Robotic Replacement of the Descending Aorta in Human Cadaver

The application of robotic surgery in vascular medicine

OBJECTIVE

The feasibility of robotically assisted laparoscopic aortic surgery has already been adequately demonstrated. Our clinical experience with robot-assisted aortoiliac reconstruction for occlusive diseases, aneurysms, and hybrid procedures performed using the Da Vinci system is described below.

METHODS

Between November 2005 and November 2011, we performed 225 robot-assisted laparoscopic aortoiliac procedures. One hundred seventy-four patients were prospectively evaluated for occlusive diseases, 43 patients for abdominal aortic aneurysm, two for common iliac artery aneurysm, two for splenic artery aneurysm, three for hybrid procedures, and one for endoleak II treatment after endovascular aneurysm repair. The robotic system was applied to construct the vascular anastomosis for thromboendarterectomy, for aortoiliac reconstruction with a closure patch, for dissection of the splenic artery, and for posterior peritoneal suturing. A combination of conventional laparoscopic surgeries and robotic surgeries was routinely included. A modified fully robotic approach without laparoscopic surgery was used in the last 55 cases in our series.

RESULTS

Two hundred seventeen cases (96%) were successfully completed robotically; one patient's surgery was discontinued during laparoscopy because of heavy aortic calcification. In seven patients (3%), conversion was necessary. The 30-day mortality rate was 0.4%, and nonlethal postoperative complications were observed in 10 patients (4.4%).

CONCLUSIONS

Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for aortoiliac vascular and hybrid procedures. Compared with purely laparoscopic techniques, the Da Vinci robotic system facilitated the creation of the aortic anastomosis and shortened the aortic clamping time.

Robotic vascular surgery, 150 cases

BACKGROUND

Based on their experience of 150 robot-assisted vascular reconstructions, the authors not only reflect on the current uses of the da Vinci robotic system in vascular surgery, but also discuss options for the further expansion of this cutting-edge technology in their area of expertise.

METHODS

To date there has not been the same level of development in laparoscopy in vascular surgery as in general surgery and, despite the numbers of published studies showing interesting results, laparoscopic vascular surgery has never been generally accepted. Robot-assisted surgery represents a new stage of progress in mini-invasive methods. During the period November 2005-September 2009, the authors performed 150 robot-assisted vascular reconstructions in the aortoiliac area. The most significant include aortofemoral reconstructions and surgery on aneurysms of the abdominal aorta, the pelvic arteries and the splenic artery, as well as their first attempts to perform hybrid interventions.

RESULTS

Four cases (2.7%) required conversion to standard surgery and four patients (2.7%) experienced more serious postoperative complications. On one occasion (0.7%) the robotic equipment broke down during the operation and surgery had to be completed laparoscopically. In one case (0.7%) the operation had to be abandoned because the finding on the aorta proved to be inoperable. In the cohort under consideration, the median operating time was 228 min, the median time taken to suture the anastomosis was 27 min and the median clamp time was 39 min.

CONCLUSIONS

Robotic operating systems improve the precision, control and dexterity of the surgical procedure and offer patients a higher quality of operating interventions.