Robot-assisted laparoscopic surgery of the infrarenal aorta

Abstract

Background: Recently introduced robot-assisted laparoscopic surgery (RALS) facilitates endoscopic surgical manipulation and thereby reduces the learning curve for (advanced) laparoscopic surgery. We present our learning curve with RALS for aortobifemoral bypass grafting as a treatment for aortoiliac occlusive disease. Methods: Between February 2002 and May 2005, 17 patients were treated in our institution with robot-assisted laparoscopic aorto-bifemoral bypasses. Dissection was performed laparoscopically and the robot was used to make the aortic anastomosis. Operative time, clamping time, and anastomosis time, as well as blood loss and hospital stay, were used as parameters to evaluate the results and to compare the first eight (group 1) and the last nine patients (group2). Results: Total median operative, clamping, and anastomosis times were 365 min (range: 225-589 min), 86 min (range: 25-205 min), and 41 min (range: 22-110 min), respectively. Total median blood loss was 1,000 ml (range: 100-5,800 ml). Median hospital stay was 4 days (range: 3-57 days). In this series 16/18 anastomoses were completed with the use of the robotic system. Three patients were converted (two in group 1, one in group 2), and one patient died postoperatively (group 1). Median clamping and anastomosis times were significantly different between groups 1 and 2 (111 min Conclusions: Robot-assisted aortic anastomosis was shown to have a steep learning curve with considerable reduction of clamping and anastomosis times. However, due to a longer learning curve for laparoscopic dissection of the abdominal aorta, operation times were not significantly shortened. Even with robotic assistance, laparoscopic aortoiliac surgery remains a complex procedure.

Robotic-assisted abdominal aortic surgery: evidence and techniques

“…The authors do not specify the criteria for patient selection or preference for RAAS over endovascular or open surgery. From 2004 to 2012, 4 other papers cumulatively reported 64 robotic-assisted bypass procedures for aorto-iliac occlusive disease [ 7 , 14 – 16 ]. In four cohorts, median operative times ranged from 188 to 493 min, cross-clamping times ranged from 60 to 86 min, 30-day mortality ranged from 0 to 5.9%, and conversion rates ranged from 0 to 20% (Table 1 ).…”

Robotic Aortic Surgery

“…11 They went on to publish promising results with respect to the steep learning curve of the operation in the initial series of 17 patients, demonstrating a 50% reduction in clamp times for the later 9 patients as compared with the initial 8 patients. 12 Stadler and colleagues, the group having the largest experience with robot-assisted laparoscopic aortoiliac procedures, recently published results from a series of 150 patients. They reported a 97.3% rate of successful completion, a 2.7% complication rate, and shortened anastomosis and clamp times (27 and 39 minutes, respectively) as compared to a purely laparoscopic approach.…”

“…13 Several groups in Europe have now demonstrated not only the feasibility of robot-assisted aortic reconstruction but also safety and shortened anastomosis times. [11][12][13][14] Our group has initiated an Investigational Device Exemption (IDE) trial, which we hope will pave the way for introducing robotic vascular surgery in the United States. We have developed and participated in a training program that begins with work on inanimate models, thereafter advancing to pig models and ultimately cadavers.…”

Computational Intelligence in Medicine and Biology: A Survey

“…Robotics are already well established and continuously evolving in the surgery domain. [40][41][42][43][44][45][46][47][48][49][50][51][52] In parallel, the design of therapy and the proper treatment scheme is feasible to be computer aided. [53][54][55][56][57] Computational intelligence techniques have been applied also to facilitate control and interface between computers and human organs 58-59 as well as surgery training through virtual reality and complex simulations.…”