INTRODUCTION: Thoracoabdominal aortic surgery is a technically demanding and extensive treatment that has its place in the era of endovascular techniques. To ensure the best possible outcomes, it requires a well-coordinated team of surgeons, anaesthetists, intensive care physicians and other medical staff. METHODS: The authors present a series of 300 patients operated on between 1 January 2003 and 15 March 2022. Although the group included sporadic cases of severe obliterating involvement of the visceral aorta, patients with thoracoabdominal aortic aneurysms (TAAA) constituted the vast majority. All known organ preservation procedures were used during the operations. The thoraco-phreno-retroperitoneal approach was chosen in almost all TAAA cases; the thoraco-phreno-transperitoneal approach was used only in two reoperations. RESULTS: In this cohort, type II thoracoabdominal aneurysm according to Crawford classification was most common (33%). This was followed by type IV (32%), type III (15.3%), type I (8.7%), type V (6.7%) and other thoracoabdominal aortic procedures (4.3%). Thirty-day mortality rate was 9.6% (2019 - 6%, 2020 - 9.5%, 2021 - 3.8%) in this group; surgical postoperative complications occurred in 36 patients (12%). Neurological complications were reported in 16 cases (5.3%), of which postoperative paraplegia was noted 6 times (2%). Temporary postoperative dialysis due to renal insufficiency was performed in 19 patients (6.3%) and 4 patients (1.3%) have entered the chronic dialysis programme. In 67 patients (23.3%), temporary tracheostomy was done postoperatively due to prolonged withdrawal from the lung ventilator. CONCLUSION: Surgical treatment of the thoracoabdominal aorta is one of the most extensive procedures in vascular surgery and the mortality and morbidity rates still remain relatively high. A multidisciplinary approach, sufficient experience and a dedicated team are essential for a successful outcome of these highly specialised operations.

• Klíčová slova
• multidisciplinary approach, multidisciplinary care, organ protection, thoracoabdominal aneurysm, thoracoabdominal aorta,
• MeSH
• aneurysma břišní aorty * chirurgie   MeSH
• aneurysma hrudní aorty * etiologie   chirurgie   MeSH
• aorta chirurgie   MeSH
• cévy - implantace protéz * MeSH
• endovaskulární výkony * MeSH
• lidé MeSH
• pooperační komplikace etiologie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Based on their experience with robot-assisted vascular surgery, the authors present some unique types of procedures they have performed in this area. METHODS: From November 2005 to February 2022, a total of 560 robotic vascular procedures were performed, of which 70 were orphan operations, corresponding to 12.5%. The most common was robotic decompression of the coeliac trunk (18 times) in Dunbar syndrome, followed by robotic repair of type II endoleak after stent graft implantation (15 times) and robotic repair of splenic artery aneurysm (11 times). Less common were isolated pelvic artery aneurysm surgery (8 times), aortic thromboenderectomy and abdominal aortic patch repair (8 times) and hybrid surgery (6 times). Completely unique are renal artery reconstruction (2 times), operation of internal mammary artery aneurysm (1 time) in a patient with Marfan syndrome and paracaval biopsy (1 time) in a cancer patient. RESULTS: In 3 cases (4.2%) the operation had to be converted to open surgery. Twice in the management of splenic artery aneurysm due to flat adhesions in the abdominal cavity and once in the endoleak operation, when due to the very fragile wall of the dilated and pulsating abdominal aortic aneurysm sac, we considered manipulation with robotic instruments to be highly risky. There was zero mortality in this cohort; one patient had to undergo laparoscopic diaphragm repair for diaphragmatic hernia at another institution after deliberation of the coeliac trunk and in one case open surgery was needed for persistent endoleak. CONCLUSION: The use of the robotic system can be beneficial also in less frequent procedures, offering the patients all the advantages of robotic surgery. However, the need of extensive experience in robotic surgery should be emphasized because these operations are rare and perfect anatomical knowledge of the area is necessary.

• Klíčová slova
• minimally invasive vascular surgery, robotic surgery, robotic vascular surgery,
• MeSH
• aneurysma břišní aorty * chirurgie   MeSH
• cévy - implantace protéz * metody   MeSH
• endoleak chirurgie   MeSH
• endovaskulární výkony * metody   MeSH
• lidé MeSH
• roboticky asistované výkony * metody   MeSH
• robotika * MeSH
• výkony cévní chirurgie metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The aim of this study was to evaluate the clinical experience with 379 robot-assisted vascular procedures performed from November 2005 to December 2016 at our institution. METHODS: A total of 366 cases (96.6%) were successfully completed using the robotic surgical systems da Vinci Standard and da Vinci Xi. RESULTS: Conversion was necessary in 13 patients (3.4%). The 30-day mortality was 0.26% and 2 (0.5%) late prosthetic infections occurred. CONCLUSIONS: From a practical point of view, the greatest advantage of robot-assisted procedures has been the speed and relative simplicity of vascular anastomosis construction. Our experience with robot-assisted surgery has demonstrated the safety and feasibility of this technique in different areas of vascular surgery.Key words: robotic vascular surgery aortic and non-aortic surgery.

