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Laparoscopic-assisted abdominal aortic aneurysmectomy.

J J Castronuovo¹, K V James, M Resnikoff

¹Department of Surgery, Morristown Memorial Hospital, Morristown, NJ, USA. castronuovo@ahsys.org

Journal of Vascular Surgery

|August 5, 2000

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Laparoscopic-assisted abdominal aortic aneurysmectomy is a safe and effective procedure for select patients. This minimally invasive approach offers benefits over open surgery, including shorter hospital stays and faster recovery.

Area of Science:

Vascular Surgery
Minimally Invasive Surgery
Abdominal Aortic Aneurysm

Background:

Abdominal aortic aneurysms (AAAs) are a significant cause of morbidity and mortality.
Traditional open surgical repair carries substantial risks.
Laparoscopic techniques offer a less invasive alternative for AAA treatment.

Purpose of the Study:

To describe the technical aspects of laparoscopic-assisted abdominal aortic aneurysmectomy (LAAA).
To report the early clinical outcomes and safety of LAAA.
To evaluate the feasibility of LAAA in a selected patient cohort.

Main Methods:

60 patients with infrarenal AAAs underwent elective LAAA between February 1997 and May 1999.
Preoperative imaging included aortography and CT scanning.

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Exclusion criteria included visceral arterial abnormalities and short proximal neck (<0.5 cm).

Aortic reconstruction utilized retroperitoneal laparoscopy with laparoscopic staplers and hemoclips.

Distal anastomoses were performed through counter incisions.

Main Results:

The 30-day mortality rate was 5.0% (3 patients).
Complications included ureteral injury, myocardial infarction, DVT, renal failure, colon ischemia, and graft infection.
Mean operative time was 7.7 hours; mean aortic cross-clamp time was 112 minutes.
Laparoscopic patients demonstrated shorter ICU and hospital stays, less ventilator support, and earlier diet resumption compared to open repair.
All bypass grafts remained patent at follow-up.

Conclusions:

Laparoscopic-assisted abdominal aortic aneurysmectomy is safe and effective for moderate-to-good risk patients.
The procedure requires specialized laparoscopic aortic surgery training.
Suitable candidates have AAAs with a proximal neck of ≥0.5 cm and no need for visceral or internal iliac artery reconstruction.
Further randomized trials are needed to confirm benefits over open repair.