Staple occlusion of the infrarenal aorta: a videoscopic retroperitoneal approach.
OBJECTIVE
The purposes of this study were to determine whether available laparoscopic stapling devices could be used to interrupt the diseased human aorta, and to develop a videoscopic technique for retroperitoneal exposure and control of the infrarenal aorta in pigs. Our long-term goal is to develop a minimally invasive approach to the treatment of abdominal aortic aneurysms by exclusion and extraanatomic bypass.


METHODS
Ten diseased, formalin-preserved human cadaver aortas underwent stapling using a laparoscopic stapling device. The aortas were then pressurized to superphysiologic levels to assess the integrity of the staple line. Ten swine underwent retroperitoneal video-assisted exploration with control and staple occlusion of the aorta and iliac artery.


RESULTS
The staple line was complete and remained intact after pressurization in nine of 10 cadaver aortas, despite the presence of complex calcified disease. One aorta had a 2-mm opening through the staple line. Through the left retroperitoneal approach, the infrarenal aorta and left iliac artery could be dissected and controlled. A modified pledgeted technique used for stapling resulted in hemostasis of the staple line and exclusion of flow without injury to adjacent structures.


CONCLUSIONS
The diseased human aorta can be occluded using available laparoscopic staplers. These swine experiments demonstrate the feasibility of the retroperitoneal approach for exclusion of infrarenal aortic aneurysms.
Murayama
K M
KM
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280, USA.
Grune
M T
MT
Matamoros
A
A
Brand
R E
RE
Baxter
B T
BT
D000818:Animals; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery; D002102:Cadaver; D004210:Dissection; D005240:Feasibility Studies; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation; D019060:Minimally Invasive Surgical Procedures; D011312:Pressure; D012039:Regional Blood Flow; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000502:physiology; D012187:Retroperitoneal Space; D013528:Surgical Staplers; D017792:Surgical Stapling; D013552:Swine; D018615:Ultrasonography, Doppler, Color; D014741:Video Recording