Desgranges P, Bourriez A, Javerliat I, Van Laere O, Losy F, Lobontiu A, Mellière D, Becquemin J P
Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France.
Eur J Vasc Endovasc Surg. 2004 May;27(5):507-11. doi: 10.1016/j.ejvs.2004.01.002.
The da Vinci trade mark Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) is a computer-enhanced telemanipulator that may help to overcome some limitations of traditional laparoscopic instruments. This prospective study was performed to assess the safety and feasibility of robotically assisted aorto-femoral bypass grafting (AF).
Five patients undergoing elective AF were enrolled in this study. In three patients, a laparotomy of 6 cm was first performed, the aorta being exposed using an Omnitract degrees retractor. In two patients, aortic dissection was performed with laparoscopy, with the patient in a modified right lateral decubitus position. In all patients, the proximal anastomosis was attempted with the da Vinci trade mark system by a remote surgeon. The role of the assistant at the patient's side was limited to exposure, haemostasis and maintaining traction on the running sutures performed by the robot. Six weeks after the operation, all patients underwent a duplex scan of the graft.
Mean operative time was 188 min. Robotically assisted aortic anastomoses were successfully completed in four out of five patients. In these four patients, adequate blood flow was observed within the graft with no need for conversion for haemostasis. In the fifth patient, despite an adequate laparoscopic aortic dissection, the anastomosis was impossible to perform due to external conflicts between the robotic arms. A conversion using conventional suture was successfully performed. No robot-related complications were noted. Six weeks after the operation, the duplex scans demonstrated a graft patency of 100%.
Robotically assisted anastomoses are possible by their unique ability to combine conventional laparoscopic surgery with stereoscopic 3D magnification and ultra-precise suturing techniques due to the flexibility of the robotic-wristed instruments using different motion scaling of surgeon hand movements. In addition, prior training in laparoscopic aortic surgery is not necessary for surgeons to obtain the level required for suturing. Further clinical trials are needed to explore the clinical potential and value of robotically assisted AF.
达芬奇商标手术系统（直观外科公司，加利福尼亚州桑尼维尔）是一种计算机增强型远程操作器，可能有助于克服传统腹腔镜器械的一些局限性。本前瞻性研究旨在评估机器人辅助腹主动脉-股动脉旁路移植术（AF）的安全性和可行性。
五名接受择期AF的患者纳入本研究。三名患者首先进行6厘米的剖腹手术，使用Omnitract角度牵开器暴露主动脉。两名患者在改良右侧卧位下进行腹腔镜主动脉夹层分离术。在所有患者中，由远程外科医生使用达芬奇商标系统尝试近端吻合术。患者旁边助手的作用仅限于暴露、止血和维持机器人进行连续缝合时的牵引。术后六周，所有患者均接受移植物的双功扫描。
平均手术时间为188分钟。五名患者中有四名成功完成了机器人辅助主动脉吻合术。在这四名患者中，移植物内观察到足够的血流，无需转为止血。在第五名患者中，尽管腹腔镜主动脉夹层分离充分，但由于机器人手臂之间的外部冲突，无法进行吻合术。成功进行了传统缝合的转换。未发现与机器人相关的并发症。术后六周，双功扫描显示移植物通畅率为100%。
由于机器人手腕器械的灵活性，利用外科医生手部运动的不同运动缩放比例，机器人辅助吻合术能够将传统腹腔镜手术与立体3D放大和超精确缝合技术相结合，具有独特的能力。此外，外科医生无需事先接受腹腔镜主动脉手术培训即可达到缝合所需水平。需要进一步的临床试验来探索机器人辅助AF的临床潜力和价值。
