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Early Concepts In Combining Robotic Surgical and Endovascular Techniques
Balazs C Lengyel, Rebecca G. Barnes, Ponraj Chinnadurai, Alan B Lumsden, Charudatta S Bavare
Houston Methodist, Houston, TX
Objectives: While other specialties embraced robotic surgery, vascular surgery was revolutionized by endovascular techniques. The combination of open surgical techniques with endovascular solutions became a standard practice. Hybrid grafts - although now been discontinued, were used for sutureless vascular anastomosis. One of the criticisms against robotics is the difficulty of creating vascular anastomosis. We aimed to prove the feasibility of a pioneering concept: merging vascular robotics with a hybrid endovascular approach to facilitate anastomosis creation. Firstly, we wanted to prove the feasibility of combining a mobile C-arm with the docked Da Vinci Xi (Intuitive Surgical, Sunnyvale, CA). Secondly, we wanted to evaluate the feasibility of a hybrid robotic anastomosis by reincarnating the idea of the hybrid vascular graft: a PTFE graft connected to a self-expanding covered stent.
Methods: All experiments were performed on a fresh frozen human cadaveric model. The cadaver was positioned with its left side slightly elevated on an interventional operating table. Four 8 mm ports were placed in the left midclavicular line and two 12 mm assist ports below in the posterior axillary line, simulating an aortic procedure. The robot was docked from the cadaver’s right side and 4 robotic instruments were introduced. The CIARTIC Move mobile C-arm (Siemens, Munich, Germany) was used.
Results: By splaying the arms of the robot while maintaining the focus we successfully created a gap, to fit the C-arm in. Aortic angiography was performed successfully. In the second part of the experiment after robotic vascular dissection, we managed to deploy an 8 mm self-expanding covered stent from the abdominal cavity (inserted through a port) into the right common iliac artery with a 6 mm PTFE graft threaded on it, to create an end-to-side hybrid anastomosis.
Conclusions: The combination of surgical robotics and endovascular techniques seems feasible and promising. Further research is warranted.
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