow-up was 9.3 months. Median operative time was 265 minutes. Median duration of aorto-prosthetic connection was 60 seconds. Thirty-day postoperative mortality was 0%. No major postoperative complications were observed. All grafts were patent at the end of follow-up and there was no early or late disruption of the proximal assembly. CONCLUSIONS EVREST greatly facilitates laparoscopic aortic surgery in occlusive disease with no need for suture or clamping of the aorta. This technique performed in a single center on 12 patients, seems to be feasible and safe. It offers the advantages of laparoscopy and those of endovascular surgery, especially in the challenging conditions encountered during aortic laparoscopic surgery. Early experience supports procedural and initial postprocedural safety and demonstrates proof-of-concept for EVREST.
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Abouei Mehrizi A, Moini M, Afshari E, Kadkhodapour J, Sadjadian A, Najarian S. Application of artificial palpation in vascular surgeries for detection of peripheral arterial stenosis. J Med Eng Technol 2014; 38:169-78. [PMID: 24669766 DOI: 10.3109/03091902.2014.891663] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Palpation is one of the applied methods that surgeons usually use during surgery in order to verify the health condition of a tissue/organ. In fact, most of surgical assessments are based on analysis of the force feedback received from tissue/organ via palpation. Although palpation has a key role in efficient progress of surgery operations, it depends very much on the experience and skill of the surgeons. This limits the application of this technique in some cases to a large extent. In this regard, an artificial tactile sensing approach is an innovative technology that tries to make tactile data more available for surgeons, especially in situations where doing the palpation is not possible or is too difficult. In this paper, having considered the present problems of artery bypass surgery in peripheral arterial occlusive disease (PAOD), applicability of a new tactile sensory system capable of detecting arterial stenosis during surgery was evaluated. Presenting the modelling and numerical solution of the problem, it was demonstrated that the artificial tactile sensing approach is not only capable of detecting the presence of an arterial stenosis in an artery, but also its type. Furthermore, it was shown that the new tactile sensory system (previously designed, fabricated and tested in laboratory) is efficiently capable of detecting the simulated artery in the simulated biological tissue as well as diagnosis of the stenosis occurred inside it.
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Affiliation(s)
- A Abouei Mehrizi
- Biomechanics Lab, Life Science Engineering Department, Faculty of New Sciences and Technologies, University of Tehran , Amir Abad, North Kargar Street, Tehran , Iran
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Alhan C, Erguner I, Senay S, Kaya H, Gullu AU, Kocyigit M, Karahasanoglu T. Endoscopic-assisted robotic aortic thrombectomy and aortobiiliac bypass: a case report. Ann Vasc Surg 2014; 28:1320.e5-8. [PMID: 24440193 DOI: 10.1016/j.avsg.2013.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 09/15/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
In this report, not only our experience with laparoscopy-assisted robotic aortic thrombectomy and aortobiiliac bypass procedure was presented but also current status of vascular interventions via endoscopically was discussed.
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Affiliation(s)
- Cem Alhan
- Department of Cardiovascular Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ilknur Erguner
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Sahin Senay
- Department of Cardiovascular Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Hakan Kaya
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Umit Gullu
- Department of Cardiovascular Surgery, Acibadem University School of Medicine, Istanbul, Turkey.
