演題

IS-1-5

Totally robotic aortic surgery: a new way for minimally invasive abdominal aortic repair?

[演者] 藤村 直樹:1
[著者] Thaveau Fabien:1, 北川 雄光:2, Chakfe Nabil:1
1:Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, 2:慶應義塾大学外科

Background: Even in the golden era of endovascular treatment, there remains a subset of patients that benefits from the conventional open repair. In 1990s, laparoscopic aortic surgery appeared as a minimally invasive surgery, however, it was not widely adopted due to the technical difficulties. Recently, robotic surgery evolved as a way to overcome some of the problems of the laparoscopic surgery. Here, we describe our experience with totally robotic aortic surgery (TRAS) and discuss its feasibility.Methods: Retrospective review of 112 patients, who underwent TRAS from November 2006 to August 2014, was conducted.Results: For the 82 occlusive diseases, 77 aorto-bilateral femoral bypasses and 5 aorto-femoral bypasses were performed with 14 cases requiring supra-renal aortic clamping. For the reconstruction of the 30 aneurysms, 12 cases used tube-graft, 8 cases used bifurcated-graft to the iliac artery and 10 cases used it to the femoral artery. Mean operative time and mean aorta clamp time was 382 min (269 - 544 min) and 106 min (34 - 195 min), respectively. There was no procedure related death, however, complications included 3 postoperative bleeding, 2 ischemic colitis, 1 urinoma, 1 renal insufficiency, and 1 infection, and required reoperation in 5 cases. As for the long-term result, primary patency for 1 year and 5 years was 96% and 86%, respectively. There was no aortic pathology related death with 5 years survival of 76%.Conclusion: From our experience, TRAS is feasible. It should be adopted and offered to some patients, especially in the center of excellence.
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