Document Detail


Robotic-assisted aortic surgery with and without minilaparotomy for complicated occlusive disease and aneurysm.
MedLine Citation:
PMID:  21917403     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Published reports of robotic-assisted aortic surgery involve a combination of laparoscopy for aortic dissection and a robotic system for vascular reconstruction. The objective of this study is to determine the feasibility and advantage of a total robotic-assisted aortic dissection and vascular reconstruction vs 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-assisted aortic procedures: aortobifemoral bypass in 12, AAA repair in 6, iliac aneurysm repair in 1, and ligation of type II endoleak after endovascular aneurysm repair in 2. Inclusion criteria included AAA >5 cm, iliac aneurysm >3 cm, and AIOD TransAtlantic InterSociety Classification (TASC) C or D lesions. The da Vinci S Surgical System (Intuitive Surgical Inc, Sunnyvale, Calif) was used for the abdominal aortic dissection in all cases and for the aortic anastomosis in three cases.
RESULTS: The 21 patients (6 women, 15 men) were an average age of 65.7 years (range, 44-86 years), had a body mass index (BMI) of 27.23 kg/m(2), and 90.4% were American Society of Anesthesiologists (ASA) class 3 or 4. Robotic dissection of the abdominal aorta was successful in 20 patients (95.2%). One patient required full conversion to open AAA repair due to trocar injury. Of the remaining 20 patients, the average robotic dissection time of the infrarenal aorta was 113.1 minutes, and the average aortic clamp time was 86 minutes. The procedure in 15 patients was performed with a minilaparotomy using an average abdominal incision of 13 cm to implant the Dacron or polytetrafluoroethylene graft. Five patients underwent a total robotic-assisted procedure with robotic aortic reconstruction or ligation of a type II endoleak. The 30-day survival rate was 100%. Median length of stay was 7.5 days. All grafts were patent at a median follow-up of 32.0 months.
CONCLUSIONS: For aortic procedures completed total robotically without an abdominal incision, the estimated blood loss was significantly less than in robotic-assisted procedures with a minilaparotomy. In these selected patients, robotic-assisted technology may be part of the armamentarium for the vascular surgeon as another less invasive method for the treatment of complicated occlusive disease or aneurysm.
Authors:
Judith C Lin; Sanjeev A Kaul; Akshay Bhandari; Edward L Peterson; James O Peabody; Mani Menon
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Publication Detail:
Type:  Journal Article     Date:  2011-09-13
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-20     Completed Date:  2012-02-02     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  16-22     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery, Henry Ford Health System, Detroit, Michigan, USA. jlin1@hfhs.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal / diagnosis,  surgery*
Arterial Occlusive Diseases / diagnosis,  surgery*
Blood Loss, Surgical / prevention & control
Blood Vessel Prosthesis Implantation / adverse effects,  methods*
Endoleak / diagnosis,  surgery*
Feasibility Studies
Female
Humans
Iliac Aneurysm / diagnosis,  surgery*
Laparoscopy* / adverse effects
Male
Michigan
Middle Aged
Robotics*
Surgery, Computer-Assisted* / adverse effects
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
J Vasc Surg. 2012 Jan;55(1):22-3   [PMID:  22182997 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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