Unique robotic vascular surgery procedures.

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.

Surgical treatment of thoracoabdominal aortic pathology - retrospective study of 300 patients.

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.

[The da Vinci robot in the field of vascular surgery]. / Uplatnení robotického systému da Vinci v cévní chirurgii.

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.

Robot assisted Aortic and Non-aortic Vascular Operations.

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.

[Current trends in the surgical management of thoracoabdominal aortic aneurysms]. / Soucasné trendy v chirurgické lécbe výdute torakoabdominální aorty.

INTRODUCTION: The authors present a group of patients, who underwent standard procedures on thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysms from 01-01-2009 to 15-09-2010. MATERIAL AND METHODS: During the above time period, a total of 29 patients were operated. The authors employed as many known organ protection procedures as possible, including reduced heparinization, mild hypothermia (32-34 degrees C), sequential aortic clamping cerebrospinal drainage, left heart bypass (a biopump) with non-ischemic canylation of the femoral artery, selective visceral blood perfusion (superior mesenteric artery and coeliac trunk) and renal arteries perfusion using cold crystallic solution. For technical reasons, monitoring of somatosensory and motor evoked potentials was used only twice. In the majority of TAAA procedures, the thoracoretroperitoneal approach was used. RESULTS: During the studied period, the overall mortality rate was 24%. In 2009, a total of 16 patients were operated, out of which 14 subjects underwent elective procedures. Two subjects underwent urgent procedures for ruptures and both of them died. In 2009, the mortality rate was 21% for planned procedures. In the following year, from January to September 15, a total of 13 patients underwent surgery, out of whom 11 underwent elective and two urgent procedures. The group's overall mortality rate was 15.4%, the mortality rate in elective surgery patients was 9% . One patient undergoing urgent surgery survived and one exited. Postoperative paraplegia was reported in one subject (3,4%), postoperative dialysis due to postoperative renal insufficiency was used in 6.9% and other postoperative complications occurred in 10,3% of the subjects. CONCLUSION: Mortality and morbidity rates in the surgical management of thoracoabdominal aortic aneurysms remain considerably high, although new procedures of organ protection help to reduce it. These highly specialized procedures require a multispecialty approach and a well- coordinated surgical team, specialized in this problematics.

Robotic vascular surgery, 150 cases.

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.

[Current potential of robot-assisted vascular surgery]. / Soucasné moznosti roboticky asistované cévní chirurgie.

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.

Is robotic surgery appropriate for vascular procedures? Report of 100 aortoiliac cases.

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.

[Hybrid robot-assisted surgery, aorto-bifemoral bypass with reconstruction of incisional hernia]. / Hybridní roboticky asistovaná operace, aortobifemorální bypass s rekonstrukcí kýly v jizve.

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.

[The effect of colostral immunity on the active formation of antibodies in pigs after the administration of inactivated vaccine against Aujeszky's disease]. / Vliv kolostrální imunity na aktivní tvorbu protilátek u prasat po aplikaci inaktivované vakcíny proti Aujeszkyho chorobe (ACH).

In a large herd of pigs where a trial was performed to cure the animals from Aujeszky's disease (AD) by applying to all animals an inactivated vaccine, a post-vaccination antibody response was studied in piglets coming from the sows that were vaccinated several times. When the piglets were vaccinated at the age of eight weeks (the average virus-neutralizing titer (VNT) of colostral antibodies was 1:11.4) and revaccinated at the age of 11 weeks, 73% of the forty-five animals (examined at the age of 17 weeks) did not have any virus-neutralizing (VN) antibodies in the blood serum. After the third vaccination dose (at the age of 17 weeks), 11% of piglets did not have any VN antibodies if they were examined at the age of 22 weeks (the average antibody VNT was 1:15.3). Applying the ELISA procedure, the antibodies were demonstrated in the sera of all piglets after three vaccination doses. Shifting the time intervals of vaccination (at the age of 8, 13 and 19 weeks), the VN antibodies were found out after three vaccination doses in the sera of all piglets examined at the age of 23 weeks (the average VNT was 1:56.4). After three vaccination doses at the age of 12, 17 and 23 weeks, the VN antibodies were also demonstrated in all piglets at the age of 27 weeks (the average VNT was 1:208).

[Survival of Aujeszky's disease virus in infected pig slurry]. / Prezívání viru Aujeszkyho choroby (ACH) v infikované prasecí kejde.

It has been demonstrated that after experimental infection of pig slurry from the space under the slatted floor (infection dose of 10(6)PFU per ml), the Aujeszky's disease virus (ADV) survived for 72 hours at the temperature of 15 degrees C and at pH 6.5, but was inactivated after 96 hours. When technologically treated pig slurry from the storage tanks was saturated with water and infected with ADV at the dose of 10(5)PFU per ml, the virus survived for 23 days when kept at 15 degrees C and 4 degrees C and at pH 6.8, but was inactivated under the same conditions after 30 days. When the infective ADV dose in the technologically treated pig slurry in the storage tanks was reduced to 10(4)PFU per ml, the virus survived 16 days at +4 degrees C and pH 7.0 and 8.0 but was inactivated within 23 days after infection.