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.