Retroperitoneal Abdominal Aortic Repair With the da Vinci Single Port System: A Porcine Model Feasibility Study

Area of Science:

• Vascular Surgery
• Robotic Surgery
• Surgical Innovation

Background:

• Robotic surgery is underutilized in vascular surgery but shows promise for abdominal aortic repair.
• A standardized retroperitoneal approach (RPA) may decrease risks associated with transabdominal aortic repair.

Purpose of the Study:

• To establish surgical techniques for robotically assisted infrarenal abdominal aortic repair.
• To evaluate the feasibility of a single-port retroperitoneal approach (RPA) for aortic repair.

Main Methods:

• Performed retroperitoneal abdominal aortic repair in four live porcine models.
• Utilized the da Vinci SP (single port) surgical system for the procedures.
• Recorded operating times for key procedural steps, including graft implantation.

Main Results:

• Feasible abdominal aortic repair via single-port RPA using the da Vinci SP system in all models.
• Efficient retroperitoneal access and docking (8-20 minutes).
• Reasonable anastomotic times (26-31.3 minutes) with successful outcomes in most models; one model experienced hemorrhage.

Conclusions:

• Single-port robotic aortic repair via RPA is technically feasible and accurate in porcine models.
• Reasonable anastomotic times and adequate surgeon comfort suggest potential for clinical translation.
• Further studies are needed to confirm clinical benefits.