Robotic-assisted visceral arterial aneurysm surgery

Surgeons at the University of Illinois Medical Center at Chicago have performed a landmark robotic-assisted minimally invasive surgery to remove a renal arterial aneurysm and reconstruct the artery using a graft from a vein in the patient's leg.

Jacqueline Jemison, 58, was being evaluated to donate one of her kidneys to a family member in need of a transplant when physicians diagnosed the rare renal arterial aneurysm.

"Robotic surgery allowed us to delicately repair the artery without removing the patient's kidney to access the aneurysm," said Dr. Pier Cristoforo Giulianotti, chief of the division of general, minimally invasive and robotic surgery and Lloyd M. Nyhus Professor of Surgery at UIC, who performed the surgery along with Dr. Fabio Sbrana, assistant professor of surgery.

Traditionally, a renal arterial aneurysm is repaired through "open" surgery, making a large 20 to 30 centimeter incision in the abdominal wall. The kidney is removed to access and repair the artery at a second operating table away from the patient. Finally the kidney is placed back into the patient as an auto-transplant.

Robotic-assisted minimally-invasive techniques allow surgeons to leave the kidney in place, clamp selective renal vessels, and maintain blood flow to other vital arteries and organs while repairing the aneurysm.

Using the da Vinci Surgical System, six eight- to 10-millimeter incisions are made in the patient's abdomen to accommodate the laparoscope and robotic-assisted surgical instruments. A slightly larger incision is made in the groin to harvest the vein graft. The benefits of robotic surgery include less surgical trauma, less blood loss, less post-operative pain, fewer complications, less visible scarring, and a faster recovery.

Renal arterial aneurysm, or bulging of an artery that supplies blood to the kidneys, occurs in less than 1 percent of the population. Patients seldom complain of symptoms, although an aneurysm may impair kidney function and lead to high blood pressure. A fatal rupture is also possible.

"Visceral aneurysms are more difficult to diagnose than the more commonly known -- yet just as dangerous -- aortic aneurysms," said Sbrana. "Patients often do not have any symptoms and they are not detected during routine medical evaluations."

Jemison's surgery took place Nov. 26 and she spent six days in the hospital.

"I thank God for this hospital, the staff, and my doctors," Jemison said. "I am so grateful that they found the aneurysm because it probably saved my life."

"It may be possible for this patient to recover and still be considered a potential kidney donor for her loved one," said transplant surgeon Benedetti, "although other family members are now being evaluated to be the donor."

Giulianotti has performed the largest series of robotic-assisted visceral arterial aneurysm surgeries in the world. Twelve were done in Italy and this is the first in the United States.

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