Garrett H Edward, Fernandez Joss D, Porter Charlotte
Cardiovascular Surgery Clinic, University of Tennessee, 6029 Walnut Grove Rd. Suite 401, Memphis, TN, 38117, USA.
J Robot Surg. 2008 Dec;2(4):247-51. doi: 10.1007/s11701-008-0118-2. Epub 2008 Nov 22.
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.
尽管用于主-髂动脉闭塞性疾病血管内治疗的技术有所改进，但主-双股动脉旁路移植术（ABF）仍具有更优的长期通畅率。为降低手术ABF的发病率，已报道了多种微创技术。达芬奇机器人可利用标准血管缝合技术辅助构建微创主动脉吻合口。本文报道了我们在开展微创外科主动脉重建项目方面的初步经验。在实验室花费大量时间在人体尸体和猪模型上研发我们的手术技术后，我们的团队于2007年启动了机器人血管外科项目。对我们最初的6例机器人辅助腹腔镜ABF病例进行了回顾性分析。采用施塔德勒技术经腹腔镜暴露主动脉，并用达芬奇机器人进行主动脉吻合。将这些结果与目前已发表的机器人ABF及其他微创主动脉重建替代方法的报告进行比较。2007年1月至2007年8月，共进行了6例机器人辅助腹腔镜ABF手术。2例患者既往有腹部手术史。4例患者既往有血管内或外科主-髂动脉重建史。手术时间从5小时26分钟至8小时12分钟不等。主动脉吻合的总阻断时间为70至100分钟，平均为75分钟。估计失血量为300至2000毫升，平均为850毫升。1例（16%）合并腹主动脉瘤的患者需要通过上腹部正中短切口中转开腹。术后住院时间为5至10天，中位数为7天。无手术死亡病例。机器人辅助腹腔镜ABF的结果与其他微创方法相当，同时学习曲线更短。采用所述技术，尽管患者既往接受过血管治疗，仍能以安全可靠的方式完成微创ABF手术。
