Replacement of the Descending Aorta using the daVinci Surgical System in a Sheep Model: Comparison of Anastomosis Techniques

OBJECTIVE: The purpose of our study was to assess the feasibility of a closed-chest replacement of the descending thoracic aorta utilizing the daVinci surgical robotic system and to compare hand-sewn running anastomosis to interrupted nitinol clips (Coalescent Surgical). METHODS: Six sheep underwent replacement of the descending aorta using Intuitive's daVinci surgical system. Using the daVinci, the descending aorta was dissected out and individual intercostal arteries were clipped and divided. Following systemic heparinization, the aorta was occluded using percutaneous vascular clamps (Chitwood clamps). The descending aorta was excised and replaced with a woven graft. The proximal and distal anastomoses were varied in each animal between a running 4-0 polypropylene technique and interrupted nitinol clips. Anastomoses were inspected for hemostasis and tested for burst strength. RESULTS: Five of six animals survived the procedure. The average procedure time was 93 minutes. Cross-clamp times range from 55 to 25 minutes (average of 37 minutes). There was no significant difference in time between U-clip anastomoses (17 +/- 4.8 minutes) and sutured anastomoses (10.6 +/- 3.1 minutes). The burst pressure was higher for sutured anastomosis than for U-clips (214.6 +/- 61 and 110 +/- 35, respectively). CONCLUSION: Replacement of the descending aorta with a graft is feasible in a closed chest model utilizing Intuitive's daVinci surgical system. While mean burst strengths were higher with a running sutured anastomosis, there was no difference in anastomotic time or ultimate hemostasis between techniques.