Reducing the operative trauma in aortoiliac reconstructions--a prospective study to evaluate the role of video-assisted vascular surgery.
OBJECTIVE
To evaluate the role of the surgical access with regard to the generation of proinflammatory proteins in patients with aortoiliac occlusive disease.


METHODS
Non-random, prospective study of patients undergoing an aortobifemoral bypass procedure.


METHODS
Twenty-six patients were divided into three groups. In the first group of eight patients, a transperitoneal median laparotomy was used. The second group comprised 10 patients in whom a laparoscopically assisted extraperitoneal minilaparotomy was performed and, in the third group, eight patients were operated on using a retroperitoneal access.


METHODS
Biochemical analysis of acute phase proteins and the cytokines interleukin-6 (Il 6), interleukin-8 (Il 8) and tumour necrosis factor (TNF).


RESULTS
Aortic cross-clamp and total operative time were significantly longer in the laparoscopic group. After 24 h Il-6 concentrations were significantly higher in the transperitoneal (p < 0.05) and the retroperitoneal group (p < 0.006). After 6 h there was a reduced Il-8 concentration in the laparoscopic group compared to patients with a standard retroperitoneal access. Neither TNF nor acute phase proteins showed any significant alterations.


CONCLUSIONS
Laparoscopic-assisted vascular surgery allows for a smaller incision and reduces the surgical trauma, as it is reflected by interleukin levels.
Kolvenbach
R
R
Department of Vascular Surgery, Augusta Hospital Düsseldorf, Germany.
Deling
O
O
Schwierz
E
E
Landers
B
B
D000209:Acute-Phase Proteins / Q000032:analysis; D000368:Aged; D000704:Analysis of Variance; D001011:Aorta / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000601:surgery; D003250:Constriction; D005069:Evaluation Studies as Topic; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010537:Peritoneum / Q000601:surgery; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000601:surgery; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014654:Vascular Patency; D014741:Video Recording
D000209:Acute-Phase Proteins; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha