title: The feasibility of hand-assisted laparoscopic aortic bypass using a low transverse incision.
abstract: BACKGROUND
  Hand-assisted laparoscopy can be used to perform aortoiliac reconstructive procedures. This study aimed to evaluate the safety and feasibility of a hand-assisted aortofemoral bypass in patients with occlusive disease using a low abdominal transverse incision to reduce postoperative respiratory problems.
  
  
  METHODS
  In 18 patients, a modified Pfannenstiel incision was performed. A hand-assist device was inserted, and the aorta was exposed using transperitoneal laparoscopy. Tunneling was performed under laparoscopic control. The anastomosis was always performed proximally to the inferior mesenteric artery. In three patients, the proximal anastomosis had to be performed laparoscopically. The indication for surgery was occlusive disease in 16 patients and a combination of an aneurysm and aortoiliac occlusion in 2 patients.
  
  
  RESULTS
  Conversion was required in one patient (1/18). In 13 patients (13/18), the total operating time did not exceed 180 min, and 61% of the patients (11/18) could be discharged by postoperative day 5. None of the patients died perioperatively (0/18). Complications were observed in six patients (6/18). Only one of these patients had respiratory problems (1/18). The remaining five patients had local complications such as wound healing problems. The anastomosis was sutured laparoscopically in three patients (3/18).
  
  
  CONCLUSIONS
  Hand-assisted laparoscopy can be performed safely using a low transverse abdominal incision. In our experience this laparoscopic access can reduce the incidence of postoperative respiratory problems and incision-related complications.
authors.affiliation: Department of Vascular Surgery, University of Rio de Janeiro, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Silva
authors.forename: R
authors.initials: R
authors.lastname: Kolvenbach
authors.forename: L
authors.initials: L
authors.lastname: Pinter
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001012:Aorta, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005240:Feasibility Studies; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D020535:Video-Assisted Surgery / Q000379:methods