The feasibility of hand-assisted laparoscopic aortic bypass
using a low transverse incision |
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Authors: | L Silva R Kolvenbach L Pinter |
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Institution: | (1) Department of Vascular Surgery, University of Rio de Janeiro, Brazil, BR;(2) Department of Vascular Surgery, Augusta Hospital, Amalien Str. 9, 40472 Duesseldorf, Germany, DE |
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Abstract: | Background: Hand-assisted laparoscopy can be used to perform aortoiliac reconstructive procedures. This study aimed to evaluate
the safety and feasibility of a hand-assisted aortofemoral bypass in patients with occlusive disease using a low abdominal
transverse incision to reduce postoperative respiratory problems. Methods: In 18 patients, a modified Pfannenstiel incision
was performed. A hand-assist device was inserted, and the aorta was exposed using transperitoneal laparoscopy. Tunneling was
performed under laparoscopic control. The anastomosis was always performed proximally to the inferior mesenteric artery. In
three patients, the proximal anastomosis had to be performed laparoscopically. The indication for surgery was occlusive disease
in 16 patients and a combination of an aneurysm and aortoiliac occlusion in 2 patients. Results: Conversion was required in
one patient (1/18). In 13 patients (13/18), the total operating time did not exceed 180 min, and 61% of the patients (11/18)
could be discharged by postoperative day 5. None of the patients died perioperatively (0/18). Complications were observed
in six patients (6/18). Only one of these patients had respiratory problems (1/18). The remaining five patients had local
complications such as wound healing problems. The anastomosis was sutured laparoscopically in three patients (3/18). Conclusions:
Hand-assisted laparoscopy can be performed safely using a low transverse abdominal incision. In our experience this laparoscopic
access can reduce the incidence of postoperative respiratory problems and incision-related complications. |
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