Current role of the minimally invasive direct aortic surgery for 3-A repair (MIDAS-3A)

Open aneurysmectomy and aortic graft is still associated with a relatively high morbidity and mortality. To decrease this surgical stress, less invasive procedure, MIDAS-3A technique (Minimally Invasive Direct Aortic Surgery for AAA) was developed, utilizing a 5 cm abdominal incision and a video-laparoscopic assistance (gas-less) to reach the AAA retroperitoneally. From Nov. 1999 to Dec. 2002, 80 patients underwent surgery. This technique provides all the benefits of an open surgical approach, to be combined with the advantages derived from minimized tissue trauma. A comparison between MIDAS-3A and CL (Conventional Laparotomy) was performed, monitorizing-nasogastric drainage;--initial feeding;--pulmonary functions (Vital Capacity, and Forced Expiration Volume);--Intensive Care Unit recovery (long stay);--length of hospital stay;--operative time;--blood loss. The perioperative (30 days) mortality (2.5%), and the morbidity (7.5%) was equal in both groups. No conversion to conventional laparotomy occurred. MIDAS-3A has significantly reduced length of hospital stay (3.5 days), and pulmonary dysfunctions. This technique provides all the benefits of open surgical approach, to be combined with the advantages derived from minimized tissue trauma. MIDAS-3A reduced trauma and pain, which resulted in a shorter hospital stay, and so lower expense and better financial consequences.