Abdominal aortic laparoscopic surgery: retroperitoneal or transperitoneal approach?

Area of Science:

• Vascular Surgery
• Minimally Invasive Procedures
• Abdominal Aortic Reconstruction

Background:

• Laparoscopic Abdominal Aortic Reconstruction (LAOR) offers potential benefits over open surgery.
• The choice between transperitoneal and retroperitoneal approaches for LAOR requires careful consideration of their respective advantages and disadvantages.

Purpose of the Study:

• To define the respective advantages and pitfalls of transperitoneal versus retroperitoneal approaches in laparoscopic abdominal aortic reconstruction (LAOR).
• To evaluate the feasibility and outcomes of LAOR using two distinct surgical approaches.

Main Methods:

• Prospective study involving ten patients undergoing LAOR for aortoiliac occlusive disease or aortic aneurysm.
• Patients were divided into two groups: Group I (n=5) underwent a retroperitoneal approach, and Group II (n=5) used a transperitoneal approach.
• Surgical times, clamping durations, complications, conversion rates, and length of hospital stay were recorded and compared between groups.

Main Results:

• No early or late mortality was observed; all bypasses remained patent at a mean follow-up of 5.7 months.
• Mean surgical and clamping times were comparable between the retroperitoneal and transperitoneal groups.
• The transperitoneal approach (Group II) was associated with fewer complications and shorter hospital stays compared to the retroperitoneal approach (Group I), despite requiring minilaparotomies in some cases.

Conclusions:

• Both transperitoneal and retroperitoneal approaches are feasible for LAOR.
• The transperitoneal approach may offer superior exposure of the right aortic wall and iliac axis, potentially reducing the need for inferior mesenteric artery division.
• Further research is warranted to confirm these preliminary findings and optimize LAOR techniques.