Totally laparoscopic abdominal aortic aneurysm repair.

Area of Science:

• Vascular Surgery
• Minimally Invasive Surgery
• Laparoscopic Surgery

Background:

• Vascular surgery has been slow to adopt minimally invasive techniques due to challenges in managing arterial anatomy.
• Advancements in laparoscopic instrumentation and surgeon experience have enabled laparoscopic aortic surgery.

Purpose of the Study:

• To review current experience with totally laparoscopic aortic aneurysm repair.
• To discuss various surgical techniques, including transperitoneal and retroperitoneal approaches.

Main Methods:

• Review of surgical techniques for totally laparoscopic aortic aneurysm repair.
• Discussion of patient selection, positioning, trocar placement, surgical patterns, and postoperative care.
• Inclusion of the authors' experience with transperitoneal and retroperitoneal approaches to infrarenal aortic aneurysms.

Main Results:

• Multiple surgical approaches exist for laparoscopic aortic surgery, including laparoscopically assisted and totally laparoscopic methods.
• Both transperitoneal and retroperitoneal approaches have been utilized for aortic access.
• Detailed surgical techniques for aneurysm bypass are described.

Conclusions:

• World experience with minimally invasive vascular surgery is limited.
• Prospective, randomized trials are necessary to demonstrate the safety of minimally invasive vascular surgery compared to open surgery.
• Wider acceptance of minimally invasive vascular surgery is anticipated if proven safe and effective, offering patient benefits.