Laparoscopic harvesting of jejunal free flaps

We studied the safety and efficacy of laparoscopic jejunal free flap harvesting with total intracorporeal small-bowel anastomosis in an animal model. Eight dogs underwent laparoscopic resection of 8 to 15 cm of jejunum with endoscopic GIA anastomoses and jejunal segment harvesting through the periumbilical laparoscopic port. In six animals, the harvested jejunum was implanted subcutaneously and revascularized by anastomosis of the mesenteric artery and vein to the femoral vessels. Both the microvascular and intracorporeal jejunal anastomoses were studied at 10 days. Mean laparoscopic operative time was 2.9 hours, with the last five procedures all completed in fewer than 2 hours. Mean ischemic time was 1.9 hours. The laparoscopically performed small-bowel anastomoses were all successful. All dogs took regular diets within 1 day, with normal bowel function returning by the second day. Both clinically and histologically, the bowel wall and mesenteric vessels of all the segments harvested demonstrated no injury despite their laparoscopic harvest. Five of the free flaps remained fully viable at 10 days. One flap failed after prolapse of the flap resulting from inadequate fixation. Laparoscopic harvesting of the jejunal free flap is safe and efficacious and offers all of the potential advantages of laparoscopic abdominal surgery.