Laparoscopic and robot-assisted approaches in abdominal aortic surgery

Background. The development of cardiovascular surgery is gradually evolving towards minimally invasive procedures. Large clinics and leading specialists are paying more and more attention to laparoscopic and robotic techniques used in surgery of the infrarenal aorta. Objective. Analysis of available literature and compilation of a comparative description of laparoscopic and robotic approaches in the treatment of patients with various diseases of the abdominal aorta; evaluation of the effectiveness of robot-assisted and laparoscopic approaches in patients with pathology of the abdominal aorta. Material and methods. Laparoscopic and robotic approaches are analyzed. Comparative tables with the results of the analysis of world literature and the results obtained through the study of our own experience are provided. The results of surgical treatment of 29 patients with various diseases of the abdominal aorta, who used laparoscopic access, and the results of treatment of 31 patients using robot-assisted aortoiliac reconstruction are analyzed. The Student’s t-test with independent samples with χ2 correction was used as a statistical method for analyzing the sample power and assessing the reliability. Results. During the analysis of the two minimally invasive approaches, no statistically significant differences were found, however, our own experience and the compilation of a comparative table revealed several differences. Statistically significant differences were found in the incidence of peri- and postoperative complications, duration of surgery, bleeding and intraoperative blood loss with initially comparable indicators in the comparison groups. During the conducted work on comparing the effectiveness of two minimally invasive approaches, it was possible to establish that the average duration of operations using the robot-assisted approach is significantly shorter (143.2 min) than with the laparoscopic approach (435 min). Complications were detected in 10 (32.2%) patients using the robot-assisted approach compared to 5 (17.2%) patients using the laparoscopic approach, the differences are statistically significant. The average intraoperative blood loss was 475.5 and 100 ml, respectively. There was no conversion in any group using the presented approaches. Conclusion. Robot-assisted access is effective in terms of reducing the duration of surgery. The use of laparoscopic access was more effective in terms of reducing intraoperative blood loss. Thus, both laparoscopic and robot-assisted approaches are applicable in infrarenal aortic surgery.