Surgical Endoscopy

, Volume 27, Issue 4, pp 1404–1405 | Cite as

Robot-assisted renal artery aneurysm repair with a saphenous vein Y-graft interposition

  • Federico Gheza
  • Francesco Coratti
  • Mario Masrur
  • David Calatayud
  • Mario Annecchiarico
  • Andrea Coratti
  • Pier Cristoforo Giulianotti
Video

Abstract

Background

Renal artery aneurysms (RAA) treatment includes both surgical repair and endovascular techniques, mostly depending on the location of aneurysm [1]. For complex RAA located at renal artery bifurcation or distally, open surgical repair represents the gold standard of treatment [2]. However, the transperitoneal open access to the renal artery requires a wide laparotomy—hence the attempt to be minimally invasive with the first reports of laparoscopic approach [3, 4]. Even if it represents a possibility, laparoscopy has not yet gained widespread acceptance for the technical difficulties in performing vascular anastomosis. We herein describe the repair of a complex RAA using the Da Vinci Surgical System.

Methods

A 41-year-old woman had an accidentally discovered saccular aneurysm of the right renal artery with a maximum diameter of 20 mm, with one in and four out. A laparoscopic robot-assisted approach was planned. Intraoperatively, we confirm the strategy to group the four output branches in two different patches. Thus, a Y-shaped autologous saphenous graft was prepared and introduced through a trocar. For the three anastomoses, a polytetrafluoroethylene running suture was preferred.

Results

The total operation time was 350 min, and the estimated surgical blood loss was about 200 ml. Warm ischemia time was 58 min for the posterior branch and 24 min for the second declamping. The patient resumed a regular diet on postoperative day 2, and the hospital stay lasted 4 days. No intraoperative or postoperative morbidity was noted. A CT scan performed 2 months later revealed the patency of all the reconstructed branches.

Conclusions

The experience of our group counts five other renal aneurysm repair performed with a robot-assisted technique [5]. The presence of five different arterial branches involved in the reconstruction makes this procedure difficult. Robot-assisted laparoscopic technique represents a valid alternative to open surgery in complex cases.

Keywords

Renal aneurysm Robotic surgery Saphenous graft Y-shape graft 

Supplementary material

Supplementary material 1 (MPG 198980 kb)

References

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Federico Gheza
    • 1
  • Francesco Coratti
    • 2
  • Mario Masrur
    • 1
  • David Calatayud
    • 1
  • Mario Annecchiarico
    • 2
  • Andrea Coratti
    • 2
  • Pier Cristoforo Giulianotti
    • 1
  1. 1.Department of General SurgeryUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of SurgeryMisericordia HospitalGrossetoItaly

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