| | - Muharrem Kocyigit
- Department of Anesthesiology, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, Acibadem University School of Medicine, Istanbul, Turkey
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21
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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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22
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Howard AQ, Sinha S, Peach G, Hinchliffe RJ. Minimally invasive surgical repair of iliac artery endofibrosis. J Vasc Surg 2013; 58:1657-60. [DOI: 10.1016/j.jvs.2013.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 11/25/2022]
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23
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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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24
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Economopoulos KP, Martinou E, Hakimian S, Schizas D, Georgopoulos S, Tsigris C, Bakoyiannis CN. An overview of laparoscopic techniques in abdominal aortic aneurysm repair. J Vasc Surg 2013; 58:512-20. [PMID: 23890444 DOI: 10.1016/j.jvs.2013.04.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/12/2013] [Accepted: 04/28/2013] [Indexed: 02/05/2023]
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Segers B, Horn D, Bazi MO, Lemaitre J, Van Den Broeck V, Stevens E, Roman A, Bosschaerts T. New development for aorto bifemoral bypass – a clampless and sutureless endovascular and laparoscopic technique. Vascular 2013; 22:188-92. [DOI: 10.1177/1708538113479731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The classic procedure for aortobifemoral bypass is open surgery. Laparoscopy has been accepted by several authors as a minimal invasive alternative for aortoiliac occlusive disease. The totally retroperitoneal laparoscopic procedure has been described as an alternative to the transperitoneal approach. Whatever the approach, the aortoprosthetic anastomosis is a major difficulty making those techniques unpopular despite obvious advantages for the patients. We report a clampless and sutureless approach for the proximal anastomosis of a totally retroperitoneal laparoscopic aortobifemoral bypass using an EndoVascular REtroperitoneoScopic Technique (EVREST). This approach was proposed to a 56-year-old man with severe aortoiliac occlusive disease. There was no indication for endovascular re-vascularization. The patient was placed in a 30° right lateral decubitus position. The dissection of the retroperitoneal space was performed and the infrarenal aorta was exposed. A bifurcated graft was inserted into the retroperitoneal space. Under videoscopic control the prosthetic limbs were brought to the groins. The main body of the graft was connected on the left side of the aorta by an intra and extra aortic covered stent-graft. This connection was performed without the use of an aortic clamp and without suture. The femoral anastomoses were performed by classic open surgery.
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Affiliation(s)
| | - David Horn
- Department of Vascular and Thoracic Surgery
| | | | | | | | - Etienne Stevens
- Intensive Care Unit, University Hospital St Pierre, 322 rue Haute, 1000 Brussels, Belgium
| | - Alain Roman
- Intensive Care Unit, University Hospital St Pierre, 322 rue Haute, 1000 Brussels, Belgium
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A Methodological Framework for the Definition of Patient Safety Measures in Robotic Surgery: The Experience of SAFROS Project. ADVANCES IN INTELLIGENT SYSTEMS AND COMPUTING 2013. [DOI: 10.1007/978-3-642-33932-5_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Vitiello V, Lee SL, Cundy TP, Yang GZ. Emerging robotic platforms for minimally invasive surgery. IEEE Rev Biomed Eng 2012; 6:111-26. [PMID: 23288354 DOI: 10.1109/rbme.2012.2236311] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recent technological advances in surgery have resulted in the development of a range of new techniques that have reduced patient trauma, shortened hospitalization, and improved diagnostic accuracy and therapeutic outcome. Despite the many appreciated benefits of minimally invasive surgery (MIS) compared to traditional approaches, there are still significant drawbacks associated with conventional MIS including poor instrument control and ergonomics caused by rigid instrumentation and its associated fulcrum effect. The use of robot assistance has helped to realize the full potential of MIS with improved consistency, safety and accuracy. The development of articulated, precision tools to enhance the surgeon's dexterity has evolved in parallel with advances in imaging and human-robot interaction. This has improved hand-eye coordination and manual precision down to micron scales, with the capability of navigating through complex anatomical pathways. In this review paper, clinical requirements and technical challenges related to the design of robotic platforms for flexible access surgery are discussed. Allied technical approaches and engineering challenges related to instrument design, intraoperative guidance, and intelligent human-robot interaction are reviewed. We also highlight emerging designs and research opportunities in the field by assessing the current limitations and open technical challenges for the wider clinical uptake of robotic platforms in MIS.
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Three trocars laparoscopic abdominal aortic aneurysm repair. J Vasc Surg 2012; 56:1422-5. [PMID: 22795521 DOI: 10.1016/j.jvs.2012.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/02/2012] [Accepted: 05/08/2012] [Indexed: 11/20/2022]
Abstract
Total laparoscopic abdominal aortic aneurysm resection with tube graft interposition was performed in a 53-year-old woman diagnosed with an infrarenal abdominal aortic aneurysm. The operation was accomplished by a method using three trocars. The operation took 240 minutes. Blood loss was 600 mL. No complications occurred in 13 months of postoperative follow-up. These results show that total laparoscopic abdominal aortic aneurysm repair with three trocars is feasible and worthwhile.
