Laparoscopic surgery in the management of complex aortic disease: techniques and lessons learned.
Laparoscopic vascular surgery must be assessed in the context of both open and endovascular interventions. The development of improved laparoscopic equipment and endoscopic techniques makes performance of laparoscopy easier, but endovascular interventions still hold wide appeal because they are minimally invasive and are easier to master by vascular surgeons. Despite decreased morbidity and recovery time, endovascular interventions have inferior durability and higher reintervention rates when compared with open aortoiliac interventions. In particular, after endovascular aneurysm repair, patients need lifelong surveillance because there is potential for delayed endoleaks, aortic neck dilatation, graft migration, and ongoing risk of aneurysmal rupture. These limitations of endovascular therapy are the impetus behind the pursuit of other minimally invasive techniques, such as laparoscopy, in vascular surgery. Currently, two evolving laparoscopic approaches are available for abdominal vascular surgery: total laparoscopic aortic surgery and hybrid techniques that combine laparoscopy with endovascular techniques to treat failing endografts.
Cagiannos
Catherine
C
Division of Vascular Surgery and Endovascular Therapy, Michael E, DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Kolvenbach
Ralf R
RR
D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002983:Clinical Competence; D019317:Evidence-Based Medicine; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D017543:Iliac Aneurysm / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D018570:Risk Assessment; D016896:Treatment Outcome