Cadaveric Feasibility of Robot-Assisted V3-Radial Artery-P2 Bypass

Giant fusiform and dolichoectatic aneurysms of the basilar trunk and vertebrobasilar junction remain among the most challenging cerebrovascular lesions. In selected cases, flow-reversal strategies combined with posterior circulation revascularization can be considered; however, V3-radial artery (RA)-P2 bypass requires deep microvascular suturing within a narrow corridor, limiting its dissemination. The aim of this study is to evaluate the technical feasibility of robot-assisted posterior circulation bypass using the da Vinci Xi system in a fresh cadaveric model.

Two fresh cadaver heads were studied with the da Vinci Xi Surgical System using 0° stereoscopic endoscopes. Distal end-to-side P2-RA anastomosis was performed using 8-0 Prolene in a running fashion, followed by proximal end-to-side V3-RA anastomosis using interrupted 8-0 Prolene sutures.

Robot-assisted V3-RA-P2 bypass was completed in both specimens. Mean anastomosis time was 37 minutes (range, 26-43) for P2-RA and 27 minutes (range, 24-36) for V3-RA. Stable stereoscopic visualization and articulated instrument control enabled consistent needle positioning and suturing at depth. Physiological patency could not be assessed in this nonperfused cadaveric setting.

In a fresh cadaveric model, the da Vinci Xi system enabled technically feasible deep posterior circulation microanastomoses while maintaining stable visualization and needle control within a constrained corridor. Further validation in perfused models with objective patency and suturing-quality metrics is warranted.