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Linsen MAM, Daniels L, Cuesta MA, Wisselink W. Endoscopic type 2 endoleak repair following endovascular aortic aneurysm repair: acute results and follow-up experience. Vascular 2011; 19:121-5. [DOI: 10.1258/vasc.2010.oa0274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate immediate and long-term results of endoscopic type 2 endoleak repair (EER) following endovascular abdominal aortic aneurysm repair. The basic methods include a retrospective review of electronic and paper medical records of patients admitted or referred to our institution for EER. Between July 1999 and October 2007, eight consecutive patients underwent EER. Mean operative time was 190 (104–355) min. One patient died preoperatively, due to profuse venous bleeding . One procedure was redone due to a missed pair of lumbar arteries. Mean hospital stay was five days (2–10). During mean follow-up, 50 months (29–91), one patient required additional coil embolization for a persistent type 2 endoleak. Four patients were diagnosed with a type 1 and one with a type 3 endoleak; three of these patients required an additional procedure. In conclusion, in this small series EER proved not to be beneficial.
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Affiliation(s)
- Matteus A M Linsen
- Department of Surgery, VU University Medical Center, Amsterdam
- Department of Surgery, Spaarne Hospital, Hoofddorp, The Netherlands
| | | | - Miguel A Cuesta
- Department of Surgery, VU University Medical Center, Amsterdam
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Najarian S, Fallahnezhad M, Afshari E. Advances in medical robotic systems with specific applications in surgery--a review. J Med Eng Technol 2011; 35:19-33. [PMID: 21142589 DOI: 10.3109/03091902.2010.535593] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Although robotics was started as a form of entertainment, it gradually became used in different branches of science. Medicine, particularly in the operating room, has been influenced significantly by this field. Robotic technologies have offered valuable enhancements to medical or surgical processes through improved precision, stability and dexterity. In this paper we review different robotics and computer-assisted systems developed with medical and surgical applications. We cover early and recently developed systems in different branches of surgery. In addition to the united operational systems, we provide a review of miniature robotic, diagnostic and sensory systems developed to assist or collaborate with a main operator system. At the end of the paper, a discussion is given with the aim of summarizing the proposed points and predicting the future of robotics in medicine.
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Affiliation(s)
- S Najarian
- Biomechanics Department, Laboratory of Artificial Tactile Sensing and Robotic Surgery, Faculty of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Hafez Avenue, Tehran, Iran.
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Clinical applications of robotic technology in vascular and endovascular surgery. J Vasc Surg 2011; 53:493-9. [PMID: 20801611 DOI: 10.1016/j.jvs.2010.06.154] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/09/2010] [Accepted: 06/15/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND Emerging robotic technologies are increasingly being used by surgical disciplines to facilitate and improve performance of minimally invasive surgery. Robot-assisted intervention has recently been introduced into the field of vascular surgery to potentially enhance laparoscopic vascular and endovascular capabilities. The objective of this study was to review the current status of clinical robotic applications in vascular surgery. METHODS A systematic literature search was performed in order to identify all published clinical studies related to robotic implementation in vascular intervention. Web-based search engines were searched using the keywords "surgical robotics," "robotic surgery," "robotics," "computer assisted surgery," and "vascular surgery" or "endovascular" for articles published between January 1990 and November 2009. An evaluation and critical overview of these studies is reported. In addition, an analysis and discussion of supporting evidence for robotic computer-enhanced telemanipulation systems in relation to their applications in laparoscopic vascular and endovascular surgery was undertaken. RESULTS Seventeen articles reporting on clinical applications of robotics in laparoscopic vascular and endovascular surgery were detected. They were either case reports or retrospective patient series and prospective studies reporting laparoscopic vascular and endovascular treatments for patients using robotic technology. Minimal comparative clinical evidence to evaluate the advantages of robot-assisted vascular procedures was identified. Robot-assisted laparoscopic aortic procedures have been reported by several studies with satisfactory results. Furthermore, the use of robotic technology as a sole modality for abdominal aortic aneurysm repair and expansion of its applications to splenic and renal artery aneurysm reconstruction have been described. Robotically steerable endovascular catheter systems have potential advantages over conventional catheterization systems. Promising results from applications in cardiac interventions and preclinical studies have urged their use in vascular surgery. Although successful applications in endovascular repair of abdominal aortic aneurysm and lower extremity arterial disease have been reported, published clinical experience with the endovascular robot is limited. CONCLUSIONS Robotic technology may enhance vascular surgical techniques given preclinical evidence and early clinical reports. Further clinical studies are required to quantify its advantages over conventional treatments and define its role in vascular and endovascular surgery.
