Robotic Replacement of the Descending Thoracic Aorta: An Alternative to Endovascular Therapy?
| Autor: | Riad Meada, Eyal E. Porat, Tam T.T. Huynh, Peter D. Herrera, Hazim J. Safi, Ali Azizzadeh, Roy Sheinbaum, Anthony L. Estrera, Charles C. Miller |
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| Rok vydání: | 2006 |
| Předmět: |
Pulmonary and Respiratory Medicine
Insufflation medicine.medical_specialty Leak medicine.medical_treatment 030204 cardiovascular system & hematology Anastomosis 03 medical and health sciences 0302 clinical medicine medicine.artery Medicine Thoracic aorta Thoracotomy CLIPS computer.programming_language business.industry General Medicine Surgery Blood pressure Clamp 030228 respiratory system cardiovascular system Cardiology and Cardiovascular Medicine business computer |
| Zdroj: | Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 1:115-118 |
| ISSN: | 1559-0879 1556-9845 |
| DOI: | 10.1097/01243895-200600130-00004 |
| Popis: | Background Replacement of the descending thoracic aorta is traditionally performed via a left thoracotomy. Endovascular treatment of descending thoracic aortic aneurysms has recently evolved as an alternative treatment for selected patients, yet no long-term results are available. The authors replaced the descending thoracic aorta in a group of pigs with an interposition Dacron graft using a closed-chest, totally robotic technique. Methods Ten pigs, weighing 25 to 45 kg, underwent surgery using the DaVinci robotic surgical system. Under single-lung ventilation and CO2 insufflation, the descending thoracic aorta was completely mobilized. Proximal and distal cross-clamps were applied through separate accessory stab wounds. The mid-descending thoracic aorta was excised. An interposition Dacron graft was robotically sewn in an end-to-end fashion to the descending thoracic aorta using interrupted nitinol clips. Results All animals survived the procedure. Mean aortic clamp time was 55 ± 14 minutes. All anastomoses were completed without difficulty with a mean total anastomotic time of 42 ± 11 minutes. The anastomoses were challenged for bleeding by administrating α1-adrenergic receptor agonists to a systolic blood pressure of 200 mm Hg with no evidence of leak. Discussion Robotic replacement of the thoracic aorta is feasible and reproducible. This procedure provides the standard Dacron graft repair with its known long-term results. The added value of robotic technology to the therapeutic armamentarium in the treatment of thoracic aortic aneurysms may be worth the effort required for procedural development. Furthermore, it may serve as a valid alternative to endovascular treatment of thoracic aortic aneurysms. |
| Databáze: | OpenAIRE |
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