Henrico Doctors' Hospital Performs World's First Fully Laparoscopic Robotically Assisted Aortic Graft

(Richmond, VA) - Henrico Doctors' Hospital is the first hospital in the world to perform a fully laparoscopic aortofemoral bypass assisted with the da Vinci Surgical System," according to William E. Kelley, Jr., M.D. The minimally invasive alternative to a highly invasive open procedure was performed by Dr. Barklie W. Zimmerman and Dr. Kelley, both members of The Richmond Surgical Group. Only four other da Vinci-assisted laparoscopic aortofemoral bypasses have been performed in the world, all in Europe. However, these cases were performed as partially open procedures, and therefore were not fully laparoscopic.

Drs. Zimmerman and Kelley performed an aortofemoral bypass on a 50-year-old male who suffered from incapacitating leg pain upon exercise due to advanced aortoiliac occlusive disease. Despite being recently treated with iliac balloon angioplasty and stenting, the patient developed a recurrence of his leg pain and reocclusion of his iliac artery. By combining the da Vinci's robotic precision with laparoscopic techniques, the surgeons performed the bypass by laparoscopically dissecting the infrarenal aorta, and by using the da Vinci to perform the end-to-side anastomosis.

"This procedure is a significant step in drastically reducing the trauma, both physical and emotional, associated with the surgical treatment of aortoiliac occlusive disease," Dr. Zimmerman reports. Typically associated with large surgical incisions that often result in lengthy and uncomfortable patient recovery, traditional open aortoiliac bypass procedures generally require a five to seven day hospital stay and a two-to-three month recovery period. The da Vinci-assisted laparoscopic surgery reduces hospital stay to two-to-three days and recovery period to one week.

Although the advantages of minimally invasive surgery have been documented, and the managed-care environment supports procedures that result in shorter hospitalization and recovery times, laparoscopic procedures for vascular occlusive disease are extremely rare. "Currently only a few centers in the U.S. and Canada are performing laparoscopic vascular surgery," Dr. Kelley reports. Although the procedure is feasible, safe, and effective, a cooperation between experienced laparoscopists and vascular surgeons is needed to overcome procedural challenges. "As experience increases, these more difficult minimally invasive procedures that have previously been performed only by the most experienced surgeons could become routine with robotic assistance," Dr. Kelley reports.

Aortoiliac Occlusive Disease is the arterial narrowing or obstruction that occurs as a result of the atherosclerotic process that reduces blood flow to the lower limbs during exercise or rest. Studies indicate that up to 5% of men, and 2.5% of women of age 60 or older have symptoms of intermittent leg pain (claudication). The prevalence is at least threefold higher when sensitive non-invasive tests are used to make the diagnosis of arterial insufficiency in asymptomatic and symptomatic patients. With a greater percentage of the North American population older than 65, the incidence of lower extremity arterial disease has progressively increased over the past few decades. Because patients with either symptomatic or asymptomatic lower extremity arterial disease have widespread arterial disease, they have a significantly increased risk of stroke, myocardial infarction, and cardiovascular death.

Surgical treatment is indicated to relieve symptoms of limb-threatening ischemia, including ischemic pain at rest, ischemic ulcers, and gangrene, as well as debilitating ambulatory leg pain due to arterial insufficiency. There is concern by many physicians regarding the advisability of open revascularization surgery, especially because patients undergoing these major procedures often require multiple transfusions, prolonged hospitalization, and intensive care. "This is precisely why minimally invasive surgery is such an important direction for this patient population," Dr. Zimmerman reports. "The da Vinci facilitates the delicate surgical tasks associated with these procedures, while the laparoscopic approach significantly reduces patient pain, blood loss, and recovery time."

The da Vinci Surgical System is the only robotic system that has received market clearance by the FDA to perform surgery. The system consists of a surgeon's viewing and control console having an integrated, high-performance 3-D vision system, a patient-side cart consisting of three robotic arms that position and precisely maneuver endoscopic instruments and an endoscope, and a variety of articulating EndoWrist instruments. By integrating computer-enhanced technology with surgeons' technical skills, the system enables surgeons to perform surgery in a manner never before experienced. The da Vinci Surgical System seamlessly and directly translates the surgeon's natural hand, wrist, and finger movements on instrument controls at the surgeon's console outside the patient's body into corresponding micro-movements of the instrument tips positioned inside the patient through small puncture incisions, or ports.

In July 2000, Dr. Kelley performed the first abdominal operation with the da Vinci Surgical System in the United States. Dr. Craig Owens assisted Dr. Kelley in the laparoscopic gallbladder operation.

Henrico Doctors' Hospital is a 340-bed tertiary care facility located in Richmond, Virginia. For over 26 years, Henrico Doctors' Hospital has provided innovative and world-class health care, typically found at a university medical center, delivered in a community hospital.