title: Robot-assisted laparoscopic aortobifemoral bypass for aortoiliac occlusive disease: early clinical experience.
abstract: BACKGROUND
  Robotic technology may facilitate laparoscopic aortic reconstruction. We present our early clinical experience with laparoscopic aortobifemoral bypass, aided by two different robotic surgical systems.
  
  
  METHODS
  Between February 2002 and April 2004, we performed eight robot-assisted laparoscopic aorto-bifemoral bypasses for aortoiliac occlusive disease. All patients were male; median age was 55 years (range: 36-64). Dissection was performed laparoscopically and the robotic system was used to construct the aortic anastomosis.
  
  
  RESULTS
  A robot-assisted anastomosis was successfully performed in seven patients. Median operative time was 405 min (range: 260-589), with a median clamp-time of 111 min (range: 85-205). Median blood loss was 900 ml (range: 200-5800). Median anastomosis time was 74 min (range 40-110). In two patients conversion was necessary, one due to bleeding of an earlier clipped lumbar artery after completion of the anastomosis, the other because of difficulties with the laparoscopic exposure of the aorta. On post-operative day 3 one patient died unexpectedly as a result of a massive myocardial infarction. Median hospital stay was 7.5 days (range: 3-57).
  
  
  CONCLUSIONS
  Our initial experience with robotic assisted laparoscopic surgery (RALS) shows it is a feasible technique for aortoiliac bypass surgery. However, laparoscopic aortoiliac surgery demands considerable experience and operative times need to be reduced before this technique can be widely implemented.
authors.affiliation: Department of Surgery, Vrije Universiteit Medical Center, 1007 MB Vrije, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Nio
authors.forename: J
authors.initials: J
authors.lastname: Diks
authors.forename: M A M
authors.initials: MA
authors.lastname: Linsen
authors.forename: M A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: C
authors.initials: C
authors.lastname: Gracia
authors.forename: J A
authors.initials: JA
authors.lastname: Rauwerda
authors.forename: W
authors.initials: W
authors.lastname: Wisselink
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000295:instrumentation; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002423:Cause of Death; D005263:Femoral Artery / Q000601:surgery*; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000601:surgery*; D020706:Laparoscopes; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage; D012371:Robotics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*