Robotically Assisted Aorto-Femoral Bypass Grafting Surgery: French Experience and Technique Description

The da Vincitrade Surgical Robot (Intuitive Surgical Inc., Sunnyvale, CA, USA) is a computer-enhanced surgery device that helps to surpass some of traditional laparoscopic instruments limitations. Our work was performed to assess the safety and feasibility of robotically assisted aorto-femoral bypass grafting (AF) as well as to describe the technique. The aortic dissection is performed laparoscopically, with the patient in a modified right lateral position. The proximal anastomosis is completed with the da Vincitrade system by a remote surgeon, positioned at a distance from the patient. The role of the assistant at the patient´s side is especially to expose, to perform haemostasis and to maintain traction on the running sutures performed by the robot. No robot-related complications were noted. Robotically assisted anastomoses are possible by its unique ability to combine conventional laparoscopic surgery with stereoscopic 3D magnification and ultra-precise suturing techniques due to the flexibility of the robotic wristed instruments using different motion scaling of surgeon hand movements. In addition, prior training in laparoscopic aortic surgery is not necessary for surgeons to obtain the level required for suturing. Further clinical trials are needed to explore the clinical potential and value of robotically assisted AF.