There has been a significant shift towards using robotic platforms for different intra-abdominal surgeries. One of the feared complications during robotic surgery is vascular injury which can be catastrophic. Therefore, it is essential to know how to approach these complications.
Patient is a 71-year-old female with BCG refractory muscle-invasive bladder cancer. Pre-operatively patient was found to have heavily calcified vessels including her aorta. Initial aortic injury happened without any obvious trauma, presumably due to her calcified aorta and poor compliance. Robotic repair was attempted as shown in the video. However, the injury expanded and decision was made to obtain as much hemostasis as possible robotically and to convert to open approach. Vascular repair with excising the aortic plaque and primary repair was performed with assistance of vascular surgery team. Rest of surgery was carried to completion without any other complications.
Patient required 6 units of packed red blood cells as well as 2 units of fresh frozen plasma and 3 units of platelets intraoperatively. She had an uncomplicated post-operative course and was discharged home on post-operative day 5.
Vascular injury during robotic surgeries is a serious complication that can have devastating outcomes. Since vascular injuries are rare and unpredictable, recorded videos such as this case can be utilized for teaching purposes. During these events it is important to stay calm and communicate clearly with anesthesia team as well as the rest of surgical staff. Robotic repair or conversion to open approach can be planned based on surgeon's discretion.