[Laparoscopy-assisted aortoiliac reconstructions].
Five patients underwent an aortobifemoral bypass using a laparoscope-assisted procedure. With the help of a wall-lifting device, balloon dissection of the retroperitoneum was performed. A total number of five ports were inserted and the aorta was dissected out from the bifurcation to the renal arteries under the guidance of a laparoscopic video camera. A 5-cm incision was required for suturing the proximal anastomosis of the bifurcated graft. Tunneling from the groin to the aorta was performed either video-assisted or with the help of the balloon dissector with a camera inside. All patients could be fully mobilized on the first postoperative day and were discharged after a mean hospital stay of 7.6 days. Mean length of the operation was 250 min. Originally, seven patients were scheduled for the video-assisted procedure. In two cases, we had to change to a conventional technique: in one case because we could not achieve adequate exposure of the aorta in an obese patient using a transperitoneal access, and in the second case owing to extensive adhesions after a bowel resection. Both patients had a regular, uneventful postoperative course. Gasless laparoscopy allowed us to use standard surgical instruments and most importantly a regular aortic clamp, which proved to be beneficial in a heavily calcified aorta. In conclusion, retroperitoneal gasless laparoscopic procedures can be safely performed in infrarenal aortoiliac reconstructions. Further clinical studies are required to prove the usefulness of this new technique.
Kolvenbach
R
R
Abteilung für Gefässchirurgie, Augusta-Krankenhaus, Düsseldorf. KMR-Duesseldorf-KOL@t-online.de
Deling
O
O
Wellmann
K
K
D000368:Aged; D001018:Aortic Diseases / Q000601:surgery*; D001161:Arteriosclerosis / Q000601:surgery*; D004434:Early Ambulation; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D007511:Ischemia / Q000601:surgery*; D020706:Laparoscopes; D007866:Leg / Q000098:blood supply*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D013525:Surgical Instruments; D016896:Treatment Outcome; D014741:Video Recording / Q000295:instrumentation