The Minimally Invasive Robotic Vascular Surgery
Petr Stadler, Libor Dvoracek, Petr Vitasek, Pavel Matous.
Na Homolce Hospital, Praha 5, Czech Republic.
OBJECTIVE: 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, robotic median arcuate ligament release and hybrid procedures performed using the robotic system is herein described.
METHODS: Between November 2005 and June 2016, we performed 363 robot-assisted vascular procedures. 256 patients were prospectively evaluated for occlusive diseases, 77 patients for abdominal aortic aneurysm (Fig), four for a common iliac artery aneurysm, 7 for a splenic artery aneurysm, one for a internal mammary artery aneurysm five for hybrid procedures, four for median arcuate ligament release and nine 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.
RESULTS: 348 cases (95,8%) were successfully completed robotically, one patient's surgery (0,3%) was discontinued during laparoscopy due to heavy aortic calcification. In 14 patients (3,8%) conversion was necessary. The thirty-day mortality rate was 0,3%, and early non-lethal postoperative complications were observed in 7 patients (1,9%).
CONCLUSIONS: Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for occlusive diseases, aneurysms, endoleak II treatment post EVAR, for median arcuate ligament release and hybrid procedures. The 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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