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Robot-assisted laparoscopic aortobifemoral bypass: initial experience developing a new program.

H Edward Garrett¹, Joss D Fernandez², Charlotte Porter¹

¹Cardiovascular Surgery Clinic, University of Tennessee, 6029 Walnut Grove Rd. Suite 401, Memphis, TN, 38117, USA.

Journal of Robotic Surgery

|September 18, 2016

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Robot-assisted laparoscopic aortobifemoral bypass (ABF) offers a safe and reliable minimally invasive option for treating aortoiliac occlusive disease. This technique demonstrates comparable outcomes to other minimally invasive methods, with a reduced learning curve for surgeons.

Area of Science:

Vascular Surgery
Minimally Invasive Surgery
Robotic Surgery

Background:

Aortobifemoral bypass (ABF) remains a gold standard for aortoiliac occlusive disease due to superior long-term patency.
Minimally invasive techniques are being developed to reduce the morbidity associated with traditional open ABF.

Purpose of the Study:

To report the initial experience and feasibility of developing a minimally invasive surgical aortic reconstruction program using the da Vinci robot for aortobifemoral bypass.
To evaluate the safety and efficacy of robot-assisted laparoscopic ABF.

Main Methods:

A retrospective review of six robot-assisted laparoscopic ABF cases performed between January and August 2007.
Laparoscopic exposure of the aorta using the Stadler technique, followed by aortic anastomosis with the da Vinci robot.

Keywords:

Arterial Human/robotic Surgical technical Vascular

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Comparison of results with published data on robotic ABF and alternative minimally invasive aortic reconstruction methods.

Main Results:

Operative times ranged from 5.4 to 8.2 hours, with a mean aortic clamp time of 75 minutes.
Estimated blood loss averaged 850 ml, and one patient (16%) required conversion to open surgery.
No operative mortality was observed, with a median postoperative length of stay of seven days.

Conclusions:

Robot-assisted laparoscopic ABF is a safe and reliable minimally invasive approach for aortoiliac occlusive disease, even in patients with prior vascular interventions.
The da Vinci robot facilitates minimally invasive aortic anastomosis, offering outcomes comparable to other minimally invasive options with a shorter learning curve.