title: Robotic-assisted aortic surgery with and without minilaparotomy for complicated occlusive disease and aneurysm.
abstract: OBJECTIVE
  Published reports of robotic-assisted aortic surgery involve a combination of laparoscopy for aortic dissection and a robotic system for vascular reconstruction. The objective of this study is to determine the feasibility and advantage of a total robotic-assisted aortic dissection and vascular reconstruction vs robotic-assisted aortic procedures for aortoiliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA).
  
  
  METHODS
  From February 2006 to August 2010, 21 patients were selected for robotic-assisted aortic procedures: aortobifemoral bypass in 12, AAA repair in 6, iliac aneurysm repair in 1, and ligation of type II endoleak after endovascular aneurysm repair in 2. Inclusion criteria included AAA >5 cm, iliac aneurysm >3 cm, and AIOD TransAtlantic InterSociety Classification (TASC) C or D lesions. The da Vinci S Surgical System (Intuitive Surgical Inc, Sunnyvale, Calif) was used for the abdominal aortic dissection in all cases and for the aortic anastomosis in three cases.
  
  
  RESULTS
  The 21 patients (6 women, 15 men) were an average age of 65.7 years (range, 44-86 years), had a body mass index (BMI) of 27.23 kg/m(2), and 90.4% were American Society of Anesthesiologists (ASA) class 3 or 4. Robotic dissection of the abdominal aorta was successful in 20 patients (95.2%). One patient required full conversion to open AAA repair due to trocar injury. Of the remaining 20 patients, the average robotic dissection time of the infrarenal aorta was 113.1 minutes, and the average aortic clamp time was 86 minutes. The procedure in 15 patients was performed with a minilaparotomy using an average abdominal incision of 13 cm to implant the Dacron or polytetrafluoroethylene graft. Five patients underwent a total robotic-assisted procedure with robotic aortic reconstruction or ligation of a type II endoleak. The 30-day survival rate was 100%. Median length of stay was 7.5 days. All grafts were patent at a median follow-up of 32.0 months.
  
  
  CONCLUSIONS
  For aortic procedures completed total robotically without an abdominal incision, the estimated blood loss was significantly less than in robotic-assisted procedures with a minilaparotomy. In these selected patients, robotic-assisted technology may be part of the armamentarium for the vascular surgeon as another less invasive method for the treatment of complicated occlusive disease or aneurysm.
authors.affiliation: Division of Vascular Surgery, Henry Ford Health System, Detroit, Michigan, USA. jlin1@hfhs.org
authors.forename: Judith C
authors.initials: JC
authors.lastname: Lin
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Kaul
authors.forename: Akshay
authors.initials: A
authors.lastname: Bhandari
authors.forename: Edward L
authors.initials: EL
authors.lastname: Peterson
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D057867:Endoleak / Q000175:diagnosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008824:Michigan; D008875:Middle Aged; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome