Robotic-assisted abdominal aortic surgery: evidence and techniques

Abstract

In various disciplines, robotic-assisted surgery is a well-proven routine procedure, but have never been established in vascular surgery so far. This review summarizes the results to date of robotic-assisted abdominal aortic surgery (RAAS) in the treatment of aorto-iliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA). Web-based literature search of robotic-assisted surgical procedures on the abdominal aorta and iliac arteries between 1990 and 2020 including the Cochrane Library, OVID Medline, Embase, and PubMed medical databases. All studies conducting Robotic-assisted surgery were included in the quantitative analysis regarding operative and cross-clamping times, conversion rates, mortality and morbidity within the first 30 days, and in-hospital stay. Case reports and case studies (< 5 patients) were not included. Twenty-four studies were deemed thematically eligible for inclusion; after exclusion of duplicate publications, nine met the inclusion criteria for further analysis. A total of 850 patients who had either abdominal aortic aneurysm or aorto-iliac occlusive disease underwent RAAS. One study of abdominal aortic aneurysm, three of aorto-iliac occlusive disease, and five studies of both disease entities were analyzed quantitatively. For AAA, conversion rates ranged from 13.1 to 20% and perioperative mortality ranged from 0 to 1.6% with in-hospital stay of 7 days. For aorto-iliac occlusive disease, conversion rates ranged from 0 to 20%, and perioperative mortality ranged from 0 to 3.6% with in-hospital stay of 5–8 days. RAAS has been shown to be technically feasible with acceptable short-term outcomes and questionable benefits in terms of in-hospital stay and complication rates. RAAS is currently considered only an outsider procedure. Randomized-controlled trials are indispensable for regular use in vascular surgery as well as a clear approval situation for the vascular sector.

Evaluation of the MMI Symani® Robotic Microsurgical System for coronary-bypass anastomoses in a cadaveric porcine model

“…The use of minimally invasive robotic surgery compared to open surgery still represents a major challenge for surgeons in the vascular eld [12,13]. Other surgical disciplines, particularly general surgery, urology and gynecology, have already established minimally invasive robotic systems as the gold standard in a bride range of procedures [1].…”

“…Nevertheless, there is still a lack of randomized studies comparing open with minimally invasive endoscopic robot-assisted surgery, and corresponding data for cardiovascular surgery are rare or unavailable [12,21]. The use of the Symani® surgical system in the area of microanastomoses certainly represents a possibility in coronary surgery as well as in other elds of cardiac surgery (CABG, MVR, tumor resection and ASD repair) [21].…”

Evaluation of the MMI Symani® robotic microsurgical system for coronary-bypass anastomoses in a cadaveric porcine model

“…The use of minimally invasive robotic surgery compared to open surgery still represents a major challenge for surgeons in the vascular field [ 12 , 13 ]. Other surgical disciplines, particularly general surgery, urology and gynecology, have already established minimally invasive robotic systems as the gold standard in a bride range of procedures [ 1 ].…”

“…Nevertheless, there is still a lack of randomized studies comparing open with minimally invasive endoscopic robot-assisted surgery, and corresponding data for cardiovascular surgery are rare or unavailable [ 12 , 21 ]. The use of the Symani ® surgical system in the area of microanastomoses certainly represents a possibility in coronary surgery as well as in other fields of cardiac surgery (CABG, MVR, tumor resection and ASD repair) [ 21 ].…”