Robot-assisted laparoscopic surgery is a feasible technique for aortoiliac surgery. The da Vinci robotic system facilitated the creation of the aortic anastomosis and shortened aortic clamp time in comparison with our laparoscopic techniques.

Robotic aortoiliac surgery appears to be safe, with a high technical success rate, with operative times and success rates comparable to conventional open surgery. The creation of the aortoiliac anastomosis appears to be quicker, and more accurate than regular laparoscopic techniques.

From a practical point of view, the greatest advantage of the robot assisted procedure has been the speed and relative simplicity of construction of the vascular anastomosis. This experience with robot assisted laparoscopic surgery has demonstrated the feasibility of this technique in different areas of vascular surgery.

Robotic operating systems improve the precision, control and dexterity of the surgical procedure and offer patients a higher quality of operating interventions.

The main advantage of TDA is reduced dissection of the aorta and pelvic arteries resulting in lowered blood loss and lymphatic injury.

Objective The feasibility of robotically assisted laparoscopic aortic surgery has already been adequately demonstrated. Our clinical experience with robot-assisted aortoiliac reconstruction for occlusive diseases, aneurysms, and hybrid procedures performed using the Da Vinci system is described below. Methods Between November 2005 and November 2011, we performed 225 robot-assisted laparoscopic aortoiliac procedures. One hundred seventy-four patients were prospectively evaluated for occlusive diseases, 43 patients for abdominal aortic aneurysm, two for common iliac artery aneurysm, two for splenic artery aneurysm, three for hybrid procedures, and one for endoleak II treatment after endovascular aneurysm repair. The robotic system was applied to construct the vascular anastomosis for thromboendarterectomy, for aortoiliac reconstruction with a closure patch, for dissection of the splenic artery, and for posterior peritoneal suturing. A combination of conventional laparoscopic surgeries and robotic surgeries was routinely included. A modified fully robotic approach without laparoscopic surgery was used in the last 55 cases in our series. Results Two hundred seventeen cases (96%) were successfully completed robotically; one patient's surgery was discontinued during laparoscopy because of heavy aortic calcification. In seven patients (3%), conversion was necessary. The 30-day mortality rate was 0.4%, and nonlethal postoperative complications were observed in 10 patients (4.4%). Conclusions Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for aortoiliac vascular and hybrid procedures. Compared with purely laparoscopic techniques, the Da Vinci robotic system facilitated the creation of the aortic anastomosis and shortened the aortic clamping time.

medical comorbidities, including ventilator dependence (2.1% vs 0.1%; P < .01), congestive heart failure (8.7% vs 3.1%; P < .01), recent myocardial infarction (4.5% vs 2%; P < .01), and insulin dependence (59.6% vs 53.6%; P ¼ .03) compared with the NRA group. Preoperative vascular disease was more severe in the RA group as well, with rest pain/gangrene (50.9% vs 39.1%; P < .01) and history of amputation (73.1% vs 49.8%; P < .01) both higher in the RA group. The RA group also had a higher proportion of emergency procedures (11.4% vs 4.4%; P < .01), longer operative time (226 6 11.5 minutes vs 208.4 6 2.6 minutes; P < .01) and longer prior hospital length of stay (16.5 6 1.8 days vs 8 6 0.3 days; P < .01). The RA group also was taken back to the operating room more frequently during the index admission (36.2% vs 15.3%; P < .01) than the NRA group. Preoperative hypertension (odds ratio, 46.7; 95% confidence interval, 34.6-62.9) and rest pain/gangrene (odds ratio, 50.1; 95% confidence interval, 36.4-69.1) were the only independent predictors of RA on multivariate analysis.Conclusions: Insulin dependence and preoperative cardiac comorbidities are not predictive of readmission rates after FPB in diabetic patients. The presence of critical limb ischemia is the most predictive factor for 30day readmission after FPB in diabetic patients.

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