Laparoscopic surgery for elective abdominal aortic aneurysm repair

Area of Science:

• Vascular Surgery
• Minimally Invasive Procedures
• Aortic Aneurysm Treatment

Background:

• Abdominal aortic aneurysm (AAA) is a dangerous aortic dilation, with prevalence increasing with age and higher risk in men.
• Open surgical repair (OSR) is traditional but invasive; endovascular aneurysm repair (EVAR) and laparoscopic repair are less invasive alternatives.
• Laparoscopic AAA repair, including hand-assisted (HALS) and total (TLS), offers potential benefits over OSR due to minimally invasive nature.

Purpose of the Study:

• To assess the effectiveness and safety of laparoscopic surgery for elective abdominal aortic aneurysm (AAA) repair.
• To compare laparoscopic AAA repair (total and hand-assisted) with open surgical repair (OSR) and endovascular aneurysm repair (EVAR) regarding perioperative mortality, operative time, and complication rates.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) and controlled clinical trials was conducted.
• Searches included the Cochrane Vascular Information Specialist (CIS) register, CENTRAL, and trials registries.
• One RCT comparing hand-assisted laparoscopic repair with EVAR in 100 male participants was included.

Main Results:

• The single RCT found no in-hospital deaths; hand-assisted laparoscopic repair had longer operative times than EVAR.
• Lower limb ischemia incidence was similar between groups; hospital stay was slightly longer for laparoscopic repair, but not statistically tested.
• Evidence quality was downgraded due to study size, wide confidence intervals, and male-only participants.

Conclusions:

• Insufficient evidence exists to conclude on the effectiveness and safety of laparoscopic AAA repair versus OSR or EVAR.
• Only one small RCT met inclusion criteria, limiting definitive conclusions.
• High-quality RCTs are required to establish the role of laparoscopic AAA repair.