title: Laparoscopy-assisted abdominal aortic aneurysm endoaneurysmorraphy: early and mid-term results.
abstract: OBJECTIVE
  This study was undertaken to evaluate the consequences on patient selection and on early and mid-term results during the learning curve of a surgical team performing laparoscopy-assisted surgery to treat abdominal aortic aneurysm (AAA).
  
  
  METHODS
  Between December 1998 and January 2002, 24 patients (22 men, 2 women; mean age, 68.2 years [range, 57-82 years]) were included in a prospective study and underwent laparoscopic transperitoneal AAA dissection followed by graft implantation through a 6 to 9 cm minilaparotomy. Perioperative data for the first 10 patients, obtained during the first 25 months of the study (group 1), were compared with data for the last 14 patients, obtained during the last 13 months of the study (group 2). Follow-up consisted of clinical examination or duplex scanning, or both, at 1, 3, 6, and 12 months and yearly thereafter, and computed tomographic scanning before discharge and yearly thereafter.
  
  
  RESULTS
  One patient (4.3%) died in the immediate postoperative period. In this patient and two others (12.5%), the minilaparotomy was extended intraoperatively, from 12 cm to 16 cm. With experience, initial contraindications such as obesity and short proximal or calcified aortic neck were eliminated, enabling increase in rate of patients included, from 27.7% during the first 25 first months to 56% during the last 13 months (P =.063). Mean duration of operative clamping decreased from 275 minutes in group 1 to 195 minutes in group 2 (P <.0001), and mean duration of aortic clamping decreased from 101 minutes in group 1 to 52 minutes in group 2 (P <.0001). The number of early repeat interventions was reduced from 3 (30%) in group 1 to 2 (14.3%) in group 2 (P =.61), and clinical recovery period decreased from 6.8 days to 4.3 days (P <.005). During mean follow-up of 17.1 months (range, 3-38 months), no late aortoiliac procedures were necessary and no prosthetic abnormality was detected.
  
  
  CONCLUSIONS
  This minimally invasive video-assisted technique provides good postoperative comfort and excellent mid-term results. Developments in experience and instrumentation have enabled us to include a growing number of patients and to reduce the duration of the procedure.
authors.affiliation: Department of Vascular Surgery, Hôpital Nord, Université de la Méditerranée, Marseilles, France. yalimi@ap-hm.fr
authors.forename: Yves S
authors.initials: YS
authors.lastname: Alimi
authors.forename: Luca
authors.initials: L
authors.lastname: Di Molfetta
authors.forename: Olivier
authors.initials: O
authors.lastname: Hartung
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Dhanis
authors.forename: Pierre
authors.initials: P
authors.lastname: Barthèlemy
authors.forename: Karim
authors.initials: K
authors.lastname: Aissi
authors.forename: Roch
authors.initials: R
authors.lastname: Giorgi
authors.forename: Claude
authors.initials: C
authors.lastname: Juhan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000193:education / Q000379:methods*; D002983:Clinical Competence; D004724:Endoscopy / Q000193:education; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome