Robotic Surgery For in situ Renal Artery Aneurysm Repair: Technical Note and Literature Review About a Mini- Invasive Alternative

Case Report: Classical surgical options for renal artery aneurysm (RAA) are usually restricted to endovascular surgery or open repair, either using an in-situ or ex-situ approach. A 45-year-old woman presenting with a 20-mm complex RAA with hilum location, not suitable for endovascular repair renal was treated with a mini-invasive robotic approach. This approach allowed an in-situ reconstruction in a complete mini-invasive manner with the Da Vinci Xi robot (Intuitive Surgical, Sunnyvale, CA). The robotic system was used for both surgical exposure and aneurysmectomy with patch closure. Clamping time was 38 minutes (warm ischemia), total operative time was 210 minutes. Liiterature Review: A comprehensive literature review was performed concerning the studies reporting a robotic approach for RAA. Main outcomes of interest were surgical technique, total operative time, clamping time, blood loss and postoperative renal function. Seven studies were identified, reporting a total of 20 RAAs. Most of the RAA were treated by aneurysmoraphy (n=9). Median total operative time varied between 228 and 300 min (range: 155 – 360 minutes), median clamping time varied between 26 and 44 minutes (range: 10 – 82 minutes). Median blood loss was comprised between100 and 150 mL (range: 25 – 650 mL). No alteration of renal function in the early post-operative period was reported. Conclusion: RAA in-situ repair with a robotic approach is feasible and safe and should be considered as an alternative to open surgical repair when endovascular technique cannot be an option.