• MeSH
• lidé MeSH
• roboticky asistované výkony * MeSH
• výkony cévní chirurgie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The aim of this study was to evaluate the clinical experience with 310 robot assisted vascular procedures. The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively uncommon. METHODS: From November 2005 to May 2014, 310 robot assisted vascular operations were performed. Two hundred and twenty four patients were prospectively evaluated for occlusive disease, 61 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, four for a splenic artery aneurysm, one for a internal mammary artery aneurysm, and after the unsuccessful endovascular treatment five for hybrid procedures, two patients for median arcuate ligament release and nine for endoleak II treatment post EVAR. Among these patients, 224 underwent robotic occlusive disease treatment (Group I), 65 robotic aorto-iliac aneurysm surgery (Group II) and 21 other robotic procedures (Group III). RESULTS: A total of 298 cases (96.1%) were successfully completed robotically. In 10 patients (3.2%) conversion was necessary. The 30 day mortality was 0.3%, and two (0.6%) late prosthetic infections were seen. Targeted Group I and Group II patients were compared. Robotic ilio-femoral bypass, aorto-femoral bypass, or aorto-iliac thrombo-endarterectomy with prosthetic patch (Group I) required an operative time of 194 (range, 127-315) minutes and robotic aorto-iliac aneurysm surgery (Group II), 253 (range, 185-360) minutes. The mean aortic cross clamping time was 37 minutes in Group I and 93 minutes in Group II. The mean blood loss was more significant in Group II (1,210 mL) than in Group I (320 mL). CONCLUSION: From a practical point of view, the greatest advantage of the robot assisted procedure has been the speed and relative simplicity of construction of the vascular anastomosis. This experience with robot assisted laparoscopic surgery has demonstrated the feasibility of this technique in different areas of vascular surgery.

• Klíčová slova
• Aortic and non-aortic surgery, Laparoscopic vascular surgery, Robot assisted vascular surgery,
• MeSH
• aneurysma břišní aorty chirurgie   MeSH
• aneurysma chirurgie   MeSH
• arteria lienalis chirurgie   MeSH
• arteriální okluzní nemoci chirurgie   MeSH
• dospělí MeSH
• endoleak etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mamární tepny chirurgie   MeSH
• nemoci aorty chirurgie   MeSH
• nemoci cév chirurgie   MeSH
• retrospektivní studie MeSH
• roboticky asistované výkony metody   MeSH
• senioři MeSH
• výkony cévní chirurgie přístrojové vybavení   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• audiovizuální média MeSH
• časopisecké články MeSH

• MeSH
• laparoskopie metody   MeSH
• lidé MeSH
• výkony cévní chirurgie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• lidé MeSH
• robotika přístrojové vybavení   metody   MeSH
• výkony cévní chirurgie přístrojové vybavení   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Based on their experience of 150 robot-assisted vascular reconstructions, the authors not only reflect on the current uses of the da Vinci robotic system in vascular surgery, but also discuss options for the further expansion of this cutting-edge technology in their area of expertise. METHODS: To date there has not been the same level of development in laparoscopy in vascular surgery as in general surgery and, despite the numbers of published studies showing interesting results, laparoscopic vascular surgery has never been generally accepted. Robot-assisted surgery represents a new stage of progress in mini-invasive methods. During the period November 2005-September 2009, the authors performed 150 robot-assisted vascular reconstructions in the aortoiliac area. The most significant include aortofemoral reconstructions and surgery on aneurysms of the abdominal aorta, the pelvic arteries and the splenic artery, as well as their first attempts to perform hybrid interventions. RESULTS: Four cases (2.7%) required conversion to standard surgery and four patients (2.7%) experienced more serious postoperative complications. On one occasion (0.7%) the robotic equipment broke down during the operation and surgery had to be completed laparoscopically. In one case (0.7%) the operation had to be abandoned because the finding on the aorta proved to be inoperable. In the cohort under consideration, the median operating time was 228 min, the median time taken to suture the anastomosis was 27 min and the median clamp time was 39 min. CONCLUSIONS: Robotic operating systems improve the precision, control and dexterity of the surgical procedure and offer patients a higher quality of operating interventions.

