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ROBOTIC VASCULAR SURGERY, OUR EXPERIENCE WITH 668 CASES.
Petr Stadler, Prof., MD, PhD.
Na Homolce Hospital, Praha, Czech Republic.
OBJECTIVES: The aim of this retrospective study was to describe and evaluate our single center experience with robotic aortic and non-aortic vascular surgery to treat mostly occlusive disease and aneurysms. The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively sporadic.
METHODS: From November 2005 to August 2024, 668 robot assisted vascular operations were performed. 419 patients were prospectively evaluated for occlusive disease, 177 patients for abdominal aortic aneurysm (AAA, Fig.), 1 for descending thoracic aorta-abdominal aortic bypass, 8 for a common iliac artery aneurysm, 13 for a splenic artery aneurysm, 1 for a internal mammary artery aneurysm, 26 patients for median arcuate ligament release, 18 for endoleak II treatment post endovascular aneurysm repair (EVAR), 2 for renal artery reconstruction, 1 paraaortic biopsia and 3 cases were inoperable. 8 hybrid procedures in study were performed. 7 patients underwent combined robotic incisional hernia prosthetic mesh repair with robotic vascular procedure and 1 patient with type B dissection and heavy stenosis of the renal artery was treated by robotic ilio-renal bypass and thoracic stent graft implantation.
RESULTS: 641 cases (96%) were successfully completed robotically, 3 patient's surgery (0,45%) was discontinued due to heavy aortic calcification and severe peri-aortitis respectively. In 24 patients (3,6%) conversion was necessary. The thirty-day mortality rate was 0,45% (3 patients), and late prothesis infection were observed in 6 patients (0,9%).
CONCLUSIONS: Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for occlusive diseases, aneurysms, endoleak II treatment post EVAR, for median arcuate ligament release and hybrid procedures. The robotic system provides a real opportunity for minimally invasive surgery in the field of vascular surgery and offers true mini-invasive surgical vascular interventions with all its advantages. Robotic AAA treatment and aorto-femoral represent the standard operations in vascular surgery, and they are not only possible but also safe and successful.
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