Laparoscopic aortic aneurysm resection.
OBJECTIVE
To describe a laparoscopic technique for resection of infrarenal abdominal aortic aneurysms (AAAs).


METHODS
The operation is based on the principle of retroperitoneal reinforced staple exclusion of the aneurysm sac with aortobifemoral or aortoiliac bypass using gas and gasless laparoscopic techniques. Patients were eligible for this procedure if their infrarenal AAAs (with or without iliac artery involvement) were considered appropriate for surgical resection; however, renal or other visceral arterial stenoses, aneurysmal disease requiring surgical treatment, and/or aneurysms of the hypogastric arteries excluded patients from laparoscopic AAA resection.


RESULTS
Of 31 candidates for this procedure, 9 were excluded owing to high surgical risk. Twenty-two patients (16 males; age range 62 to 88 years) were deemed appropriate for the laparoscopic procedure. Maximum aneurysm diameter ranged from 4.0 to 8.0 cm. The operation was completed successfully in 20 (91%) patients. Two (9%) deaths in high-risk patients admitted early to the study occurred within 30 days of surgery. The only major complication was an injured ureter, for which a nephrectomy was performed. Comparison to a historical cohort of conventionally treated patients showed that the study group needed less ventilator support, had shorter intensive care and hospital stays, and resumed diet earlier despite relatively prolonged anesthesia and aortic clamping times.


CONCLUSIONS
The laparoscopic approach to infrarenal AAAs appears feasible, with several potential advantages in low- and moderate-risk patients. Once the technique is optimized, randomized prospective studies will be needed to verify the apparent benefits demonstrated by these initial patients.
Edoga
J K
JK
Department of Surgery, Morristown Memorial Hospital, New Jersey, USA.
James
K V
KV
Resnikoff
M
M
Asgarian
K
K
Singh
D
D
Romanelli
J
J
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017792:Surgical Stapling; D016896:Treatment Outcome