Chapter 64 - Laparoscopic and Robotic Aortic Surgery

Abstract

The lack of trained vascular surgeons with the skills to perform laparoscopic aortic repair and the improved outcomes after aortoiliac stenting and after endovascular aneurysm repair (EVAR) led to question the need for laparoscopic aortic repair. There is, however, a subset of patients that will benefit from a potentially less invasive alternative to open repair when EVAR or iliac stenting is not achievable. In this setting, laparoscopic aortic surgery may be considered as an option. We describe in this chapter the current laparoscopic techniques used for aortic reconstruction, including total laparoscopic aortic bypass with specificity for abdominal aortic aneurysm repair, hand-assisted and robot-assisted laparoscopic aortic surgery, showing the advantage of the robot with its 5 degrees of freedom when suturing the aortic anastomosis. We described for each procedure the conditions required to master all aspects of the laparoscopic technique with the help of eight videos. Finally, we added a summary of published studies on total laparoscopic aortic surgery for occlusive and aneurysmal disease with analysis of perioperative outcomes.