Laparoscopic - Assisted aortoiliac reconstructions

Five patients underwent an aortobifemoral bypass using a laparoscope-assisted procedure. With the help of a wall-lifting device, balloon dissection of the retroperitoneum was performed. A total number of five ports were inserted and the aorta was dissected out from the bifurcation to the renal arteries under the guidance of a laparoscopic video camera. A 5-cm incision was required for suturing the proximal anastomosis of the bifurcated graft. Tunneling from the groin to the aorta was performed either video-assisted or with the help of the balloon dissector with a camera inside. All patients could be fully mobilized on the first postoperative day and were discharged after a mean hospital stay of 7.6 days. Mean length of the operation was 250 min. Originally, seven patients were scheduled for the video-assisted procedure. In two cases, we had to change to a conventional technique: in one case because we could not achieve adequate exposure of the aorta in an obese patient using a transperitoneal access, and in the second case owing to extensive adhesions after a bowel resection. Both patients had a regular, uneventful postoperative course. Gasless laparoscopy allowed us to use standard surgical instruments and most importantly a regular aortic clamp, which proved to be beneficial in a heavily calcified aorta. In conclusion, retroperitoneal gasless laparoscopic procedures can be safely performed in infrarenal aortoiliac reconstructions. Further clinical studies are required to prove the usefulness of this new technique.