Video-assisted aortic surgery

Background: There are several laparoscopic techniques that can be used to perform a total or video-assisted aorto-femoral bypass grafting procedure. Major drawbacks of laparoscopic aortic surgery are the long operating times and the steep learning curve required for these procedures. Hand-assisted laparoscopy is a novel technique that allows surgeons to use their hands and laparoscopic instruments in the operative field while maintaining a pneumoperitoneum. Study Design: A prospective nonrandomized study was conducted in a community medical center. Any patient with aortoiliac occlusive disease or an abdominal aortic aneurysm who was determined to be suitable for a laparoscopic aorto-femoral bypass grafting procedure was included in the study. The main outcomes measured were: operating time, aortic cross-clamp time, incision size, complications, conversion rate to an open procedure, length of stay in the ICU, and postprocedural hospital stay. A concurrent control group of 20 patients was compared with the minimally invasive group. Results: Forty-one consecutive patients were scheduled for the laparoscopic operation. Conversion to an open procedure was necessary in three patients. There were two major complications, including the development of renal failure in one patient who died 28 days postoperatively. The mean postprocedural hospital stay was 4.5 +/- 2.5 days (range 2 to 15 days). The mean operating time was 163.1 +/- 38.7 minutes, including an aortic cross-clamp time of 38.3 +/- 9.7 minutes. Postoperative hospital stay and the time required in the ICU were significantly shorter after the laparoscopic procedure compared with a conventional bypass grafting procedure. Conclusions: Hand-assisted laparoscopy is a minimally invasive technique with operating times and outcomes similar to those of conventional procedures. The possibilities of this technique in patients with aortoiliac disease should be evaluated in a prospective randomized study. (J Am Coll Surg 2000;190:451-457. (C) 2000 by the American College of Surgeons).