Current modifications to totally laparoscopic “apron technique”

Dion, Yves-Marie; Thaveau, Fabien; Fearn, Shirley J.

doi:10.1016/s0741-5214(03)00230-1

Cited by 40 publications

(22 citation statements)

References 8 publications

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“…Different laparoscopic aortic approaches have been described. [12][13][14] We use a modified transperitoneal approach as described by Štádler et al 15 The small intestine and omentum are moved toward the diaphragm. An incision of the peritoneum is made alongside the left gonadal vein.…”

Section: Surgical Techniquementioning

confidence: 99%

The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease

Novotný

Dvořák

Staffa

2011

Journal of Vascular Surgery

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Our results show that the success rate of robot-assisted laparoscopic aortofemoral bypass grafting is high and the complication rate is low. Anastomosis creation, one of the main difficulties of laparoscopic bypass grafting, has been overcome using the robotic operating system and its learning curve is short. However, the endoscopic dissection of the aortoiliac segment remains the most difficult part of the operation and should be addressed in further development of the method to reduce the operative times. Long-term results and potential benefits of this minimally invasive method have to be verified by randomized controlled clinical trials.

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Section: Surgical Techniquementioning

confidence: 99%

The learning curve of robot-assisted laparoscopic aortofemoral bypass grafting for aortoiliac occlusive disease

Novotný

Dvořák

Staffa

2011

Journal of Vascular Surgery

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“…The ''apron'' technique [10] is a time-consuming technique and the thin apron flap tears easily, which often results in conversion. After initial experience with both these techniques, we opted for the transabdominal route [5], using extreme patient rotation.…”

Section: Discussionmentioning

confidence: 99%

“…Details of different surgical techniques have been described elsewhere [1,3,5,8,10,11,18]. After performance of the initial transabdominal approach with the ''apron'' technique [10] and a retroperitoneal approach [18], we preferred the transabdominal approach with extreme patient-rotation as described by Coggia et al [5].…”

Section: Surgical Techniquementioning

confidence: 99%

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Robot-assisted laparoscopic surgery of the infrarenal aorta

et al. 2007

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Background: Recently introduced robot-assisted laparoscopic surgery (RALS) facilitates endoscopic surgical manipulation and thereby reduces the learning curve for (advanced) laparoscopic surgery. We present our learning curve with RALS for aortobifemoral bypass grafting as a treatment for aortoiliac occlusive disease. Methods: Between February 2002 and May 2005, 17 patients were treated in our institution with robot-assisted laparoscopic aorto-bifemoral bypasses. Dissection was performed laparoscopically and the robot was used to make the aortic anastomosis. Operative time, clamping time, and anastomosis time, as well as blood loss and hospital stay, were used as parameters to evaluate the results and to compare the first eight (group 1) and the last nine patients (group2). Results: Total median operative, clamping, and anastomosis times were 365 min (range: 225-589 min), 86 min (range: 25-205 min), and 41 min (range: 22-110 min), respectively. Total median blood loss was 1,000 ml (range: 100-5,800 ml). Median hospital stay was 4 days (range: 3-57 days). In this series 16/18 anastomoses were completed with the use of the robotic system. Three patients were converted (two in group 1, one in group 2), and one patient died postoperatively (group 1). Median clamping and anastomosis times were significantly different between groups 1 and 2 (111 min Conclusions: Robot-assisted aortic anastomosis was shown to have a steep learning curve with considerable reduction of clamping and anastomosis times. However, due to a longer learning curve for laparoscopic dissection of the abdominal aorta, operation times were not significantly shortened. Even with robotic assistance, laparoscopic aortoiliac surgery remains a complex procedure.

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“…They speculated that in the not so distant future it would become a part of the repertoire for surgeons performing vascular surgery. The modified peritoneal apron technique described by these authors recently gave importance to patient positioning and creation of a short peritoneal apron [10].…”

Section: Discussionmentioning

confidence: 99%