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Video-assisted aortic surgery.

R Kolvenbach¹, L Da Silva, O Deling

¹Department of Vascular Surgery, Augusta Hospital, Duesseldorf, Germany.

Journal of the American College of Surgeons

|April 11, 2000

Summary

Hand-assisted laparoscopy offers a minimally invasive approach for aorto-femoral bypass grafting, demonstrating comparable outcomes to traditional methods. This technique shows promise for patients with aortoiliac disease, warranting further investigation.

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Area of Science:

Vascular Surgery
Minimally Invasive Surgery
Surgical Technology

Background:

Laparoscopic aorto-femoral bypass grafting presents challenges including extended operating times and a steep learning curve.
Hand-assisted laparoscopy (HAL) integrates surgeon's hands with laparoscopic instruments, maintaining pneumoperitoneum for improved operative control.

Purpose of the Study:

To evaluate the efficacy and safety of hand-assisted laparoscopy (HAL) for aorto-femoral bypass grafting.
To compare outcomes of HAL with conventional open bypass grafting procedures.

Main Methods:

A prospective nonrandomized study included patients with aortoiliac occlusive disease or abdominal aortic aneurysms suitable for laparoscopic bypass.
Key outcomes measured included operating time, cross-clamp time, complications, conversion rates, and hospital stay.

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A concurrent control group of 20 patients undergoing conventional bypass was compared to the minimally invasive group.

Main Results:

Forty-one patients underwent HAL, with 3 requiring conversion to open surgery. Two major complications occurred, including one fatality.
Mean operating time was 163.1 minutes, with a mean aortic cross-clamp time of 38.3 minutes.
Postoperative hospital stay and ICU time were significantly shorter in the HAL group compared to conventional bypass.

Conclusions:

Hand-assisted laparoscopy is a viable minimally invasive option for aorto-femoral bypass grafting, achieving outcomes comparable to conventional surgery.
Further evaluation through a prospective randomized study is recommended to confirm the benefits of HAL in patients with aortoiliac disease.