Robotically Assisted, Minimally Invasive Ascending Aortic Replacement: A Feasibility Study in Anatomical Models.

Area of Science:

• Minimally invasive surgery
• Vascular surgery
• Robotic surgery

Background:

• Robotic technology is established in cardiac procedures like mitral valve repair and coronary artery bypass grafting.
• Its application in vascular surgery, particularly for ascending aortic replacement, remains largely unexplored.
• This study addresses the gap in knowledge regarding robotic ascending aortic replacement.

Purpose of the Study:

• To establish fundamental surgical techniques for robotically assisted ascending aortic replacement.
• To evaluate the feasibility and preliminary outcomes of this novel procedure in anatomical models.

Main Methods:

• The DaVinci 5 robotic platform was used for ascending aortic replacement in 6 porcine thoracic organ packs and 2 human cadaver models.
• The procedure involved ascending aorta resection and Dacron graft implantation.
• Key procedural steps, operative times, and anastomotic accuracy were recorded.

Main Results:

• Robotically assisted ascending aortic replacement was feasible in all porcine and human cadaveric simulations.
• Anastomotic times were recorded, with proximal and distal anastomoses in porcine models taking 9.7 ± 3.2 and 10.7 ± 4.5 minutes, respectively.
• Human cadaveric models showed slightly longer anastomotic times (12.3 ± 1.9 and 13.3 ± 2.0 minutes) with high suture accuracy.

Conclusions:

• Robotic replacement of the ascending aorta is technically feasible in anatomical models.
• The procedure demonstrated reasonable anastomotic times and high accuracy, indicating potential suitability for clinical settings.
• Robotic suturing on the ascending aorta can be performed with accuracy and efficiency.