Gasless videoendoscopic implantation of an aortobifemoral vascular prosthesis via a transperitoneal versus extraperitoneal approach: An experimental study

Purpose: To report progress in the development of a new minimally invasive surgical technique for aortobifemoral grafting utilizing gasless videoendoscopy. Methods: In an experimental study, aortobifemoral Dacron vascular prostheses were implanted in 20 human cadavers using videoendoscopic techniques in both transperitoneal and extraperitoneal approaches. Rather than inducing pneumoperitoneum, the abdominal wall was elevated with an electrically powered lifting system. Results: Each approach was utilized in 10 cadavers for implantation of 20 aortobifemoral grafts under endoscopic guidance in a gasless field. Average operative time for the transperitoneal approach was 3.8 hours (range 3.0 to 5.5), slightly less than the average 4.1 hours (range 3.0 to 6.0) for the extraperitoneal access. Both access routes provided adequate visualization of the operative field. Conclusions: Advantages of gasless endoscopy include the use of conventional instruments and the potential benefits associated with a minimally invasive approach. Optical magnification facilitates suturing of the femoral anastomosis, improves examination of the vascular walls, and allows a more accurate suturing technique.