This study is a retrospective review of all patients treated with a robotic-assisted mininvasive surgery for visceral artery aneurysms (VAA) at a single Institution. Robotic surgery seems to offer an important alternative to the traditional treatment.
Materials and Methods: between September 2001 and June 2007, 12 patients aged 41-78 (mean = 59.25) underwent minimally invasive robotic surgery for asymptomatic visceral aneurysms. The arteries involved were respectively: the splenic artery (SAA) in 9 patients and the renal artery (RAA) in 3 patients (1 being mono-renal) with mean aneurysm size of 20.3±5.8 mm. The “Da Vinci” surgical robotic system (Intuitive Surgical Inc., USA) was used in all cases.
Results: in the first case, a robotic-assisted laparoscopic (RAL) splenic aneurysmectomy between ligatures without splenectomy was performed. In nine cases (6 splenic aneurysms and 3 renal aneurysms), a RAL resection with a vascular structure reconstruction (5 end-to-end anastomosis, 3 Y saphenous vein graft interposition and 1 PTFE graft interposition) and associated end-organ flow preservation was performed. In another case, involving the splenic hilum only a partial vascular reconstruction associated with a robotic emisplenectomy was feasible. Only one case of SAA (within the splenic ileum) required an aneurysmectomy with a concomitant laparoscopic splenectomy, without possibility of vascular reconstruction and end-organ flow preservation.
Average intraoperative time: 225.83±64.06 min (range: 90-310). Mean estimated blood loss: 173±180.1 ml (range: 0-500). The mean hospital stay of non complicated cases has been 3.0±1.75 (range:2-7). Mean time to a regular diet: 1.7±0.6 days (range:1-3). Morbidity rate: 8.3% (case #1: splenic postoperative infarction). No death was observed. In all patients with vascular reconstruction, the duplex-scan surveillance showed a regular organ perfusion with mean follow-up of 41 months (range: 16-72).
Conclusions: the authors believe that robotic-assisted laparoscopic surgery for asymptomatic VAA treatment could be an effective alternative to the traditional open treatment and could become the new standard of care.
Program Number: P396