Totally Robotic Aortic Surgery versus Robotic-Assisted Aortic Surgery with Mini-Laparotomy

Abstract

Objectives: Safety and efficacy of totally laparoscopic aortic surgery and laparoscopic-assisted aortic surgery with minilaparotomy have been demonstrated in previous studies. Published reports of robotic-assisted aortic surgery involve a combination of laparoscopy for aortic dissection and robotic system for vascular reconstruction. The objective of this study is to determine the feasibility and advantage of a totally robotic aortic dissection and vascular reconstruction versus robotic-assisted aortic procedures for aortoiliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA). Methods: From February 2006 to August 2010, 21 patients were selected for robotic aortic procedures: 12 had aortobifemoral bypass, 6 had AAA repairs, 1 had iliac aneurysm repair, and 2 had ligation of type II endoleak after endovascular aneurysm repair. Inclusion criteria included AAA >5 cm, iliac aneurysm >3 cm, and AIOD TransAtlantic InterSociety Consensus C or D. The daVinci S Surgical System was used for the aortic dissection in all cases and the aortic anastomosis in three. Institutional Review Board approval and informed consent were obtained. Results: The 21 patients (6 women, 15 men) were an average age of 65.7 years (range, 44-86 years) and body mass index of 27.23 kg/m2, and 90.4% were American Society of Anesthesiology 3 or 4. Twenty patients (95.2%) underwent successful robotic dissection of the abdominal aorta. One patient underwent full conversion to open AAA repair due to trocar injury. Of the remaining 20 patients, the average robotic dissection of the infrarenal aorta was 113.1 minutes and average aortic clamp time was 86 minutes. Procedures in 15 patients were performed with a minilaparotomy using an average abdominal incision of 13 cm to implant the Dacron or PTFE graft. Five patients underwent a totally robotic procedure with robotic aortic reconstruction or ligation of type II endoleak. Thirty-day survival rate was 100%. Median length of stay (LOS) was 7.5 days. All grafts were patent with a median follow-up of 26.5 months. Conclusions: In this selected group of patients, totally robotic aortic surgery for aortic dissection and vascular reconstruction is feasible. For aortic procedures completed total robotically without an abdominal incision, the estimate blood loss was significantly less than robotic-assisted procedures with minilaparotomy.TableTotally robotic versus robotic-assisted aortic proceduresAortic clamp timeEstimated blood loss (mL)LOS (days)Mini-incision(min)(mL)(days)(cm)Totally robotic (n = 5)602006.6NoneRobotic-assisted (n = 15)89.51474. 411.713 Open table in a new tab