Wu Timothy, Prema Jateen, Zagaja Gregory, Shalhav Arieh, Bassiouny Hisham S
University of Chicago, Pritzker School of Medicine, Chicago, IL 60637, USA.
Ann Vasc Surg. 2009 Sep-Oct;23(5):686.e11-6. doi: 10.1016/j.avsg.2009.02.005. Epub 2009 Jul 24.
A 65-year-old man with coronary artery disease, hypertension, and peripheral vascular disease was found to have an asymptomatic abdominal aortic aneurysm (AAA) of 5.5 cm on surveillance for his peripheral vascular disease. Cardiac stress testing demonstrated no evidence of myocardial ischemia, and he opted to undergo open repair of his aneurysm. Laparorobotic repair of the infrarenal AAA using the da Vinci robotic system was performed with an aortobifemoral bypass. We describe a novel technique for AAA exclusion using a cerclage method, which greatly facilitates repair of infrarenal AAAs using laparorobotic techniques. Laparorobotic repair of infrarenal AAA can be greatly facilitated by AAA sac exclusion and obliteration without the need to ligate all lumbar arteries or to open the aneurysm. This virtually avoids blood loss from the sac and minimizes the possibility for open conversion as a result of poor visualization. Minimally invasive aortic intervention for aneurysmal disease using laparascopic methods has been reported in the literature. Problems associated with this technique include a prolonged learning curve and difficulty completing intracorporeal anastomoses. Robotic surgery provides an advantage over laparoscopic surgery in its ability to provide greater degrees of freedom in a relatively small field of view along with superior high-definition, three-dimensional visualization. To date, there have been no known reports of using robotic surgery in the United States as a sole method for repair of AAA. We report our technique of combining robotic surgery with a novel procedure for sac exclusion and obliteration to successfully repair AAA without the need for opening the aneurysm sac and endoaneurysmorrhaphy.
一名患有冠状动脉疾病、高血压和外周血管疾病的65岁男性，在对其外周血管疾病进行监测时发现有一个5.5厘米的无症状腹主动脉瘤（AAA）。心脏负荷试验未显示心肌缺血的证据，他选择接受动脉瘤开放修复术。使用达芬奇机器人系统对肾下腹主动脉瘤进行腹腔镜机器人修复，并进行主动脉双股动脉旁路移植术。我们描述了一种使用环扎法排除腹主动脉瘤的新技术，该技术极大地促进了使用腹腔镜机器人技术修复肾下腹主动脉瘤。通过排除和闭塞腹主动脉瘤囊，可以极大地促进肾下腹主动脉瘤的腹腔镜机器人修复，而无需结扎所有腰动脉或打开动脉瘤。这实际上避免了瘤囊出血，并将因视野不佳而转为开放手术的可能性降至最低。文献中已报道了使用腹腔镜方法对动脉瘤疾病进行微创主动脉干预。与该技术相关的问题包括学习曲线延长和完成体内吻合困难。机器人手术相对于腹腔镜手术的优势在于，它能够在相对较小的视野内提供更大的自由度，以及卓越的高清三维可视化。迄今为止，在美国尚无使用机器人手术作为腹主动脉瘤唯一修复方法的已知报道。我们报告了我们将机器人手术与一种新的瘤囊排除和闭塞程序相结合的技术，以成功修复腹主动脉瘤，而无需打开动脉瘤囊和进行瘤内缝合法。
