The Learning Curve of Totally Laparoscopic Aortobifemoral Bypass for Occlusive Disease. How Many Cases and How Safe?

Abstract

Surg 2008;35:715-22. Objectives: To compare the safety and efficacy of a bioresorbable paclitaxel-eluting wrap implanted with a synthetic vascular graft (treatment) versus the graft implanted alone (control).Design: Prospective, randomized, controlled, multicentre, 2-year clinical study conducted in adults scheduled to undergo femoropopliteal peripheral bypass surgery with a polytetrafluoroethylene (PTFE) graft.Materials and methods: Hundred and nine subjects were randomized 2:1 to treatment or control. All subjects were implanted with a 6 mm expanded PTFE vascular graft; in addition, treated subjects had a 2.5 cm ϫ 4 cm paclitaxel-eluting wrap (1.6 g/mm 2 ) placed around the distal graft anastomosis.Results: The overall incidence of adverse events was similar in both groups. Treated subjects required fewer limb amputations than controls (15.5% vs 18.4%) and time to amputation for those that required amputation was twice as long (153 days vs 76 days). Among diabetics, this effect was pronounced with 13.8% of treated subjects requiring limb amputations compared with 23.5% of controls. Over the course of study, the diameter at the distal graft anastomosis was greater in treated subjects than in controls (difference of 2.1 mm at 2 yr, p ϭ 0.03).Conclusions: The paclitaxel-eluting wrap maintained graft patency at the distal anastomosis and was safe to use in patients who had received a peripheral bypass PTFE graft.

Laparoscopic Kidney Transplantation: An Initial Experience

“…Vascular injury during laparoscopic ablative surgery are often managed by intracorporeal suturing without conversion to open surgery (10)(11)(12)(13). Feasibility of laparoscopic vascular reconstructive surgeries like repair of abdominal aortic aneurysm and renal artery aneurysms have been described more recently (14)(15)(16). Such experience clearly underscores laparoscopy as an attempt to reduce the wound related morbidity for urological and vascular surgery.…”

Mid-term results of robot-assisted laparoscopic surgery for aortoiliac occlusive disease

“…[2][3][4] Laparoscopic aortic surgery has been developed to reduce operative trauma and to facilitate quicker ambulation. [5][6][7][8][9][10][11] Performing a vascular anastomosis using laparoscopic techniques is challenging, however, and successful performance of laparoscopic aortic surgery requires dedication and vast amounts of training. 7,8 Robot technology may help to overcome some of the limitations of traditional laparoscopic instruments, thus shortening the learning curve.…”

Laparoscopic versus Open Approach for Aortobifemoral Bypass for Severe Aorto-iliac Occlusive Disease – A Multicentre Randomised Controlled Trial

“…As studied earlier, the laparoscopic aortobifemoral bypass procedure has a considerable learning curve. 12 To compare two mature techniques, a randomised controlled trial can only be set up if participating centres have passed this learning curve. However, if differences in postoperative course are obvious, at a certain level of experience it becomes difficult to justify randomisation.…”