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Current trends in robotic vascular surgery
Petr Stadler.
Na Homolce Hospital, Praha 5, Czech Republic.

The feasibility of laparoscopic aortic surgery has been adequately demonstrated. Our clinical experience with robot-assisted aortoiliac reconstruction for occlusive diseases, aneurysms, endoleak II treatment and hybrid procedures performed using the da Vinci system is herein described.
Between November 2005 and August 2013, we performed 290 robot-assisted vascular procedures. 212 patients were prospectively evaluated for occlusive diseases, 57 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, three for a splenic artery aneurysm, one for a internal mammary artery aneurysm five for hybrid procedures, and eight for endoleak II treatment post EVAR. The robotic system was applied to construct the vascular anastomosis, for the thromboendarterectomy, for the aorto-iliac reconstruction with a closure patch, for dissection of the splenic artery, and for the posterior peritoneal suture. A combination of conventional laparoscopic surgeries and robotic surgeries were initially included. A modified, fully-robotic approach without laparoscopic surgery was used in the last 120 cases in our series.
279 cases (96%) were successfully completed robotically, one patient's surgery was discontinued during laparoscopy due to heavy aortic calcification. In tent patients (3,4%) conversion was necessary. The thirty-day mortality rate was 0,3%, and early non-lethal postoperative complications were observed in six patients (2%).
Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for occlusive diseases, aneurysms, endoleak II treatment post EVAR and hybrid procedures. The da Vinci robotic system facilitated the creation of the aortic anastomosis, and shortened the aortic clamping time as compared to purely laparoscopic techniques.

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