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Jongkind V, Diks J, Yeung KK, Cuesta MA, Wisselink W. Mid-term results of robot-assisted laparoscopic surgery for aortoiliac occlusive disease. Vascular 2011; 19:1-7. [DOI: 10.1258/vasc.2010.oa0249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate middle-term clinical results of robot-assisted laparoscopic surgery (RALS) to treat aortoiliac occlusive disease (AIOD). Between 2002 and 2007, 28 consecutive patients received robot-assisted laparoscopic aortobifemoral bypass grafting ( n = 24) or aortoiliac endarterectomy ( n = 4). Patients were followed prospectively. RALS could be completed successfully in 24 patients; conversion to open surgery was necessary in four patients (14%). Median operative time was 350 min. Median aortic clamping time was 70 min. Median hospital stay was five days. One patient died within 30 days. Non-lethal complications occurred in four patients (14%). Clinical symptoms improved in all patients. Primary and secondary limb-based patencies at 36 months were 89% and 91%, respectively. In conclusion, RALS is a feasible and durable technique for patients with AIOD. Although operative times are long, RALS allows rapid postoperative recovery.
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Affiliation(s)
| | - Jeroen Diks
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Kak Khee Yeung
- Department of Surgery, VU University Medical Center, Amsterdam
| | - Miguel A Cuesta
- Department of Surgery, VU University Medical Center, Amsterdam
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Novotný T, Dvořák M, Staffa R. The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease. J Vasc Surg 2011; 53:414-20. [DOI: 10.1016/j.jvs.2010.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 08/18/2010] [Accepted: 09/01/2010] [Indexed: 11/15/2022]
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Jongkind V, Akkersdijk GJ, Yeung KK, Wisselink W. A systematic review of endovascular treatment of extensive aortoiliac occlusive disease. J Vasc Surg 2010; 52:1376-83. [DOI: 10.1016/j.jvs.2010.04.080] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 03/28/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
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Giulianotti PC, Bianco FM, Addeo P, Lombardi A, Coratti A, Sbrana F. Robot-assisted laparoscopic repair of renal artery aneurysms. J Vasc Surg 2010; 51:842-9. [DOI: 10.1016/j.jvs.2009.10.104] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 10/02/2009] [Accepted: 10/08/2009] [Indexed: 10/20/2022]
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Cagiannos C, Kolvenbach RR. Laparoscopic surgery in the management of complex aortic disease: techniques and lessons learned. Vascular 2009; 17 Suppl 3:S119-28. [PMID: 19919802 DOI: 10.2310/6670.2009.00061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Laparoscopic vascular surgery must be assessed in the context of both open and endovascular interventions. The development of improved laparoscopic equipment and endoscopic techniques makes performance of laparoscopy easier, but endovascular interventions still hold wide appeal because they are minimally invasive and are easier to master by vascular surgeons. Despite decreased morbidity and recovery time, endovascular interventions have inferior durability and higher reintervention rates when compared with open aortoiliac interventions. In particular, after endovascular aneurysm repair, patients need lifelong surveillance because there is potential for delayed endoleaks, aortic neck dilatation, graft migration, and ongoing risk of aneurysmal rupture. These limitations of endovascular therapy are the impetus behind the pursuit of other minimally invasive techniques, such as laparoscopy, in vascular surgery. Currently, two evolving laparoscopic approaches are available for abdominal vascular surgery: total laparoscopic aortic surgery and hybrid techniques that combine laparoscopy with endovascular techniques to treat failing endografts.
