Robot Attack on Vascular Surgery

Abstract

Over the past few years, technological developments in global medicine have given rise to a whole series of new surgical techniques, particularly in minimally invasive surgery (Dion et al., 1996). Few people can now imagine general surgery or gynaecology without laparoscopic techniques, although this was not initially the case. Laparoscopic interventions reduce patient trauma, lower treatment and recovery times and, finally, also reduce overall treatment costs. Major developments in laparoscopic surgery in the 1990s have had an impact on vascular surgery. Minimally invasive approaches used in general surgery have gradually become a novel technique used in vascular surgery. Laparoscopy was introduced into vascular surgery much later than other areas and was approached with far greater apprehension, as well as with limited interest, by a number of renowned vascular surgeons, who were censorious of it from the very beginning (Dion et al., 1998). The main reasons for this lack of interest in laparoscopic vascular surgery were the difficulties associated with suturing of the vascular anastomosis, the long clamping times and complications in accessing the aorta and pelvic arteries, which are located low down next to the spine. On an imaginary scale of difficulty, vascular laparoscopic techniques would score extremely high, vascular surgeons in general have very little experience of laparoscopy and the learning curve is a long one. These are probably the main reasons preventing the further expansion of vascular laparoscopy, although there are centres in both Europe and the United States that are actively using vascular laparoscopic methods. Total laparoscopic aortoiliac surgery can be performed on patients with occlusive diseases and aneurysms. Robotics, which began to appear in 2000, is a state-of-the-art surgical technology (Marescaux et al., 2001). The Department of Vascular Surgery at Prague’s Na Homolce Hospital has been performing laparoscopic reconstructions since 2003 and these have been robot-assisted since the end of 2005. Under the direction of Dr. Petr Stadler, the robotic vascular team has not only created its own modified transperitoneal approach for these interventions, but has catapulted Czech robotic vascular surgery to the forefront of this modality worldwide. (Fig. 1. Robotic master console). O pe n A cc es s D at ab as e w w w .ite ch on lin e. co m