Laparoscopic Aortic Aneurysm Resection

Abstract

Purpose: 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.

Experimental Study of Aortic Anastomosis Using a Circular Stapling Device in the Porcine Model

“…Although there are many reports of laparoscopic abdominal aortic repair, manual suturing is used as the gold standard for these aortic anastomoses. [3][4][5][6][7][8][9][10] The properties of the aortic wall, the difficulty of handling the automatic anastomotic device within the operative field, and the inability to invert an anastomosis are enumerated as obstacles to the development of such devices for the aorta. The advent of an automatic anastomotic device for the aorta would shorten the operation and would be useful in laparoscopic surgery or in deep, narrow operative fields.…”

Total Laparoscopic Aortic Repair for Occlusive and Aneurysmal Disease: First 95 Cases

“…However, despite its potential advantages and feasibility, total laparoscopic aortic repair is still used in only a few centers. [3][4][5] The purpose of this article is to present preliminary experience with total laparoscopic aortic repair disease in 95 patients treated for occlusive or aneurysmal disease at the University Hospitals of Poitiers and Toulouse, France. The first 70 patients were treated in Toulouse and the last 25 in Poitiers where the technique is was developed under the instruction of the first author.…”

Systematic review of perioperative outcomes following laparoscopic abdominal aortic aneurysm repair

“…Additionally, robotic-assisted techniques (both endovascular and non-endovascular) may in the future add another dimension to aortic aneurysm repair. 29–37…”