• MeSH
• aneurysma břišní aorty chirurgie   MeSH
• arteria iliaca chirurgie   MeSH
• časové faktory MeSH
• dospělí MeSH
• laparoskopie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• robotika metody   MeSH
• senioři MeSH
• výkony cévní chirurgie * škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIM: Based on experience with 150 robot-assisted vascular reconstructions, the authors discuss current potential applications of the Da Vinci robotic system in vascular surgery, as well as a potential for further use of this new technology in vascular surgery. MATERIAL AND METHODOLOGY: In vascular surgery, laparoscopic methods have never been used as much as in general surgery. Although many studies presenting interesting outcomes have been published, laparoscopic vascular surgery has not been generally accepted. Its main problems include duration of the procedure and, in particular, the vascular staple size and associated difficulties with the vascular anastomosis suturing. However, recently, there have been many revolutionary advancements in medicine, including vascular surgery. Robot-assisted surgery is the next step in the development of miniinvasive methods. From November 2005 to August 2009, the authors performed 150 robot-assisted vascular reconstructions in the aorto-iliac region. Besides aorto-femoral reconstructions, the most significant procedures also included aortic aneurysm procedures, procedures on pelvic and splenic arteries, as well as hybrid procedures. RESULTS: In four cases (2.7%) conversion to classical procedures were required and four subjects (2.7%) developed serious postoperative complications. In a single case (0.7%), the robotic apparatus had a defect during the procedure and the procedure was completed using laparoscopy. In a single case (0.7%), the procedure had to be cancelled because of an inoperable finding on the aorta. The average duration of the procedure in this study group was 228 minutes, the average time required for anastomosis suturing was 27 minutes and the average stapling time was 39 minutes. CONCLUSION: Robotic systems increase accuracy, control and quality of surgical procedures and offer higher quality surgery to patients. The authors managed to reach the world primacy in the field of vascular surgery and the Czech Republic has become a significant world leader in this superspecialized surgical specialty.

• MeSH
• dospělí MeSH
• laparoskopie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• robotika * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výkony cévní chirurgie * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

The authors describe their first hybrid, combined robot-assisted surgical procedure. The procedure included robot-assisted aorto-bifemoral reconstruction and robot-assisted incisional hernioplasty in one step. The procedure has not been published in the literature yet, and it indicates that, with certain experience, concomittant management of a secondary disorder may be performed together with a minimally invasive procedure for a primary condition, with a very good outcome.

• MeSH
• aorta abdominalis chirurgie   MeSH
• arteria femoralis chirurgie   MeSH
• bérec krevní zásobení   MeSH
• intermitentní klaudikace chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• robotika * MeSH
• ventrální hernie etiologie   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

AIM: The aim of our study was to evaluate our clinical experience of the da Vincitrade mark system for robot-assisted aortoiliac reconstructions to treat occlusive disease and aneurysm. MATERIAL AND METHODS: Between November 2005 and January 2008 100 consecutive patients were scheduled to undergo robot-assisted laparoscopic aortoiliac procedures. Patients with serious medical problems and those who had previously undergone major abdominal surgery were excluded from the clinical study. Ninety patients were prospectively evaluated for arterial occlusive disease (AOD), seven patients for abdominal aortic aneurysms (AAA), two for common iliac artery aneurysms (CIAA) and one for a combination of CIAA and AOD. RESULTS: Ninety-seven of 100 procedures (97%) were successfully completed robotically, while conversions were necessary in three patients (3%). The median operating time was 235 minutes (range 150 to 360 minutes), with a median clamp-time of 42 minutes (range 25 to 120 minutes). The median anastomosis time was 29 minutes (range 12 to 60 minutes) and median blood loss was 430mL (range 50 to 1500mL). The median intensive care unit stay was 1.7 days and the median hospital stay was 5.1 days. A regular oral diet was resumed after a mean of 2.4 days. Thirty-day survival was 100% and non-lethal postoperative complications were observed in three patients (3%). CONCLUSIONS: Robotic aortoiliac surgery appears to be safe, with a high technical success rate, with operative times and success rates comparable to conventional open surgery. The creation of the aortoiliac anastomosis appears to be quicker, and more accurate than regular laparoscopic techniques.

• MeSH
• anastomóza chirurgická MeSH
• aneurysma břišní aorty chirurgie   MeSH
• aneurysma ilické tepny chirurgie   MeSH
• aorta abdominalis chirurgie   MeSH
• arteria iliaca chirurgie   MeSH
• arteriální okluzní nemoci chirurgie   MeSH
• dospělí MeSH
• laparoskopie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace MeSH
• robotika * metody   MeSH
• senioři MeSH
• výkony cévní chirurgie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH