Sutureless thoracic aorta to femoral artery bypass with robotic videoendoscopic approach: a fast track procedure

Abstract

This study was undertaken to determine the feasibility of robotic videoendoscopic thoracic aorta to femoral artery bypass. In six pigs, three ports were inserted in the fourth, eighth and tenth left intercostal spaces. Lung retraction was obtained by insufflating CO2. The ZEUS robotic surgical system and the AESOP system were used to perform aortic dissection and to position the camera via voice control. A length of 5 cm of descending thoracic aorta was exposed. A 4mm polytetrafluoroethylene (PTFE) graft was used as conduit. The proximal anastomosis was constructed using a prototype of sutureless aortic connector. Left femoral artery was exposed and an endograsp was passed to create a retroperitoneal tunnel. The prosthesis was then anastomosed to the left femoral artery. CO2 insufflating pressure was 9+/-1 mmHg. The operation was completed in three animals while the other three died. In two animals, the death was due to aortic injury during aortic exposure and in one complications of anesthesia. Total operative time was 48+/-15 min. Robotic videoendoscopic descending thoracic aorta to femoral artery bypass is a technically feasible operation in a pig model. The use of the sutureless device to perform the proximal anastomosis dramatically reduces the technical demand of this procedure.