Laparoscopy-assisted aortobifemoral bypass through the transperitoneal retrorenal approach

The aim of laparoscopic vascular surgery in the aortoiliac segment is to replicate the excellent outcomes of open aortic surgery while providing the advantages of minimally invasive surgery. We report the case of a 49-year old man with disabling hip claudication and rest pain in his left lower extremity. On examination the patient had reduced right femoral pulse and absent pulses in his left lower extremity. Angiography revealed occlusive disease in the left aortoiliac segment and right common iliac artery stenoses. Laparoscopic aortobifemoral bypass was planned. The surgical technique included 70 degrees -right lateral decubitus position and retrorenal retrocolic dissection from the left common iliac artery to the left renal vein. Minilaparotomy consisted of aortic clamping, arteriotomy, and end-to-side aorto-prosthetic anastomosis with Dacron graft. Time to extubation was 5 hours; peristalsis was recovered 72 hours after surgery. The patient was discharged from hospital after cardiologic assessment 9 days after surgery.