Robot-assisted Vascular Reconstructions in the Aortoiliac Region – A Review of 42 Cases
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| Year of publication | 2010 |
| Type | Appeared in Conference without Proceedings |
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| Description | Introduction: A trend towards minimal invasivity in vascular surgery is obvious. The aim of our study was to evaluate the results of robot-assisted aortoiliac procedures in a group of 42 patients. Materials/Methods: We combined three surgical approaches – conventional in the groin (dissection, anastomosis creation), laparoscopic for the dissection of the aorta (transperitoneal approach, six 12 mm trocars) and the robot-assisted proximal anastomosis creation. The benefits of the procedure were assessed by the evaluation of operative data, postoperative course and complication rates. Results: Between May 2006 and January 2010, 42 patients (34 men, 8 women) at a mean age of 59 years (range 48 to 75 years) underwent 42 robot-assisted arterial reconstructions. We created 21 aortofemoral, 19 aortobifemoral a 2 iliofemoral bypasses. Median proximal anastomosis time was 23 minutes (range 18 to 50 minutes), median clamping time 60 minutes (range 40 to 95 minutes), median operative time 295 minutes (range 180 to 475 minutes) and median blood loss 260 mL (range 50 to1200 mL). Median intensive care unit stay was 2 days (range 1 to 8 days). 30-day mortality 0% and no cardiopulmonary or hepatorenal complications were observed. During follow-up (mean 18 months, range 2 to 48 months) 3 early graft occlusions occurred (7%). In all cases, the cause was an insufficient outflow, which was deep femoral artery. Endarterectomy of superficial femoral artery and in other two cases femoropopliteal bypasses were the solutions. In one case (2.3%) a port-site hernia occurred as a late complication. No graft infection was observed. The secondary patency of reconstructions was 100%. Conclusions: The use of robotic systems during aortoiliac reconstructions allows us to create central anastomosis with high precision and speed (anatomosis time, clamping time), approximating that of conventional vascular surgery. Thus, robotic systems help us to overcome the main limitations of pure laparoscopic approach. |