Although robot-assisted surgical procedures using the da Vinci robotic system (Intuitive
Surgical, Sunnyvale, CA) have been performed in more than 13 million procedures worldwide
over the last two decades, the vascular surgical community has yet to fully embrace
this approach (Intuitive Surgical Investor Presentation Q3 (2023) https://investor.intuitivesurgical.com/static-files/dd0f7e46-db67-4f10-90d9-d826df00554e.
Accessed February 22, 2024). In the meantime, endovascular procedures revolutionized
vascular care, serving as a minimally invasive alternative to traditional open surgery.
In the pursuit of a percutaneous approach, shorter postoperative hospital stay, and
fewer perioperative complications, the long-term durability of open surgical vascular
reconstruction has been compromised (in Lancet 365:2179-2186, 2005; Patel in Lancet
388:2366-2374, 2016; Wanhainen in Eur J Vasc Endovasc Surg 57:8-93, 2019). The underlying
question is whether the robotic-assisted laparoscopic vascular surgical approaches
could deliver the robustness and longevity of open vascular surgical reconstruction,
but with a minimally invasive delivery system. In the meantime, other surgical specialties
have embraced robot-assisted laparoscopic technology and mastered the essential vascular
skillsets along with minimally invasive robotic surgery. For example, surgical procedures
such as renal transplantation, lung transplantation, and portal vein reconstruction
are routinely being performed with robotic assistance that includes major vascular
anastomoses (Emerson in J Heart Lung Transplant 43:158-161, 2024; Fei in J Vasc Surg
Cases Innov Tech 9, 2023; Tzvetanov in Transplantation 106:479-488, 2022; Slagter
in Int J Surg 99, 2022). Handling and dissection of major vascular structures come
with the inherent risk of vascular injury, perhaps the most feared complication during
such robotic procedures, possibly requiring emergent vascular surgical consultation.
In this review article, we describe the impact of a minimally invasive, robotic approach
covering the following topics: a brief history of robotic surgery, components and
benefits of the robotic system as compared to laparoscopy, current literature on "vascular"
applications of the robotic system, evolving training pathways and future perspectives.
