Journal «Angiology and Vascular Surgery» • 

2020 • VOLUME 26 • №4

Robotic-assisted operations for pathology of the aortoiliac segment: own experience

Saaya Sh.B., Rabtsun A.A., Popova I.V., Gostev A.A., Cheban A.V., Ignatenko P.V., Starodubtsev V.B., Karpenko A.A.

Cardiosurgical Department of Vascular Pathology and Hybrid Technologies, National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia

Objective. The present study was aimed at assessing the results of a total of 40 vascular operations carried out using the robotic-assisted da Vinci surgical system.

Patients and methods. Between January 2013 and September 2019, a total of 40 robotic-assisted vascular operations were performed at the Department of Vascular Pathology and Hybrid Technologies of the Centre of Vascular and Hybrid Surgery. Of these, 31 interventions were carried out for occlusion of the aortoiliac segment and 9 for removal of an aneurysm of the infrarenal portion of the abdominal aorta. The patients were arbitrarily divided into 2 groups: the first group included those subjected to aortofemoral bypass grafting procedures for atherosclerotic steno-occlusive lesions of the aorta and iliac arteries, whereas the second group comprised the patients who underwent aneurysmoectomies with linear prosthetic repair of the abdominal aorta.

Results. Altogether, elective robotic-assisted operations were successfully performed in 38 (95%) cases. Conversion to a laparotomic approach was required in 2 (5%) patients. The mean time of creating an anastomosis with the abdominal aorta amounted to 51 minutes (range 30-90), being 42±4.75 min for aortofemoral bypass grafting and 83±5.00 min for aneurysmoectomies with linear prosthetic repair of the abdominal artery. The average blood loss was 316 (range 50-1000) ml, amounting to 280±209 ml and 438±322 ml for group I and group II, respectively. With the exception of one case, all patients spent 24 hours in the intensive care unit to be then transferred to the specialized ward. The average length of hospital stay amounted to 9.8 days. One patient experienced haemorrhage from the central anastomosis in the early postoperative period and was emergently operated on from a laparotomic approach. Four (10%) patients developed nonlethal complications which were treated conservatively. During the 30-day follow-up period, no lethal outcomes, thromboses, nor infections of the prostheses were observed.

Conclusions. From a practical point of view, the major advantages of using the robotic-assisted complex include minimal surgical trauma, reduced blood loss, a wide range of high-precision movements of the manipulators, 3-D visualization with a 5-fold magnification, thus making it possible to create a vascular anastomosis sufficiently fast in very tight spaces in the body. Our experience with laparoscopic robotic-assisted surgery demonstrated feasibility of using this technique for treatment of pathology of the aortoiliac segment.

KEY WORDS: robotic-assisted vascular surgery, laparoscopic vascular surgery, abdominal aortic aneurysm, da Vinci surgical robot, minimally invasive surgery.

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