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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
PubMed
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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.

Related Experiment Videos

  • 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.