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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Transverse minilaparotomy for open abdominal aortic aneurysm repair
Hany Hafez1, Mlotshwa Makhosini, Nima Abbassi-Ghadi
1Department of Vascular Surgery, St. Richard's Hospital, Chichester, United Kingdom. mail@hanyhafez.net
Introduction:
Traditional open surgical repair for abdominal aortic aneurysm (AAA) is a major procedure with a relatively high risk of perioperative morbidity. This article describes the results of minimally invasive open AAA repair through a transverse left upper quadrant minilaparotomy.
Methods:
Between January 2007 and June 2010, 83 consecutive patients (77 men) underwent elective or urgent repair of a nonruptured AAA through a horizontal transperitoneal left upper quadrant minilaparotomy. Postoperatively, patients were fast-tracked through a multidisciplinary recovery program.
Results:
Repairs were urgent in 15 patients (18%), and 10 (12%) had aortoiliac aneurysms. American Society of Anesthesiologists (ASA) scores 1 to 4 were 3.6%, 44.6%, 42%, and 11%, respectively. Median (range) age was 73 (61-87) years, AAA size was 5.9 (5.1-10) cm, body mass index was 27 (19-39) kg/m(2), operation time was 150 (85-280) minutes, blood loss was 625 (200-4150) mL, critical care bed days was 1 (0-19), and hospital stay was 4 (2-88) days. Four (4.8%) patients returned to the operating theater within the same admission. No patients required conversion to full laparotomy and none had reintervention postdischarge. Two patients (2.4%) died in the hospital, and 18 (21.7%) had postoperative adverse events, ranging from urinary retention to myocardial infarction. New-onset atrial fibrillation was the commonest of these events (11, 13.3%). Respiratory tract infection incidence was low (4.8%). Incisional herniation developed in two patients (2.4%) at a median (range) follow-up of 10 (6-25) months. Correcting for age, cardiac complications were associated with increased odds of hospital stay >4 days (odds ratio [OR], 7.59; 95% confidence interval [CI], 1.12-52.42; P = .014). Correcting for ASA score, advancing age was associated with increased risk of cardiac complications (OR, 1.18; 95% CI, 1.08-1.28; P = .001), whereas AAA screening (patient identified through screening) and maintaining higher intraoperative systolic pressure were both protective (OR, 0.24; 95% CI, 0.07-0.87; P = .018) and (OR, 0.93; 95% CI, 0.89-0.98; P = .009), respectively.
Conclusion:
Left upper quadrant minilaparotomy is a feasible minimally invasive approach to open AAA repair. This technique is associated with low morbidity and mortality and short hospital stay, particularly in patients identified through AAA screening.
Insights
Minimally invasive open repair of abdominal aortic aneurysms (AAA) using a left upper quadrant minilaparotomy is feasible. This approach offers low morbidity and mortality, with shorter hospital stays, especially for screened patients.
Area of Science:
- Vascular Surgery
- Minimally Invasive Surgery
- Abdominal Aortic Aneurysm (AAA) Repair
Background:
- Traditional open abdominal aortic aneurysm (AAA) repair carries significant perioperative risks.
- Minimally invasive techniques aim to reduce morbidity associated with AAA repair.
Purpose of the Study:
- To evaluate the outcomes of minimally invasive open AAA repair using a transverse left upper quadrant minilaparotomy.
- To assess the feasibility, safety, and efficacy of this approach.
Main Methods:
- A consecutive series of 83 patients underwent elective or urgent repair of nonruptured AAA via a left upper quadrant minilaparotomy.
- Patients were managed postoperatively through a multidisciplinary recovery program.
Main Results:
- The procedure demonstrated low rates of complications, mortality (2.4%), and reintervention.
- Hospital stay was short (median 4 days), with low critical care bed days (median 1 day).
- Factors associated with adverse outcomes included advanced age and cardiac complications, while AAA screening and higher intraoperative systolic pressure were protective.
Conclusions:
- Left upper quadrant minilaparotomy is a viable, minimally invasive option for open AAA repair.
- The technique is associated with favorable outcomes, including reduced morbidity and mortality.
- Patients identified through AAA screening particularly benefit from this approach.
