Early and Mid-term Results of Totally Laparoscopic Surgery for Aortoiliac Disease

Abstract

The present article is the first in the literature reporting short- and medium-term results using a totally laparoscopic technique for aortoiliac disease.Forty-nine patients, 6 having an associated small aneurysm, were scheduled for totally laparoscopic surgery (TLS) for aortoiliac occlusive disease and 2 for treatment of aortic aneurysmal disease (AAA). Patients' characteristics, intraoperative, postoperative data and mid-term data were recorded.TLS was successfully completed in 45 patients. Of those patients, 41 received an aortobifemoral bypass; three, an iliofemoral bypass; and one, an aortoaortic bypass. Five patients were converted from TLS to video-assisted laparoscopic surgery using incisions varying in size from 7 cm to 11 cm. One patient underwent conversion to standard open surgery. One death occurred unrelated to the technique. Major perioperative complications related to the technique were few and presented in the early phase of the study: One intraoperative embolization to the lower limbs that needed embolectomy, and one acute aortic false aneurysm. Midterm results were favorable, demonstrating two limb graft thromboses. Hernias at trocar sites occurred in only 3.9%. The patients benefited from this procedure, which is considered definitive like its standard open counterpart. The conversion rate is lower than that reported for acute cholecystitis. Selection of patients has been less stringent during the second half of the study in term of inclusion of patients with AAA and of more TASC IV patients. Surgeons willing to learn this technique should attend dedicated courses. In the future, as this surgical innovation matures, controlled randomized studies should be initiated.

Total laparoscopic juxtarenal abdominal aortic aneurysm repair

“…Previous series have already demonstrated that these well-known advantages of laparoscopy were also valid after laparoscopic aortic surgery. 8,9,21,[24][25][26][27][28][29][30] We did not observe adverse events after a median follow-up of 19 months. These data are similar to those of open repair and demonstrate the mid-term reliability of laparoscopic JAAA repair.…”

Robot-assisted laparoscopic aortobifemoral bypass: initial experience developing a new program

“…When stents and surgical bypass are compared the cumulative 18 months patency has favored surgical bypass (93 vs. 77%) [11]. Dion and others have reported a conversion rate from totally laparoscopic procedures to hand-assisted or mini-laparotomy procedures of 10-15% which is consistent with our conversion rate of 16% [7,12].…”

“…Stadler et al were able to perform the aortic anastomosis with robotic assistance in a mean clamp time of 54 versus 99 min when done totally laparoscopically by Dion [3,7]. Our own clamp time was a median of 75 min while our animal model laparoscopic aortic anastomosis time was in excess of 100 min.…”

Robot-assisted laparoscopic surgery of the infrarenal aorta

“…Compared to various larger series [4,7,9,12,14,15], the aortic anastomosis time and the aortic clamp time in this series became acceptable after the first 8 patients. In our institution patients are treated by endovascular techniques for aortoiliac occlusive disease, and only a few patients need surgery.…”