Role of the robot in totally laparoscopic aortic repair for occlusive and aneurysmal disease.

INTRODUCTION: The feasibility of robotically-assisted laparoscopic aortic surgery has been adequately demonstrated. The authors report on their clinical experience with robot-assisted aortoiliac reconstruction for aorto-iliacocclusive disease, aortic aneurysm and two hybrid procedures performed using the da Vinci system.

MATERIALS/METHOD: Between November 2005 and December 2008, we performed 130 robot-assisted laparoscopic aortoiliac procedures. One hundred sixteen patients were prospectively evaluated for occlusive disease, ten patients for abdominal aortic aneurysm, two for a common iliac artery aneurysm and two for hybrid procedures. Dissection of the aorta and the iliac arteries was performed laparoscopically using a transperitoneal direct approach technique and the robotic system was used to construct the vascular anastomosis, for the thromboendarterectomy, for the aorto-iliac reconstruction with the patch closure and for the posterior peritoneal suture.

RESULTS: Overall, 126 cases (97%) were successfully completed robotically, while three were converted. In three patients conversion was necessary, one due to bleeding from an earlier clipped lumbar artery after completion of the anastomosis, the second because difficulties were encountered with the Endo Gia stapler during the exclusion of a common iliac artery aneurysm after completion of the robotic anastomosis and the last due to bleeding from the robotic anastomosis and the lumbar arteries. One case was canceled after laparoscopy by reason of heavy aortic calcification. Thirty-day survival was 100% and non-lethal postoperative complications were observed in three patients (2.3%).

CONCLUSION: Our 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 compared to purely laparoscopic techniques. Robotic maneuvers offer an unique ability to combine conventional laparoscopic surgery with stereoscopic 3D magnification and ultra-precise suturing techniques. However, previous laparoscopic aortoiliac experience is necessary before performing robot-assisted procedures in vascular surgery.