title: Performance measurements in endolaparoscopic infrarenal aortic graft implantation using computer-enhanced instrumentation: a laboratory model for training.
abstract: BACKGROUND
  Performance measurements in an endolaparoscopic aortic animal laboratory model have been reported since Dion's work (1995). The purpose of this paper is to report performance measurements using computer-enhanced surgical instrumentation in a porcine model.
  
  
  METHODS
  From February 2000 to December 2002, training in robotic instrumentation consisted of implantation of infrarenal aortic grafts in 3 groups of 5 animals each. The time frame to complete all 15 procedures reflects 2 major difficulties: the need to schedule procedures based on the surgeon's time off from his solo practice and the availability of laboratory sites to complete the procedures. A full endolaparoscopic technique was used to perform 2 end-to-end anastomoses through an intraperitoneal approach. A different method of computer-enhanced instrumentation was used for each group of animals as follows: (1) AESOP robotic arm and HERMES integrated voice control instrumentation, (2) AESOP-HERMES-ZEUS robotic systems, (3) da Vinci robotic system. The aortic clamp time, total operative time, and blood loss were recorded for each procedure. Secondary endpoints included spinal cord ischemia, graft thrombosis, and bleeding.
  
  
  RESULTS
  All animals tolerated the procedure. All grafts were patent and suture anastomoses intact. Two instances of bleeding, both of which were controlled laparoscopically, occurred. Aortic clamping time was significantly improved in Group 3 compared with that in Group 2 (P=0.008).
  
  
  CONCLUSIONS
  The results of the first group reflect previous experience with the AESOP-HERMES instrumentation. However, the times of the ZEUS group and da Vinci group reflect initial exposure to the technology. The remote position of the surgeon at the console did not appear to affect the performance as shown in the last group. The da Vinci group provides an advantage compared with the ZEUS group. Both systems showed adaptability and versatility in controlling adverse bleeding encounters.
authors.affiliation: Minimally Invasive Vascular Surgery Center, St. Vincent Mercy Medical Center, 2213 Cherry Street, Toledo, OH 43608, USA.
authors.forename: Bernardo D
authors.initials: BD
authors.lastname: Martinez
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Wiegand
authors.forename: Jose
authors.initials: J
authors.lastname: Mendez
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000193:education / Q000295:instrumentation / Q000379:methods*; D005260:Female; D010535:Laparoscopy; D023421:Models, Animal; D012371:Robotics; D020760:Spinal Cord Ischemia / Q000517:prevention & control; D025321:Surgery, Computer-Assisted; D013552:Swine