Robotic-Assisted Transabdominal Inferior Retroperitoneal Approach: an Alternative to Cattell-Braash Maneuver

Introduction The Cattell-Braasch maneuver has been widely used to provide adequate exposure for aorto-caval space (ACS) since the 1960s. Given its requirement of complex visceral mobilization and significant physiological disturbance, we proposed a new alternative surgical technique to access ACS: t...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2023-10, Vol.27 (10), p.2268-2271
Main Authors: Wang, S. Jennifer, Wang, Jiping
Format: Article
Language:English
Subjects:
Abdomen
Cancer
Coronary vessels
Dissection
Flatulence
Gastroenterology
Gastrointestinal surgery
Humans
Laparoscopy
Laparoscopy - methods
Length of stay
Medicine
Medicine & Public Health
Mesentery
Multimedia Article
Neoplasms - surgery
Patients
Physiology
Retroperitoneal Space - surgery
Robotic Surgical Procedures - methods
Robotics
Small intestine
Surgeons
Surgery
Surgical techniques
Tumors
Veins & arteries
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Summary:Introduction The Cattell-Braasch maneuver has been widely used to provide adequate exposure for aorto-caval space (ACS) since the 1960s. Given its requirement of complex visceral mobilization and significant physiological disturbance, we proposed a new alternative surgical technique to access ACS: the transabdominal inferior retroperitoneal approach (TIRA) with robotic assistance. Methods Patients were placed in the Trendelenburg position, and the retroperitoneum was accessed from the iliac artery level and dissected toward the 3rd and 4th portion of the duodenum along the anterior surface of IVC and aorta. Results TIRA has been used in 5 consecutive patients at our institution whose tumors were located in the ACS below the level of SMA origin. The tumor sizes ranged from 1.7 to 5.6 cm. The median OR time was 192 min with a median EBL of 5 ml. Four out of the five patients passed flatus before or on post operative day (POD) 1, and the other patient passed flatus at POD2. The shortest length of stay was
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-023-05733-6