Robotic single-port femoral artery dissection and anastomosis with the da Vinci system: a cadaveric feasibility study

Vascular surgical site infections (SSI) are common and associated with graft infection, surgical reintervention, and increased lengths of stay. While antibiotic prophylaxis and negative pressure dressings have improved SSI rates, reported incidence remains as high as 30%. Robotic approaches have decreased surgical site infections in multiple surgical specialties, but remain without a vascular surgery indication. We propose a novel method for robotic groin dissection and anastomosis using a single-port placement from the mid-thigh to eliminate a femoral incision. A single-port robotic platform (da Vinci SP surgical system) was used to perform femoral groin dissection and graft anastomosis from a 3 cm incision at the mid-thigh, 15 cm from the inguinal ligament in two cadaver models. Femoral dissection and anastomosis were feasible in all attempts by a novice robotic surgeon with the approach. Dissection was completed to the level of the inguinal ligament with isolation and vessel loop control of the inferior epigastric, lateral circumflex, common femoral, superficial femoral, and profunda femoris arteries. Time from dissection to creation of arteriotomy ranged from 152 to 55 min with a 97-min reduction between the first and second procedure. Creation of the vascular anastomosis with 6 mm ringed PTFE ranged from 41 to 45 min. Robotic single-port groin dissection and vascular anastomosis are feasible from a mid-thigh approach. Beginner robotic surgeons can demonstrate an efficient learning curve with quick reduction in operating time between attempts. This novel technique has the potential to reduce groin infections and improve surgical outcomes.