Robot-assisted laparoscopic repair of renal artery aneurysms.
OBJECTIVE
The aim of this article is to report our experience in the repair of renal artery aneurysms using robot-assisted surgery.


METHODS
Between December 2002 and March 2009, five women with a mean age of 63.8 years (range, 57-78 years) underwent robot-assisted laparoscopic repair of renal artery aneurysms by the same surgeon at two different institutions, the Department of General Surgery, Misericordia Hospital, Grosseto, Italy (three patients) and the Division of Minimally Invasive and Robotic Surgery at the University of Illinois, Chicago (two patients). The mean size of the lesions was 19.4 mm (range, 9-28 mm). Four of the lesions were complex aneurysms involving the renal artery bifurcation. Two patients were symptomatic and three had hypertension. In situ repair by aneurysmectomy was performed in all cases, followed by revascularization. In complex aneurysms, an autologous saphenous vein graft was used for the reconstruction.


RESULTS
The mean operative time was 288 minutes (range, 170-360 min) and the estimated surgical blood loss was 100 ml (range, 50-300 ml). Warm ischemia time was 10 minutes in the patient treated by aneurysmectomy, followed by direct reconstruction. The average warm ischemia time was 38.5 minutes (range, 20-60 min) for patients treated with saphenous vein graft interposition. The mean time to resume a regular diet was 1.6 days (range, 1-2 days). The mean postoperative length of hospital stay was 5.6 days (range, 3-7 days). No postoperative morbidity was noted. The mean follow-up time for the entire series was 28 months (range, 6-48 months). Color Doppler ultrasonography examination showed patency in all reconstructed vessels. One patient had stenosis of one of the reconstructed branches, which was treated with percutaneous angioplasty.


CONCLUSIONS
Robot-assisted laparoscopic repair of renal artery aneurysms is feasible, safe and effective. The technical advantages of the robotic system allows for microvascular reconstruction to be performed using a minimally invasive approach, even in complex cases. This approach may also allow for improved postoperative recovery and reduce the morbidity correlated with open repair of renal artery aneurysms. Although more experience and technical refinements are necessary, robot-assisted laparoscopic repair of renal artery aneurysms represents a valid alternative to open surgery.
Giulianotti
Pier Cristoforo
PC
Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA. piercg@uic.edu
Bianco
Francesco Maria
FM
Addeo
Pietro
P
Lombardi
Antonella
A
Coratti
Andrea
A
Sbrana
Fabio
F
D000368:Aged; D000783:Aneurysm / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002641:Chicago; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D012501:Saphenous Vein / Q000637:transplantation*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*