Abstract
Renal artery aneurysm (RAA) is a rare condition, traditionally managed with endovascular or open surgical techniques.
To report our experience with robotic RAA repair.
Nine consecutive patients underwent intracorporeal robotic surgery for 10 RAAs.
Two patients underwent concomitant robotic partial nephrectomy. One patient had RAA in a solitary kidney. Median RAA diameter was 2.2 (1.8–3)cm. Intracorporeal transarterial hypothermic renal perfusion was performed in five patients. Robotic techniques included tailored aneurysmectomy and repair (n=5), excision with end-to-end anastomosis (n=2), aneurysmectomy with branch reimplantation (n=1), prosthetic interposition graft repair (n=1), and simple nephrectomy (n=1; this patient's data were excluded from analysis).
Demographics, RAA characteristics, intraoperative techniques, perioperative outcomes, and follow up data were analyzed. Aneurysms were diagnosed by computed tomography, angiography, or incidentally during the performance of a partial nephrectomy.
All cases were performed robotically, without conversion to open surgery. Median (range) operative time was 3.8 (3–6)h, warm ischemia time 26 (19–32)min, hypothermic renal perfusion time 34 (29–69)min, and estimated blood loss 100 (25–400)ml. No intraoperative blood transfusion was required. Median hospital stay was 3 (2–6)d. One patient had a Clavien-Dindo grade II complication. At median follow-up of 16 (2–67)mo, all patients had preserved renal function. Follow-up imaging confirmed normal caliber reconstructed renal arteries with globally perfused kidneys, except for two kidneys with small segmental infarcts due to an intentionally ligated small polar vessel. Limitations include the small number of patients and the retrospective nature of the study.
Robotic repair of complex RAAs is feasible. Surgical expertise, patient selection, and RAA-specific vascular reconstruction are critical for success. Greater experience is needed to evaluate the proper place of robotic repair of RAAs.
We report intracorporeal robotic repair for complex renal artery aneurysms. This robotic operation is feasible and safe, and replicates open principles. However, it requires considerable experience and expertise.
We report our experience with nine consecutive patients who underwent robotic aneurysm repair. Techniques after the excision included tailored repair, end-to-end anastomosis, branch reimplantation, and graft interposition. This technique is feasible. However, surgical expertise and proper patient selection are critical.