Totally retroperitoneal laparoscopic aortobifemoral bypass

Area of Science:

• Vascular Surgery
• Minimally Invasive Surgery
• Laparoscopic Techniques

Background:

• Aorto-iliac occlusive disease often requires aortobifemoral bypass, traditionally performed via open surgery.
• Laparoscopic approaches have emerged as minimally invasive alternatives, with transperitoneal routes being common.
• The totally retroperitoneal laparoscopic approach offers a distinct alternative to the transperitoneal method.

Observation:

• A 51-year-old male patient with severe bilateral intermittent claudication and lower limb ulcers due to aorto-iliac occlusive disease was selected for this procedure.
• Endovascular revascularization was not indicated for this patient.
• The patient was positioned in a right lateral decubitus position, and the retroperitoneal space was accessed laparoscopically.

Findings:

• The infrarenal aorta was successfully exposed and clamped using laparoscopic instruments.
• A bifurcated graft was anastomosed to the aorta using a running suture.
• Prosthetic limbs were tunnelized retroperitoneally to the groins under laparoscopic visualization, with femoral anastomoses completed via open surgery.

Implications:

• This case demonstrates the feasibility of a totally laparoscopic retroperitoneal approach for aortobifemoral bypass.
• This technique may offer advantages for patients with aorto-iliac occlusive disease, potentially reducing invasiveness.
• Further research and case studies are warranted to establish the long-term efficacy and benefits of this laparoscopic approach.