The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease

Abstract

Our results show that the success rate of robot-assisted laparoscopic aortofemoral bypass grafting is high and the complication rate is low. Anastomosis creation, one of the main difficulties of laparoscopic bypass grafting, has been overcome using the robotic operating system and its learning curve is short. However, the endoscopic dissection of the aortoiliac segment remains the most difficult part of the operation and should be addressed in further development of the method to reduce the operative times. Long-term results and potential benefits of this minimally invasive method have to be verified by randomized controlled clinical trials.

Robotic technology in cardiovascular medicine

“…These operations can currently be performed at fewer than five centres worldwide, and large series have only been published by investigators from the most-active centre (Na Homolce Hospital, Prague, Czech Republic). 50,51 No deaths were recorded in the group of 150 patients reported by the Na Homolce Hospital in 2010; conversion to standard surgery through mini or full laparotomy was required in four patients (2.7%), and the same number experienced major postoperative complications. 50 The median aortic clamp time in this series was 39 min (range: 22-120 min) , and the median p ostoperative length of stay was 5 days (range: 4-10 days).…”

“…50 Iliofemoral reconstruction is indicated in external iliac artery occlusion and patent common iliac artery; aortofemoral unilateral reconstruction is indicated in total occlusion of a single iliac artery; and bilaterally when both iliac arteries are affected. 51 Usually an end-to-side graft to artery anastomosis is constructed. A total of 100 aortoiliac cases were evaluated by Stadler et al in 2010, with a 3% conversion rate to open surgery, 0% p erioperative m ortality, and a mean hospital stay of 5.1 days.…”

Robotic-assisted aortic surgery with and without minilaparotomy for complicated occlusive disease and aneurysm

“…Robotic-assisted laparoscopic aortic surgery is feasible in the treatment of aortoiliac occlusive disease 13 and renal artery aneurysm, 16 and the learning curve is important. 14 The role of robotic technology in vascular surgery is still undefined. The limitation of this study is the small number of patients over a span of 4 years, which hinders the progress of mastering the learning curve in robotic-assisted aortic surgery and leads to patient selection bias.…”

“…This is consistent with other reports of robotic-assisted vascular reconstruction. Novotny et al 14 showed that anastomosis creation has been overcome using the robotic operating system and its learning curve is short. Stadler et al 18 showed that robotic operating systems improve the precision, control, and dexterity of the surgical procedure with a high technical success rate.…”

“…[9][10][11][12] Published reports of roboticassisted aortic surgery involve a combination of laparoscopy for aortic dissection and a robotic system for vascular reconstruction. 13,14 Currently, the usage for robotic-assisted aortic surgery includes failure of previous stenting or TASC C and D for AIOD, a large aneurysm in a relatively healthy individual, and individuals with enlargement of the aneurysm sac after endograft exclusion. This study was conducted to determine the feasibility and advantage of total robotic-assisted The upper right insert shows port placement for the robotic and laparoscopic instruments: 1, proximal aortic clamp; 2, assistant port for retracting and suctioning; 3, assistant port for the stapling device; 4, distal aortic clamp; 5, robotic left arm; 6, robotic camera; and 7, robotic right arm.…”