Challenges of conversion from robotic surgery for vascular complications

A 67-year-old woman with endometrial adenocarcinoma had sustained an aortic injury during robotically assisted retroperitoneal lymphadenectomy. Repair could not be performed laparoscopically; however, graspers were used to maintain hemostasis while conversion to open surgery was initiated. Safety mechanisms locked the graspers in place, preventing tissue release, but resulting in additional aortic injury. Forceful removal of the graspers was eventually successful, and definitive aortic repair was then performed. Vascular surgeons who are not familiar with robotic surgery techniques should be aware that removal of robotic hardware requires the use of stepwise algorithms, which, if performed out of order, can introduce significant challenges.