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Journal of Robotic Surgery

, Volume 13, Issue 3, pp 505–509 | Cite as

Technical details and preliminary results of a full robotic type II endoleak treatment with the da Vinci Xi

  • Luca MorelliEmail author
  • Simone Guadagni
  • Gregorio Di Franco
  • Matteo Palmeri
  • Niccolò Furbetta
  • Desirée Gianardi
  • Matteo Bianchini
  • Andrea Moglia
  • Giulio Di Candio
  • Mauro Ferrari
  • Raffaella Berchiolli
Brief Communication
  • 66 Downloads

Abstract

Type II endoleak (T2E) represents a frequent and often challenging complication of endovascular aneurysm repair (EVAR). Endovascular treatment is the standard and most used strategy, but the recurrence after it remains high, especially due to lumbar arteries (LA) and inferior mesenteric artery (IMA) feeding. While conventional laparoscopy has been considered as an emerging method, robotic surgery is not reported yet for this indication. We herein describe our technique of minimally invasive T2E repair using a full robotic approach with the da Vinci Xi, reporting our preliminary experience with the first two patients who underwent this operation at our Institution. The procedure comprises two phases. The first phase consists of IMA ligation, left colon mobilization and infra-renal exposure of the anterior longitudinal ligament of the column and of the left side of the sac. The second phase entails the posterior aneurysm mobilization and the selective clipping of LA responsible of the T2E, as identified by the pre-operative CT scan. No intra-operative complications occurred and the average length of surgery was 183 min. The average length of hospitalization was 2.5 days. Robotic T2E repair can be considered a safe procedure and the da Vinci Xi, thanks to its increased dexterity and flexibility, allows to easily perform this multi-target operation (IMA and LA). The articulated instruments with motion scaling and tremor filtering facilitate a gently vascular dissection and an easy IMA and LA identification, dissection, and ligation. The TilePro function permits the operator to control from the console, with intra-operative color-Doppler ultrasound, the absence of residual endoleaks.

Keywords

Endoleak Abdominal aortic aneurysms Robotic repair Da Vinci Xi 

Notes

Funding

No funding was received for this project.

Compliance with ethical standards

Conflict of interest

Luca Morelli, Simone Guadagni, Gregorio Di Franco, Matteo Palmeri, Niccolò Furbetta, Desirée Gianardi, Matteo Bianchini, Andrea Moglia, Giulio Di Candio, Mauro Ferrari and Raffaella Berchiolli declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  • Luca Morelli
    • 1
    • 2
    Email author
  • Simone Guadagni
    • 1
  • Gregorio Di Franco
    • 1
  • Matteo Palmeri
    • 1
  • Niccolò Furbetta
    • 1
  • Desirée Gianardi
    • 1
  • Matteo Bianchini
    • 1
  • Andrea Moglia
    • 2
  • Giulio Di Candio
    • 1
  • Mauro Ferrari
    • 2
    • 3
  • Raffaella Berchiolli
    • 2
    • 3
  1. 1.General Surgery Unit, Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisaItaly
  2. 2.EndoCAS (Center for Computer Assisted Surgery)University of PisaPisaItaly
  3. 3.Vascular Surgery Unit, Department of CardioVascular SurgeryUniversity of PisaPisaItaly

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