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Affiliation(s)
- Catherine Cagiannos
- Division of Vascular Surgery and Endovascular Therapy, Michael E, DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Alimi Y, Saint Lebes B, Garitey V, Afrapoli A, Boufi M, Hartung O, Garcia S, Mouret F, Berdah S. A Clampless and Sutureless Aorto-Prosthetic End-to-Side Anastomotic Device: An Experimental Study. Eur J Vasc Endovasc Surg 2009; 38:597-602. [DOI: 10.1016/j.ejvs.2009.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Accepted: 07/05/2009] [Indexed: 11/29/2022]
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Minimally Invasive Interventions in Aorto-iliac Occlusive Disease. Surg Laparosc Endosc Percutan Tech 2009; 19:285-9. [DOI: 10.1097/sle.0b013e3181a6f349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kenngott HG, Müller‐Stich BP, Reiter MA, Rassweiler J, Gutt CN. Robotic suturing: Technique and benefit in advanced laparoscopic surgery. MINIM INVASIV THER 2009; 17:160-7. [DOI: 10.1080/13645700802103381] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jansen SJ, Ducke W, Hartley DE, Semmens JB, Lawrence-Brown MMD. A Laparoscopic Endovascular Aortobifemoral Conduit That Can Be Retained as a Long-term Bypass: A Solution for Patients With Inadequate Iliac Access. J Endovasc Ther 2009; 16:114-9. [DOI: 10.1583/08-2417.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cau J, Ricco JB, Corpataux JM. Laparoscopic aortic surgery: Techniques and results. J Vasc Surg 2008; 48:37S-44S; discussion 45S. [DOI: 10.1016/j.jvs.2008.08.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 08/05/2008] [Accepted: 08/08/2008] [Indexed: 11/25/2022]
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Garrett HE, Fernandez JD, Porter C. Robot-assisted laparoscopic aortobifemoral bypass: initial experience developing a new program. J Robot Surg 2008; 2:247-51. [PMID: 27637795 DOI: 10.1007/s11701-008-0118-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 10/24/2008] [Indexed: 10/21/2022]
Abstract
Despite improved technology for endovascular treatment of aorto iliac occlusive disease, aortobifemoral bypass (ABF) continues to offer superior long-term patency. In an effort to reduce the morbidity of surgical ABF, multiple minimally invasive techniques have been reported. The da Vinci robot may facilitate the construction of a minimally invasive aortic anastomosis using standard vascular suture techniques. Our initial experience in the development of a minimally invasive surgical aortic reconstruction program is reported. After extensive time in the laboratory developing our surgical technique in human cadavers and a pig model, our team initiated a robotic vascular surgery program in 2007. A retrospective review of our initial six robot-assisted laparoscopic ABF cases was conducted. The aorta was exposed laparoscopically using the Stadler technique and the aortic anastomosis performed with the da Vinci robot. These results are compared with currently published reports of robotic ABF and alternative methods of minimally invasive aortic reconstruction. From January 2007 to August 2007, six robot-assisted laparoscopic ABFs were performed. Two patients had prior abdominal surgical procedures. Four patients had prior endovascular or surgical aorto iliac reconstruction. Operative time varied from 5 h 26 min to 8 h 12 min. Total clamp time, for the aortic anastomosis, ranged from 70 to 100 min with a mean of 75 min. Estimated blood loss ranged from 300 to 2,000 ml with a mean of 850 ml. Conversion with a short upper midline incision was required in one patient (16%) with an associated abdominal aortic aneurysm. Post operative length of stay ranged from five to ten days with a median of seven days. There was no operative mortality. Results from robotically assisted laparoscopic ABF are equivalent to those from other minimally invasive options while enabling a much shorter learning curve. Using the technique described, minimally invasive ABF was accomplished in a safe and reliable manner despite prior vascular treatment.
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Affiliation(s)
- H Edward Garrett
- Cardiovascular Surgery Clinic, University of Tennessee, 6029 Walnut Grove Rd. Suite 401, Memphis, TN, 38117, USA
| | - Joss D Fernandez
- Cardiovascular Surgery Clinic, University of Tennessee, 6029 Walnut Grove Rd. Suite 401, Memphis, TN, 38117, USA.
| | - Charlotte Porter
- Cardiovascular Surgery Clinic, University of Tennessee, 6029 Walnut Grove Rd. Suite 401, Memphis, TN, 38117, USA
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Millon A, Boufi M, Garitey V, Ramos-Clamote J, Hakam Z, Mouret F, Chevalier J, Alimi Y. Evaluation of a New Vascular Suture System for Aortic Laparoscopic Surgery: An Experimental Study on Pigs and Cadavers. Eur J Vasc Endovasc Surg 2008; 35:730-6. [DOI: 10.1016/j.ejvs.2007.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 12/13/2007] [Indexed: 11/29/2022]
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