title: Development and comparison of transperitoneal and retroperitoneal approaches to laparoscopic-assisted aortofemoral bypass in a porcine model.
abstract: OBJECTIVE
  Transperitoneal and retroperitoneal approaches to video-assisted aortofemoral bypass were developed and compared using gasless laparoscopic techniques in a porcine model.
  
  
  METHODS
  Ten pigs were randomized to either a transperitoneal or retroperitoneal approach. Aortic clamp time, total operative time, and complications were recorded. Both operations used an external lift device to maintain the working space. Retroperitoneal operations first used serial balloon inflation to dissect the retroperitoneum. After exposure of the infrarenal aorta, a graft was tunneled under endoscopic visualization. End-to-side aortic and femoral anastomoses were created with conventional instruments through 4 cm incisions.
  
  
  RESULTS
  Mean +/- SEM aortic clamp time, operative duration, and graft patency rates were similar for both approaches (difference not significant by unpaired t test). Intraoperative complications related to the use of the laparoscopic technique included injury to the bladder and small bowel (n=2) and occurred only in the transperitoneal group.
  
  
  CONCLUSIONS
  The use of a gasless technique allowed direct visualization, standard instrumentation, and conventional anastomotic techniques. The retroperitoneal approach used the peritoneal sac to exclude the bowel, simplifying the aortic dissection. Gasless laparoscopic-assisted aortofemoral bypass can be performed by both transperitoneal and retroperitoneal approaches and holds promise as a minimally invasive treatment for aortoiliac occlusive disease.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St. Louis, MO 63100, USA.
authors.forename: D B
authors.initials: DB
authors.lastname: Jones
authors.forename: R W
authors.initials: RW
authors.lastname: Thompson
authors.forename: N J
authors.initials: NJ
authors.lastname: Soper
authors.forename: J M
authors.initials: JM
authors.lastname: Olin
authors.forename: B G
authors.initials: BG
authors.lastname: Rubin
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001012:Aorta, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D007431:Intraoperative Complications; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D010537:Peritoneum / Q000601:surgery*; D011138:Polytetrafluoroethylene; D013552:Swine
chemical_list: D011138:Polytetrafluoroethylene