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Endoscopic Assisted Robotic Aortic Thrombectomy and Aorto-biiliac By-pass
Cem Alhan, Sahin Senay, Hakan Kaya, Ahmet U. Gullu, Muharrem Kocyigit, Ilknur Erguner, Tayfun Karahasanoglu.
Acibadem University, School of Medicine, Istanbul, Turkey.

OBJECTIVE: In this video work, we present the details of our technique in a patient with infrarenal aortic obstruction treated by endoscopic assisted robotic aortic thrombectomy and aorto-biiliac by-pass.
METHODS: A forty-seven year old man diagnosed with obstruction at infrarenal aorta undergone to endoscopic assisted robotic surgery. The aortic thrombus and plaque were removed from the aortic lumen and a14-7 mm polytetrafluoroethylene prosthesis (Gore-tex, Gore Medical®) was introduced into the retroperitoneal cavity. The two robotic arms were used to perform the aorta to graft anastomosis in an end-to-side fashion with PTFE suture (Gore-tex, Gore Medical ®).
RESULTS: The proximal and distal anastomosis was performed within 20 min, 13 min, 13 min. respectively .Total operative time was 360 minutes. The graft was patent at CT angiography on postoperative 3th day. The patient was discharged from hospital 4 days postoperatively and he is still in a good condition at 1 year of follow up.
CONCLUSIONS: Laparoscopic or robotic techniques in vascular surgery has not gained widespread acceptance or applicability as it is commonly used in general or urologic surgery. However, the described method presented in this video may find broader application with this advancing technology.

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