Clinical efficacy of Da Vinci robot-assisted iliofemoral vein bypass grafting

Abstract

Objective To explore the clinical efficacy of Da Vinci robot-assisted iliofemoral vein bypass grafting. Methods The retrospective descriptive study was conducted. The clinical data of one 66-year-old male patient who underwent Da Vinci robot-assisted iliofemoral vein bypass grafting in the First Affiliated Hospital of Army Military Medical University in March 2019 were collected. The patient was failed to recanalize iliofemoral vein stent thrombosis by endovascular measures and underwent Da Vinci robot-assisted iliofemoral vein bypass grafting after balloon occlusion preset in the common iliac vein. Observation indicators: (1) intra- and post-operative situations; (2) follow-up and survival situations. Follow-up using outpatient examination was performed to detect the patient′s postoperative survival and swelling reduction of affected extremity up to April 2019. Results (1) Intra- and post-operative situations: the patient underwent Da Vinci robot-assisted iliofemoral vein bypass grafting successfully. The operation time of balloon occlusion preset by digital subtraction angiography was 35 minutes. The operation time of Da Vinci robot-assisted iliofemoral vein bypass grafting was 502 minutes (50 minutes of exposure time of femoral vein, 80 minutes of exposure time of iliac vein, 40 minutes of great saphenous vein harvesting time, 70 minutes of end to side anastomosis between autogenous great saphenous vein and femoral vein, 10 minutes of subcutaneous tunnel construction, 90 minutes of end to side anastomosis between autogenous great saphenous vein and iliac vein, 60 minutes of suturing except vessel closure, 102 minutes of preparation time, check and washing time). The volume of intraoperative blood loss was 500 mL and no intraoperative complications occurred. The autogenous great saphenous vein graft was well filled and no bleeding was found at both proximal and distal anastomoses after iliofemoral vein bypass grafting. There were 4 abdominal Trocar holes including 2 of 1.2 cm and 2 of 0.8 cm. The incisional length of right groin and left great saphenous vein harvesting region was 5.0 cm and 15.0 cm, respectively. At the discharge time, the patient had swelling subsided partially at right lower extremity and skin tesion reduced significantly compared with the admission. The perimeters at 15 cm above right knee joint and left knee joint were 53.5 cm and 48.0 cm. The maximum perimeters of right calf and left calf were 41.0 cm and 38.0 cm. No postoperative complications occurred. Duration of hospital stay after surgery was 3 days. (2) Follow-up and survival situations: the patient was followed up for 1 month, with good survival. The patient had swelling subsided of affected extremity. The perimeters at 15 cm above right and left knee joint were 52.0 cm and 48.0 cm. The maximum perimeters of right calf and left calf were 40.0 cm and 38.0 cm. Conclusion The Da Vinci robot-assisted iliofemoral vein bypass grafting is safe and feasible, with good short-term outcomes. Key words: Vein thrombus; Da Vinci robotic surgical system; Vein; Bypass grafting; Minimally invasive surgery