Petr Stadler
Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic

Abstract:

Objective:
The robot represents the next step in the use of minimally invasive 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 2010, we performed 190 robot-assisted laparoscopic aortoiliac procedures. 154 patients were prospectively evaluated for occlusive disease, 31 patients for abdominal aortic aneurysm, two for a common iliac artery aneurysm, one for a splenic artery aneurysm, and two for hybrid procedures. 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. A combination of conventional laparoscopic surgeries and robotic surgeries were standardly included. The modified full robotic approach without laparoscopic surgery was used in the last 20 cases in our series.

Results:
183 cases (96%) were successfully completed robotically, one patient''s surgery was discontinued during laparoscopy due to heavy aortic calcification. In six patients (3%) conversion was necessary. The thirty-day mortality rate was 0,5% and non-lethal postoperative complications were observed in nine patients (4,7%).

Conclusions:
Clinical experience with robot-assisted laparoscopic surgery shows that it is a feasible technique for vascular surgery. The da Vinci robotic system facilitated mostly the creation of the aortic anastomosis and shortened aortic clamping time as compared to purely laparoscopic techniques.

Keywords: robotic surgery, vascular surgery, minimally invasive surgery