Surgical Robotics in Vascular Surgery

OBJECTIVES:
The safety, benefits and usefulness of laparoscopic surgery have been previously demonstrated. The robot represents the next step in the use of minimally invasive techniques in surgery. Our clinical experience with robot-assisted aortoiliac reconstruction for occlusive diseases, aneurysms, and hybrid procedures performed using the da Vinci system is described.
METHODS:
Between November 2005 and December 2009, we performed 160 robot-assisted laparoscopic aortoiliac procedures. 138 patients were prospectively evaluated for occlusive disease, 17 patients for abdominal aortic aneurysm, two for a common iliac artery aneurysm, one for a splenic artery aneurysm, and two for hybrid procedures. A combination of conventional laparoscopic surgery and robotic surgery was used. The robotic system was applied to construct the vascular anastomosis, for the thromboendarterectomy, for the aorto-iliac reconstruction with the patch closure, for dissection of the splenic artery, and for the posterior peritoneal suture.
RESULTS:
155 cases (97%) were successfully completed robotically, one patient's surgery was discontinued during laparoscopy due to heavy aortic calcification. In four patients (2.5%) conversion was necessary. The thirty-day survival rate was 100% and non-lethal postoperative complications were only observed in four patients (2.5%).
CONCLUSIONS:
Clinical experience with robot-assisted laparoscopic surgery shows that it is a feasible technique for aortoiliac vascular and hybrid procedures. The da Vinci robotic system facilitated the creation of the aortic anastomosis and shortened aortic clamping time as compared to purely laparoscopic techniques. Robotic surgery enhances success percentages in vascular surgery, and can provide valuable assistance in hybrid procedures.