Robotic operational systems improve accuracy, control of and skilful management of surgical procedures up to levels unachievable by a human factor itself. A surgeon is also allowed to conduct the types of miniinvasive procedures, which cannot be conducted using contemporary technologies. High degree of the procedure's safety can be achieved. Currently, the robotic surgical systems are used in top clinics worldwide and the concept of the robotic operating theatre is considered to become standard for some procedures in future. In October 2005, a multispecialist robotic centre was opened in the Hospital Na Homolce, which then created a new qualitative standard in the miniinvasive surgical management. The authors present the initial group of patients, who were operated from November 2005 to January 2006 with employement of the da Vinci robotic system, listing its pros and cons.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• robotika * metody   MeSH
• senioři MeSH
• výkony cévní chirurgie * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

OBJECTIVE: The feasibility of robotically assisted laparoscopic aortic surgery has already been adequately demonstrated. Our clinical experience with robot-assisted aortoiliac reconstruction for occlusive diseases, aneurysms, and hybrid procedures performed using the Da Vinci system is described below. METHODS: Between November 2005 and November 2011, we performed 225 robot-assisted laparoscopic aortoiliac procedures. One hundred seventy-four patients were prospectively evaluated for occlusive diseases, 43 patients for abdominal aortic aneurysm, two for common iliac artery aneurysm, two for splenic artery aneurysm, three for hybrid procedures, and one for endoleak II treatment after endovascular aneurysm repair. The robotic system was applied to construct the vascular anastomosis for thromboendarterectomy, for aortoiliac reconstruction with a closure patch, for dissection of the splenic artery, and for posterior peritoneal suturing. A combination of conventional laparoscopic surgeries and robotic surgeries was routinely included. A modified fully robotic approach without laparoscopic surgery was used in the last 55 cases in our series. RESULTS: Two hundred seventeen cases (96%) were successfully completed robotically; one patient's surgery was discontinued during laparoscopy because of heavy aortic calcification. In seven patients (3%), conversion was necessary. The 30-day mortality rate was 0.4%, and nonlethal postoperative complications were observed in 10 patients (4.4%). CONCLUSIONS: Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for aortoiliac vascular and hybrid procedures. Compared with purely laparoscopic techniques, the Da Vinci robotic system facilitated the creation of the aortic anastomosis and shortened the aortic clamping time.

• MeSH
• anastomóza chirurgická metody   MeSH
• aneurysma břišní aorty mortalita   chirurgie   MeSH
• aneurysma ilické tepny mortalita   chirurgie   MeSH
• aneurysma chirurgie   MeSH
• arteria lienalis chirurgie   MeSH
• arteriální okluzní nemoci chirurgie   MeSH
• dospělí MeSH
• endarterektomie metody   MeSH
• kardiovaskulární nemoci chirurgie   MeSH
• laparoskopie * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• robotika * MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• výkony cévní chirurgie přístrojové vybavení   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví 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

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

INTRODUCTION: The feasibility of robotically-assisted laparoscopic aortic surgery has been adequately demonstrated. The authors report on their clinical experience with robot-assisted aortoiliac reconstruction for aorto-iliacocclusive disease, aortic aneurysm and two hybrid procedures performed using the da Vinci system. MATERIALS/METHOD: Between November 2005 and December 2008, we performed 130 robot-assisted laparoscopic aortoiliac procedures. One hundred sixteen patients were prospectively evaluated for occlusive disease, ten patients for abdominal aortic aneurysm, two for a common iliac artery aneurysm and two for hybrid procedures. Dissection of the aorta and the iliac arteries was performed laparoscopically using a transperitoneal direct approach technique and the robotic system was used to construct the vascular anastomosis, for the thromboendarterectomy, for the aorto-iliac reconstruction with the patch closure and for the posterior peritoneal suture. RESULTS: Overall, 126 cases (97%) were successfully completed robotically, while three were converted. In three patients conversion was necessary, one due to bleeding from an earlier clipped lumbar artery after completion of the anastomosis, the second because difficulties were encountered with the Endo Gia stapler during the exclusion of a common iliac artery aneurysm after completion of the robotic anastomosis and the last due to bleeding from the robotic anastomosis and the lumbar arteries. One case was canceled after laparoscopy by reason of heavy aortic calcification. Thirty-day survival was 100% and non-lethal postoperative complications were observed in three patients (2.3%). CONCLUSION: Our clinical experience with robot-assisted laparoscopic surgery shows that it is a feasible technique for aortoiliac vascular and hybrid procedures. The da Vinci robotic system facilitated the creation of the aortic anastomosis and shortened aortic clamping time compared to purely laparoscopic techniques. Robotic maneuvers offer an unique ability to combine conventional laparoscopic surgery with stereoscopic 3D magnification and ultra-precise suturing techniques. However, previous laparoscopic aortoiliac experience is necessary before performing robot-assisted procedures in vascular surgery.

• MeSH
• aneurysma břišní aorty chirurgie   MeSH
• arteria iliaca * MeSH
• arteriální okluzní nemoci chirurgie   MeSH
• chirurgie s pomocí počítače metody   MeSH
• design vybavení MeSH
• dospělí MeSH
• laparoskopie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• robotika přístrojové vybavení   MeSH
• senioři MeSH
• výkony cévní chirurgie přístrojové vybavení   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

OBJECTIVE: The feasibility of laparoscopic aortic surgery with robotic assistance has been sufficiently demonstrated. Reported is the clinical experience of robot-assisted aortoiliac reconstruction for occlusive disease and aneurysm performed using the da Vinci system. METHODS: Between November 2005 and June 2006, 30 robot-assisted laparoscopic aortoiliac procedures were performed. Twenty-seven patients were prospectively evaluated for occlusive disease, two patients for abdominal aortic aneurysm, and one for common iliac artery aneurysm. Dissections of the aorta and iliac arteries were performed laparoscopically using a transperitoneal direct approach technique, a modification of the Stádler method. The robotic system was used to construct anastomoses, to perform thromboendarterectomies and, in most of the cases, for posterior peritoneal suturing. RESULTS: Robot-assisted procedures were successfully performed in all patients. The robot was used to perform both the abdominal aortic and common iliac artery aneurysm anastomoses, the aortoiliac reconstruction with patch, and to complete the central, end-to-side anastomosis in another operation. Median operating time was 236 minutes (range, 180 to 360 minutes), with a median clamp time of 54 minutes (range, 40 to 120 minutes). Operative time is defined as the time elapsed from the initial incision to final skin closure. Median anastomosis time was 27 minutes (range, 20 to 60 minutes), and median blood loss was 320 mL (range, 100 to 1500 mL). No conversion was necessary, 30-day survival was 100%, median intensive care unit stay was 1.8 days, and median hospital stay was 5.3 days. A regular oral diet was resumed after a mean time of 2.5 days. CONCLUSION: Robot-assisted laparoscopic surgery is a feasible technique for aortoiliac surgery. The da Vinci robotic system facilitated the creation of the aortic anastomosis and shortened aortic clamp time in comparison with our laparoscopic techniques.

• MeSH
• anastomóza chirurgická metody   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
• následné studie MeSH
• prospektivní studie MeSH
• robotika * MeSH
• senioři MeSH
• výkony cévní chirurgie 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
• časopisecké články MeSH