History and perspectives in laparoscopic vascular surgery

Laparoscopic techniques have changed the face of many surgical specialties. In this article, we describe the evolution of laparoscopy in vascular surgery from its beginning in the early 1990s. We discuss the present laparoscopic techniques for treatment of aortoiliac disease, their advantages and limitations. We suggest the vascular surgeon learns laparoscopy on the model used in general surgery a decade ago. Although more studies are needed to further define the role of laparoscopy, present indications can be found in those patients with TASC III and IV occlusive lesions and in patients with abdominal aortic aneurysms who are candidate to tube grafts or aortobifemoral bypass. With further refinements in technology (anastomotic stapling device, robotics) and techniques, laparoscopy should replace many open surgeries presently done for aortoiliac disease but will also have to be considered for treatment of mesenteric disease as described in the text.