Learning Curve of Robotic-Assisted Anastomosis: Shorter than the Laparoscopic Technique? An Educational Study

Lucereau, Benoit; Thaveau, Fabien; Lejay, Anne; Roussin, Mathieu; Georg, Yannick; Heim, Frédéric; Lee, Jason T.; Chakfé, Nabil

doi:10.1016/j.avsg.2015.12.001

Cited by 17 publications

(8 citation statements)

References 12 publications

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“…Another important aspect could be the possible reduction of incisional hernias after open aortic replacement by the minimally invasive access approach in RAAS [ 29 ]. The intuitive use of the robotic-assisted system and linear hand–eye coordination demonstrate a very sharp learning curve in the use of robotic surgical techniques [ 15 , 30 ]. Another limitation of robotic-assisted vascular surgery is the absence of haptic feedback.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted abdominal aortic surgery: evidence and techniques

et al. 2022

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In various disciplines, robotic-assisted surgery is a well-proven routine procedure, but have never been established in vascular surgery so far. This review summarizes the results to date of robotic-assisted abdominal aortic surgery (RAAS) in the treatment of aorto-iliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA). Web-based literature search of robotic-assisted surgical procedures on the abdominal aorta and iliac arteries between 1990 and 2020 including the Cochrane Library, OVID Medline, Embase, and PubMed medical databases. All studies conducting Robotic-assisted surgery were included in the quantitative analysis regarding operative and cross-clamping times, conversion rates, mortality and morbidity within the first 30 days, and in-hospital stay. Case reports and case studies (< 5 patients) were not included. Twenty-four studies were deemed thematically eligible for inclusion; after exclusion of duplicate publications, nine met the inclusion criteria for further analysis. A total of 850 patients who had either abdominal aortic aneurysm or aorto-iliac occlusive disease underwent RAAS. One study of abdominal aortic aneurysm, three of aorto-iliac occlusive disease, and five studies of both disease entities were analyzed quantitatively. For AAA, conversion rates ranged from 13.1 to 20% and perioperative mortality ranged from 0 to 1.6% with in-hospital stay of 7 days. For aorto-iliac occlusive disease, conversion rates ranged from 0 to 20%, and perioperative mortality ranged from 0 to 3.6% with in-hospital stay of 5–8 days. RAAS has been shown to be technically feasible with acceptable short-term outcomes and questionable benefits in terms of in-hospital stay and complication rates. RAAS is currently considered only an outsider procedure. Randomized-controlled trials are indispensable for regular use in vascular surgery as well as a clear approval situation for the vascular sector.

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Section: Discussionmentioning

confidence: 99%

Robotic-assisted abdominal aortic surgery: evidence and techniques

et al. 2022

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“…However, adequate and sufficient laparoscopic experience is required, with a potentially long learning curve, in particular in vascular surgery where use of the robot is not frequent. The robot assisted laparoscopic approach has the potential to increase the surgeons learning curve, 19 but the methods used to measure and define learning curves remain imprecise and sometimes inconsistent. 20 Robotic assistance provides improved surgical precision due to the instrument's seven degree of freedom joints, tremor filtration, and three dimensional vision of abdominal cavity structures.…”

Section: Discussionmentioning

confidence: 99%

Robot Assisted Laparoscopy for Median Arcuate Ligament Syndrome Relief

Magnus

Chakfé

Lejay

et al. 2022

EJVES Vascular Forum

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“…However, the improved dexterity offered by the robotic system may help overcome these challenges. We previously demonstrated an easier learning curve in completion of vascular anastomoses with the robotic system when it is used by vascular trainees 13 . The slow adoption of robotic vascular surgery can also be attributed to the perceived risk associated with the telemanipulation of vessels.…”

Section: Discussionmentioning

confidence: 99%

Total robotic iliac aneurysm repair with preservation of the internal iliac artery using sutureless vascular anastomosis

Colvard

Georg

Lejay

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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Objective Internal iliac artery (IIA) preservation is associated with improved outcomes after both open and endovascular aortoiliac aneurysm repair. Total robotic laparoscopic repair of aortoiliac aneurysms has been reported in the past, but not in combination with sutureless anastomosis applied to the IIAs. The objective of this study was to demonstrate the feasibility of the total robotic laparoscopic technique including a method of deploying the Gore Hybrid Vascular Graft (GHVG; W. L. Gore & Associates, Flagstaff, Ariz) using robotic instruments. Methods Between June 2015 and December 2016, four patients underwent total robotic laparoscopic repair of isolated common iliac artery (CIA) aneurysms. Two patients had unilateral aneurysms and two had bilateral aneurysms. Unilateral CIA aneurysms were treated with a graft from the proximal CIA to the proximal external iliac artery, and bilateral CIA aneurysms were treated with a bifurcated graft between the distal aorta and both proximal external iliac arteries. The nitinol reinforced section of the GHVG was then inserted and deployed into the corresponding IIA, and the nonreinforced segment was sewn in an end-to-side fashion to the iliac graft. Results The median age of patients was 55.5 years (range, 48-64 years); median body mass index was 24.9 kg/m 2 (range, 23-26.4 kg/m 2 ). All four cases were technically successful. Operative times were 325 and 332 minutes for unilateral cases and 491 and 385 minutes for bilateral cases. For the entire series, median proximal clamping time was 143 minutes (range, 110-163 minutes), and the median time to deploy the GHVG was 15 minutes (range, 8-27 minutes). The median estimated blood loss was 1800 mL (range, 800-2100 mL). Intraoperative cell salvage was used in all cases. No intraoperative or postoperative complications occurred. No patient required blood transfusion. All patients tolerated a regular diet on postoperative day 2 and were discharged on postoperative day 4. Patients returned to work and full physical activity within 6 weeks (range, 2-6 weeks). At 6-month follow-up, computed tomography angiography demonstrated 100% patency of iliac artery grafts as well as of the GHVGs. Conclusions Total robotic laparoscopic CIA aneurysm repair is feasible in both unilateral and bilateral cases in carefully selected patients. The GHVG can be successfully deployed using robotic technique for IIA preservation during total robotic CIA aneurysm repair.

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Learning Curve of Robotic-Assisted Anastomosis: Shorter than the Laparoscopic Technique? An Educational Study

Cited by 17 publications

References 12 publications

Robotic-assisted abdominal aortic surgery: evidence and techniques

Robotic-assisted abdominal aortic surgery: evidence and techniques

Robot Assisted Laparoscopy for Median Arcuate Ligament Syndrome Relief

Total robotic iliac aneurysm repair with preservation of the internal iliac artery using sutureless vascular anastomosis

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