The use of robot-assisted surgery for visceral abdominal aneurysms treatment
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LETTER TO THE EDITOR
The use of robot‑assisted surgery for visceral abdominal aneurysms treatment Valentina Pucci1 · Roberto D’Ischia1 · Lorenzo Maria Fatucchi1 · Michele Marconi2 Received: 6 July 2020 / Accepted: 13 July 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Dear Editor, We read with great interest the article by Obara et al. entitled “Current management strategies for visceral artery aneurysms: an overview”, recently published in Surgery Today [1]. Visceral artery aneurysms (VAAs) include aneurysms of the anterior branches of the abdominal aorta, which grants the blood supply to the abdominal viscera. Asymptomatic VAAs are now being encountered more frequently due to the widespread use of advanced diagnostic abdominal imaging, and their incidental finding leaves clinicians with a dilemma as to the best course of management. While the majority of asymptomatic VAAs can be safely observed, rupture remains the most feared complication. The choices of management include serial observations with imaging studies, surgical procedures or a minimally invasive endovascular intervention such as embolization or covered stent placement [2]. A surgical or endovascular intervention obviously removes the risk of rupture, with its associated mortality, but is not indicated in all cases, and hence the risk of the specific procedure must be weighed against the known risk of rupture of a VAA. There is no consensus about the optimal management for VAAs. Complications are more likely after open repair and this, with the good outcomes of endovascular treatment, justifies the endovascular approach as a first-line option. However, this technique is not always feasible due to anatomical characteristics, to the aneurysm location or to the risk of interruption to the parenchymal blood supply. The surgical approach on the contrary has some potential benefit, * Valentina Pucci [email protected] 1
General Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, Pisa 56124, Italy
Vascular Surgery Unit, University of Pisa, Pisa, Italy
2
allowing a clear visual confirmation of the condition of the end organ after the aneurysmectomy and, therefore, confirming the need for revascularization and checking the results during the procedure. The authors clearly described the treatment choices for each type of VAA; however the possible role of robotic assisted surgery (RAS) in this setting has totally been ignored, despite recent evidences in literature about its possible application [3–5]. Actually, the application of minimally invasive surgery to the treatment of VAAs is increasing, even if it can be very challenging. An option to reduce the limitation of laparoscopic technique and increase the feasibility and safety of such procedures could be the restoration of the tactile feedback with the hand-assisted laparoscopic technique, as already demonstrated in other fields [6]. Indeed, the robotic assistance can be the real innovation in this ar
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