Is Robotic Surgery Right for Vascular Procedures?

OBJECTIVES:
The feasibility of laparoscopic aortic surgery with robotic assistance has been sufficiently demostrated. The authors report the clinical experience with robot-assisted aortoiliac reconstruction for occlusive disease and aneurysm performed using the da Vinci™ system.
METHODS:
Between November 2005 and September 2007, we performed 80 robot-assisted laparoscopic aortoiliac procedures. Seventy-three patients were prospectively evaluated for occlusive disease, six patients for abdominal aortic aneurysm and one for common iliac artery aneurysm. Dissection of the aorta and iliac arteries were performed laparoscopically and the robotic system was used to construct the anastomosis, for thromboendarterectomy, for aorto-iliac reconstruction with the patch closure and for posterior peritoneal suture.
RESULTS:
Seventy-seven of 80 procedures (96,25%) were successfully completed robotically, while three were converted. In three patients (3,75%) conversion to mini or full laparotomy were necessary. Median operative time was 196min (150-360), with the median crossclamp-time of 35min (range 25-120). Average anastomosis construction time was 19min (range 12-60) and blood loss was 280ml (range 50-1500). Mean ICU and hospital stays were 1,7 and 5,1 days, respectively. Oral regular diet was allowed after mean 2,4 days. Thirty-day survival was 100% and non-lethal postoperative complications were observed in two patients (2,5%).
CONCLUSIONS:
The da Vinci™ robotic system facilitated creation of the aortic anastomosis and shortened aortic clamping time compared to purely laparoscopic techniques. Robotic manoeuvres are special by their unique ability to combine conventional laparoscopic surgery with stereoscopic 3D magnification and ultra-precise suturing techniques. However, previous laparoscopic aortoiliac experience is very suitable for robot-assisted procedures in vascular surgery. Robotic surgery represent the right direction for vascular surgery.