Objective: The aim of this retrospective study was to describe and evaluate our single center experience with robotic aortic and non-aortic vascular surgery to treat mostly occlusive disease and aneurysms. 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 June 2020, 500 robot assisted vascular operations were performed. 326 patients were prospectively evaluated for occlusive disease, 127 patients for abdominal aortic aneurysm (AAA), 5 for a common iliac artery aneurysm, 10 for a splenic artery aneurysm, 1 for a internal mammary artery aneurysm, 16 patients for median arcuate ligament release, 10 for endoleak II treatment post endovascular aneurysm repair (EVAR), 2 for renal artery reconstruction and 3 cases were inoperable. 5 hybrid procedures in study were performed.

Results: 477 cases (95,4%) were successfully completed robotically, 3 patient's surgery (0,6%) was discontinued due to heavy aortic calcification and severe peri-aortitis respectively. In 20 patients (4%) conversion was necessary. The thirty-day mortality rate was 0,4% (2 patients), and early non-lethal postoperative complications were observed in 8 patients (1,7%).

Conclusions: Our experience with robot-assisted laparoscopic surgery has demonstrated the feasibility of this technique for occlusive diseases, aneurysms, endoleak II treatment post EVAR, for median arcuate ligament release and hybrid procedures. The robotic system provides a real opportunity for minimally invasive surgery in the field of vascular surgery and offers true mini-invasive surgical vascular interventions with all its advantages. Robotic AAA treatment and aorto-femoral represent the standard operations in vascular surgery, and they are not only possible but also safe and successful.

In many young patients, blood pressure with a tendency to be low associated with fine vessels causes many arteriovenous fistulas for hemodialysis (AVF) in upper limbs with prostheses to fail.

These patients remain for months or for life with indwelling catheters, with the risk of infection that means and a decrease in their quality of life. In some, another AVF is made with prostheses in femoral vessels, but the problems associated with the prostheses continue.

For this reason we think of a technique that is with a vein, which these patients would benefit.

In this way we avoid the risk of occlusion due to hypotension and infections typical of AVF with prostheses.

Avoid indwelling catheters and AVFs with femoral prostheses in young patients with exhaustion of vascular accesses.

Material and method

Between July and October 2020, 5 patients were operated on with transposition of the femoral vein.

It was used in 4 patients under 30 years of age and in a 57-year-old patient.

In all 5, access to upper limbs was exhausted. The 57-year-old also had a left femoral AVF with prosthesis.

Varicose veins and lower limb arteriopathy were ruled out in the 5 patients.

Results

In all the patients they began to puncture at approximately 30 days; with flows greater than 300 ml / min and venous resistance less than 200 mmHg.

The punctures were started with needle No. 17, currently No. 15. The pump flow is between 300 and 400 ml / min, the venous resistance is less than 200 mmHg. The KTV around 1.5.