PRELIMINARY EXPERIENCE OF THE AORTO-FEMORAL SHUNTING USING THE DA VINCI SURGICAL SYSTEM

Introduction. Robot surgery is one of the most high-demand and dynamic developing realms of medicine. It is widely used in urology, proctology, thoracic, cardiovascular surgery and gynecology. In February 2018 a robot surgery centre opened in Volga Federal District of the Russian Federation based on the clinic of the Bashkir State Medical University (city of Ufa).

Materials and methods. The present paper demonstrates the first successful robot-assisted vascular operations within a master-class called "Aorto-Femoral Shunting with the use of robot-assisted surgical system Da Vinci".

Results. Exemplified with three operations: two linear aorto-femoral shunting and lumbar sympathectomy demonstrate technical peculiarities and advantages of robot-assisted vascular surgery. The findings show positive short-term results of the performed surgical interference that combine minimal injury and blood loss which help to reduce hospital stay in an intensive therapy department and intestinal distention duration. These clinical effects enabled to provide early activization of patients and possibility to adequately correct nutritional status with enteral feeding. The above-mentioned advantages eventually resulted in reduction of post-operation stay of patients in in-patient department and of cost of treatment.

Conclusion. Robot-assisted surgical system Da Vinci being the most cutting-edge in the realm of endoscopic surgery, enables to carry out operational interference with minimal blood loss and injury of tissues which helps to reduce postoperation and recovery periods. 

1. Zamor K.C., Hoel A.W., Helenowski I.B., Beck A.W., Schneider J.R., Ho K.J. Comparison of direct and less invasive techniques for the treatment of severe aortoiliac occlusive disease. Ann Vasc Surg. 2018;46:226–233. DOI: 10.1016/j.avsg.2017.07.002

2. 2 Goode S.D., Keltie K., Burn J., Patrick H., Cleveland T.J., Campbell B., et al. Effect of procedure volume on outcomes after iliac artery angioplasty and stenting. Br J Surg. 2013;100(9):1189–96. DOI: 10.1002/bjs.9199

3. 3 Bruls S., Quaniers J., Tromme P., Lavigne J.P., Van Damme H., Defraigne J.O. Comparison of laparoscopic and open aortobifemoral bypass in the treatment of aortoiliac disease. Results of a contemporary series (2003–2009). Acta Chir Belg. 2012;112(1):51–8. PMID: 22442910

4. 4 Ahmed N., Gollop N.D., Ellis J., Khan O.A. How does elective laparoscopic abdominal aortic aneurysm repair compare to endovascular aneurysm repair? Interact Cardiovasc Thorac Surg. 2014;18(6):814–20. DOI: 10.1093/icvts/ivu031

5. 5 Garrett H.E. Jr., Fernandez J.D., Porter C. Robot-assisted laparoscopic aortobifemoral bypass: initial experience developing a new program. J Robot Surg. 2008;2(4):247–51. DOI: 10.1007/s11701-008-0118-2

6. 6 Karpenko A.A., Starodubtsev V.B., Ignatenko P.V., Rabtsun A.A., Mitrofanov V.O. Results of endovascular interventions in patients with occlusive stenotic lesions of arteries of the aortoiliac segment. Angiology and Vascular Surgery. 2016;22(2):77–84. (in Russ.)

7. 7 Howard A.Q., Bennett P.C., Ahmad I., Choksy S.A., Mackenzie S.I., Backhouse C.M. Introduction of laparoscopic abdominal aortic aneurysm repair. Br J Surg. 2015;102(4):368–74. DOI: 10.1002/bjs.9714

8. 8 Guo L.R., Gu Y.Q., Qi L.X., Tong Z., Wu X., Guo J.M., et al. Totally laparoscopic bypass surgery for aortoiliac occlusive disease in China. Chin Med J (Engl). 2013;126(16):3069–72. PMID: 23981614

9. 9 Lin J.C. The role of robotic surgical system in the management of vascular disease. Ann Vasc Surg. 2013;27(7):976–83. DOI: 10.1016/j.avsg.2013.02.004

10. 10 Kolvenbach R. Hand-assisted laparoscopic abdominal aortic aneurysm repair. Semin Laparosc Surg. 2001;8(2):168–177. PMID: 11441406

11. 11 Da Silva L., Kolvenbach R., Pinter L. The feasibility of hand-assisted laparoscopic aortic bypass using a low transverse incision. Surg Endosc 2002;16(1):173–176., DOI: 10.1007/s004640090106

12. 12 Lin J.C., Kaul S.A., Bhandari A., Peterson E.L., Peabody J.O., Menon M. Robotic-assisted aortic surgery with and without minilaparotomy for complicated occlusive disease and aneurysm. J Vasc Surg. 2012;55(1):16–22. DOI: 10.1016/j.jvs.2011.06.103

13. 13 Stadler P., Dvoracek L., Vitasek P., Matous P., Wu T., Prema J., et al. Robot assisted aortic and non-aortic vascular operations. Eur J Vasc Endovasc Surg. 2016;52(1):22–8. DOI: 10.1016/j.ejvs.2016.02.016

14. 14 Abdollah F., Jindal T., Menon M. Surgical training in the robotic surgery era: the importance of structured programs. Eur Urol Focus. 2017;3(1):117–118. DOI: 10.1016/j.euf.2016.05.007

15. 15 Smorgick N., As-Sanie S. The benefits and challenges of robotic-assisted hysterectomy. Curr Opin Obstet Gynecol. 2014;26(4):290–4. DOI: 10.1097/GCO.0000000000000080

16. 16 Helgetveit I., Krog A.H. Totally laparoscopic aortobifemoral bypass surgery in the treatment of aortoiliac occlusive disease or abdominal aortic aneurysms — a systematic review and critical appraisal of literature. Vasc Health Risk Manag. 2017;13:187–199. DOI: 10.2147/VHRM.S130707

17. 17 Stadler P., Dvoracek L., Vitasek P., Matous P. The application of robotic surgery in vascular medicine. Innovations (Phila). 2012;7(4):247–53. DOI: 10.1097/IMI.0b013e31827333cb

18. 18 Kim E.R., Lim C., Kim D.J., Kim J.S., Park K.H. Robot-assisted cardiac surgery using the da Vinci Surgical System: a single center experience. Kor J Thorac Cardiovasc Surg. 2015;48(2):99–104. DOI: 10.5090/kjtcs.2015.48.2.99