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J Robot Surg. 2019 Aug 29. doi: 10.1007/s11701-019-01011-3. [Epub ahead of print]

REBOA as a rescue strategy for catastrophic vascular injury during robotic surgery.

Author information

1
Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital Medical Center, 500 West Thomas Road, Suite 400, Phoenix, AZ, 85013, USA. lcengland@gmail.com.
2
Creighton University School of Medicine Phoenix Regional Campus, St. Joseph's Hospital Medical Center, 500 West Thomas Road, Suite 400, Phoenix, AZ, 85013, USA.

Abstract

Catastrophic bleeding is a feared complication of robotic abdominal procedures that involve dissection in close proximity to major vessels. In the event of uncontrollable hemorrhage, standard practice involves emergency undocking with conversion to laparotomy. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapid and life-saving technique gaining acceptance in the trauma setting for the management of catastrophic hemorrhage. The purpose of this study was to evaluate feasibility of REBOA for emergency hemostasis during robotic surgery. The surgical robot was docked to a REBOA mannequin to simulate an upper abdominal surgery. A femoral arterial line was placed in the mannequin. Supplies needed for REBOA insertion were opened and arranged on the surgical back table. The surgeon was seated at the console with an assistant scrubbed. A catastrophic vascular injury was announced. The time it took the surgeon to achieve aortic occlusion by the REBOA was recorded. Four surgeons participated and performed three timed trials each. Each surgeon, irrespective of experience with REBOA or years in surgical practice, was able to obtain aortic occlusion in less than 2 min. The mean time to aortic occlusion for all surgeons was 111 s. No manipulation of the robotic arms was required to perform the procedure. Aortic occlusion was achieved rapidly with REBOA. Ability to achieve prompt aortic control was not associated with surgical experience or prior familiarity with the REBOA device. Prophylactic femoral access and preparation of supplies facilitates prompt placement of the occlusion balloon. REBOA should be considered as a viable alternative to open laparotomy for temporary hemorrhage control during robotic surgery.

KEYWORDS:

Aortic occlusion; REBOA; Robotic surgery

PMID:
31463880
DOI:
10.1007/s11701-019-01011-3

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