Treatment of Aortoiliac Occlusive Lesions by Aortic Robotic Surgery: Learning Curve and Midterm Outcome

Willy Sutter; Jean-Marc Alsac; Iannis Ben Abdallah; Cassandre Michel; Pierre Julia; Jean-Philippe Empana; Salma El Batti

doi:10.1016/j.avsg.2024.02.018

Treatment of Aortoiliac Occlusive Lesions by Aortic Robotic Surgery: Learning Curve and Midterm Outcome

Ann Vasc Surg. 2024 Apr 7:104:258-267. doi: 10.1016/j.avsg.2024.02.018. Online ahead of print.

Authors

Willy Sutter¹, Jean-Marc Alsac², Iannis Ben Abdallah³, Cassandre Michel⁴, Pierre Julia², Jean-Philippe Empana⁵, Salma El Batti³

Affiliations

¹ Integrative Epidemiology of Cardiovascular Diseases Team, Paris Cardiovascular Research Center- INSERM UMR-S 970, Paris, France; Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: willy.sutter@aphp.fr.
² Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
³ Université de Paris-Cité, Paris, France; Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR-S 1140, Laboratoire de recherches Biochirurgicales de la Fondation Carpentier, Université de Paris-Cité, Paris, France.
⁴ Vascular Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁵ Integrative Epidemiology of Cardiovascular Diseases Team, Paris Cardiovascular Research Center- INSERM UMR-S 970, Paris, France.

PMID: 38593921
DOI: 10.1016/j.avsg.2024.02.018

Abstract

Backgroud: The learning curve and midterm results of aortoiliac occlusive disease (AIOD) revascularization by robot-assisted laparoscopic (RAL) surgery may be known.

Methods: A prospective single-center study was conducted in the vascular surgery department of Georges Pompidou European Hospital (Paris, France). Patients with AIOD treated by RAL from February 2014 to February 2019 were included. Demographic characteristics, past medical history, Trans-Atlantic Inter-Society Consensus (TASC) lesions classifications, mortality, primary and secondary patency, as well as complication rates were collected. Safety was analyzed by the cumulative sum control chart method with a conversion rate of 10%, operative time by cumulative average-time model, and primary and secondary patency by the Kaplan-Meier method.

Results: Seventy patients were included, 18 (25.7%) with TASC C lesions and 52 (74.3%) with TASC D lesions. Before discharge, 14 (24.3%) patients had surgical complications. Among them, 10 (14.3%) required at least one reintervention. One (1.4%) patient died during the hospitalization. The learning curve in terms of safety (conversion rate) was 13 cases with an operating time of 220 minutes after 35 patients. During follow-up (median 37 months [21; 49]), 63 patients (91.3%) improved their symptoms, 53 (76.8%) became asymptomatic, and 3 graft limb occlusions occurred. The primary patency at 12, 24, 36, and 48 months was 94%, 92%, 92%, and 92%, respectively, while the secondary patency for the same intervals was 100%, 98.1%, 98.1%, and 98.1%, respectively.

Conclusions: Robotic surgery in AIOD revascularization seems safe and effective; allowing to treat patients with few comorbidities and severe lesions, in a dedicated center experienced in RAL, with excellent patency. Prospective clinical trials should be performed to confirm safety.