A Technical and Safety Feasibility Study of Creating Arteriovenous Fistulas for Dialysis Using a Novel Robotic Microsurgical System.

BACKGROUND

Modern robotic systems, particularly for microsurgical procedures, are offering increasingly new perspectives in the field of vascular surgery. A novel robot-assisted platform specially designed for microanastomoses is already used successfully in lymphatic vessel surgery and special flap plasty procedures. To expand these applications to the vascular field, this clinical feasibility study evaluated this system for creating arteriovenous fistulas in the upper extremity for dialysis.

METHODS

Following conventional vessel preparation, the anastomoses for the arteriovenous fistulas were performed using the microsurgical robotic platform. An experienced vascular surgeon performed the anastomoses (vein to artery, end-to-side) with continuous sutures. Once the anastomoses had been completed and blood flow was restored, they were tested for leaks.

RESULTS

In all 3 patients, an arteriovenous fistula was successfully created using the microsurgical device. Preparing and positioning the robotic system was straightforward and uncomplicated. Anastomosis times varied between 28 and 36 minutes. In one case, a second stitch was required after blood flow was restored, which was also performed using the device. Follow-up ultrasound examinations revealed successful fistula reconstruction in all patients without any complications.

CONCLUSIONS

The microsurgical robotic platform has been successfully used to create precise arteriovenous anastomoses for dialysis therapy. This robotic system may offer a variety of advantages, especially for small vessels, including improved tissue preservation, precision, and visualization. Further development of these technologies could lead to new applications, particularly in vascular medicine.