Laparoscopy-assisted aortobifemoral bypass

Therapeutic laparoscopy has substantially simplified the postoperative course of patients suffering from hepatobiliary, gastric, or colonic disease. One important advantage of this modality is the decrease in postoperative pain, which diminishes the potential for cardiopulmonary problems. Patients with aortoiliac atherosclerotic disease are at high risk for postoperative complications, and a minimally invasive procedure may favorably affect their postoperative recovery. We describe here the first patient on whom we performed a laparoscopy-assisted aortobifemoral bypass. Under the pneumoperitoneum, seven 10-mm trocars were inserted to permit aortic dissection and creation of retroperitoneal tunnels to the femoral regions. After evacuation of the pneumoperitoneum, an 8-cm midline incision was made to allow a side-to-end aortic anastomosis. The patient's postoperative period was uncomplicated by any cardiopulmonary problems despite his history of three myocardial infarctions; the patient had minimal pain that allowed for a quick return to ambulation. This procedure is minimally invasive and appeared to simplify the postoperative period in our patient. It could become the procedure of choice for certain patients with aortoiliac disease.