Laparoscopy-assisted abdominal aortic aneurysm endoaneurysmorraphy: early and mid-term results.

OBJECTIVES This study was undertaken to evaluate the consequences on patient selection and on early and mid-term results during the learning curve of a surgical team performing laparoscopy-assisted surgery to treat abdominal aortic aneurysm (AAA). PATIENTS AND METHODS Between December 1998 and January 2002, 24 patients (22 men, 2 women; mean age, 68.2 years [range, 57-82 years]) were included in a prospective study and underwent laparoscopic transperitoneal AAA dissection followed by graft implantation through a 6 to 9 cm minilaparotomy. Perioperative data for the first 10 patients, obtained during the first 25 months of the study (group 1), were compared with data for the last 14 patients, obtained during the last 13 months of the study (group 2). Follow-up consisted of clinical examination or duplex scanning, or both, at 1, 3, 6, and 12 months and yearly thereafter, and computed tomographic scanning before discharge and yearly thereafter. RESULTS One patient (4.3%) died in the immediate postoperative period. In this patient and two others (12.5%), the minilaparotomy was extended intraoperatively, from 12 cm to 16 cm. With experience, initial contraindications such as obesity and short proximal or calcified aortic neck were eliminated, enabling increase in rate of patients included, from 27.7% during the first 25 first months to 56% during the last 13 months (P =.063). Mean duration of operative clamping decreased from 275 minutes in group 1 to 195 minutes in group 2 (P <.0001), and mean duration of aortic clamping decreased from 101 minutes in group 1 to 52 minutes in group 2 (P <.0001). The number of early repeat interventions was reduced from 3 (30%) in group 1 to 2 (14.3%) in group 2 (P =.61), and clinical recovery period decreased from 6.8 days to 4.3 days (P <.005). During mean follow-up of 17.1 months (range, 3-38 months), no late aortoiliac procedures were necessary and no prosthetic abnormality was detected. CONCLUSION This minimally invasive video-assisted technique provides good postoperative comfort and excellent mid-term results. Developments in experience and instrumentation have enabled us to include a growing number of patients and to reduce the duration of the procedure.

[1]  O. Hartung,et al.  [Thoracoscopic bypass from the descending thoracic aorta to the femoral artery. Experimental study and clinical application]. , 2003, Journal des maladies vasculaires.

[2]  O. Hartung,et al.  [Laparoscopic transperitoneal replacement of the abdominal aorta with left renal artery reimplantation: experimental study on pigs]. , 2002, Journal des maladies vasculaires.

[3]  R. Kolvenbach,et al.  Laparoscopy-assisted aneurysm resection as a minimal invasive alternative in patients unsuitable for endovascular surgery. , 2001, Journal of vascular surgery.

[4]  S. Carr,et al.  Minimal incision aortic surgery. , 2001, Journal of vascular surgery.

[5]  G. Moneta,et al.  Functional outcome after open repair of abdominal aortic aneurysm. , 2001, Journal of vascular surgery.

[6]  O. Hartung,et al.  Laparoscopic aortoiliac surgery for aneurysm and occlusive disease: when should a minilaparotomy be performed? , 2001, Journal of vascular surgery.

[7]  C. Brunet,et al.  Intestinal retractor for transperitoneal laparoscopic aortoiliac reconstruction , 2000, Surgical Endoscopy.

[8]  J J Castronuovo,et al.  Laparoscopic-assisted abdominal aortic aneurysmectomy. , 2000, Journal of vascular surgery.

[9]  J. Cerveira,et al.  Minimal incision abdominal aortic aneurysm repair. , 1999, Journal of vascular surgery.

[10]  L. Swanström,et al.  Totally Laparoscopic Abdominal Aortic Aneurysm Repair , 1999, Seminars in laparoscopic surgery.

[11]  H. Gelabert,et al.  Endovascular, transperitoneal, and retroperitoneal abdominal aortic aneurysm repair: results and costs. , 1999, Journal of vascular surgery.

[12]  J. Romanelli,et al.  Laparoscopic surgery for abdominal aortic aneurysms , 1998, Surgical Endoscopy.

[13]  S. Berdah,et al.  [Laparoscopic replacement of the abdominal aorta. Experimental study in the pig]. , 1998, Journal des maladies vasculaires.

[14]  J. Cohen,et al.  Laparoscopic-assisted abdominal aortic aneurysm repair , 1995, Surgical Endoscopy.

[15]  A. Mäkinen,et al.  Cholecystectomy: comparison of minilaparotomy and laparoscopy. , 1995, International surgery.

[16]  O. Creech Endo‐aneurysmorrhaphy and Treatment of Aortic Aneurysm , 1966, Annals of surgery.

[17]  Y. Dion,et al.  Totally laparoscopic abdominal aortic aneurysm repair. , 2001, Journal of vascular surgery.

[18]  O. Hartung,et al.  Abdominal aortic laparoscopic surgery: retroperitoneal or transperitoneal approach? , 2000, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[19]  L. Swanstrom,et al.  Totally laparoscopic abdominal aortic aneurysm repair , 1999, Surgical Endoscopy.

[20]  J. Cohen,et al.  Laparoscopically assisted abdominal aortic aneurysm repair: first 20 cases. , 1998, Journal of vascular surgery.