Robotic surgery in abdominal aortoiliac aneurysm and occlusive disease: a systematic review and single-arm...

Abdominal aortic aneurysms (AAA) and aorto-iliac occlusive disease (AIOD) are traditionally managed via open or endovascular techniques. Robotic surgery emerges as an alternative, offering enhanced visualization, precision, and ergonomics. A systematic review was conducted across PubMed, Embase, and Cochrane to identify observational studies up to September 2024. Continuous outcomes were pooled as mean values with 95% confidence intervals (CIs), and binary outcomes as proportions. Heterogeneity was assessed using the Cochrane Q-test and I² statistic. Analyses were performed using R (v4.4.1). Ten studies comprising 595 patients were included. Of these, 402 (67.5%) underwent fully robotic procedures and 193 (32.5%) robotic-assisted surgery. AIOD was the primary indication in 70.5% of cases and AAA in 21.5%. Pooled operative time was 301.2 min (95% CI 238.2-380.9), cross-clamping time 74.3 min (95% CI 56.8-97.2), and anastomotic time 45.5 min (95% CI 29.2-71.1). Mean blood loss was 727.5 mL (95% CI 454.4-1164.7), and hospital stay averaged 7.3 days (95% CI 4.8-11.0). Thirty-day mortality was 3% (95% CI 0%-5%), prosthesis patency at 12 weeks was 92% (95% CI 82%-97%), mesenteric ischemia occurred in 5% (95% CI 2%-11%), and conversion to open surgery in 5% (95% CI 2%-8%). Subgroup analysis revealed higher cross-clamping time and blood loss in AAA compared to AIOD. Robotic aortic surgery demonstrates acceptable short-term outcomes in AAA and AIOD, with low morbidity and promising technical feasibility. Further studies with long-term follow-up are needed to validate its role in aortic surgery.