Laparoscopic aortobifemoral bypass

Ahn, Samuel S.; Hiyama, Darryl T.; Rudkin, George H.; Fuchs, Gerhard; Ro, Kyung M.; Concepcion, Blessie

doi:10.1016/s0741-5214(97)70156-3

Cited by 39 publications

(10 citation statements)

References 5 publications

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“…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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Section: Surgical Techniquementioning

confidence: 99%

“…A small group of pioneers have shown it to be a feasible technique for both the treatment of aortoiliac occlusive disease as for aneurysm repair [1,3,5,8,11]. However, vascular surgeons seem reluctant to introduce it into their everyday practice.…”

mentioning

confidence: 99%

Robot-assisted laparoscopic surgery of the infrarenal aorta

et al. 2007

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“…Inicialmente, o mesmo interesse e entusiasmo pela CVL não foi observado na cirurgia vascular 1,7 . Dificuldades técnicas iniciais na dissecção e clampeamento vascular, falta de materiais e acessórios específicos, dificuldade técnica e grande curva de aprendizado não estimularam muitos cirurgiões vasculares a se dedicarem à técnica videolaparoscópica 1,7,8 .…”

Section: Introductionunclassified

Curva de aprendizado em cirurgia aórtica videolaparoscópica: estudo experimental em porcos

Yoshida

Rollo

et al. 2008

J. vasc. bras.

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ResumoContexto: A cirurgia videolaparoscópica (CVL) vem evoluindo como alternativa cirúrgica menos invasiva para o tratamento da doença aterosclerótica oclusiva aorto-ilíaca e do aneurisma da aorta abdominal. Poucos estudos avaliaram objetivamente a curva de aprendizado com essa técnica em cirurgia vascular.Objetivo: Avaliar objetivamente os tempos e a evolução de cada passo cirúrgico e demonstrar a exeqüibilidade dessa técnica. Métodos:Entre outubro 2007 e janeiro de 2008, dois cirurgiões vasculares iniciantes na CVL operaram, após cursos e treinamentos, seis porcos consecutivos, com dissecção aórtica e interposição de um enxerto de dácron em um segmento da aorta infra-renal abdominal, com técnica totalmente laparoscópica.Resultados: Todos os tempos cirúrgicos foram decrescentes ao longo do estudo, apresentando redução de 45,9% no tempo total de cirurgia, 85,8% no tempo de dissecção da aorta, 81,2% na exposição da aorta, 55,1% no clampeamento total, 71% na confecção da anastomose proximal e 64,9% na anastomose distal. Conclusão:O presente estudo mostrou que os resultados técnicos satisfatórios da CVL vascular ocorreram somente após longa curva de aprendizado, que foi decrescente ao longo do tempo, à medida que aumentou a experiência e vivência com os materiais e com a visão não-estereoscópica. Essa técnica pode ser realizada com perfeição por cirurgiões vasculares desde que façam cursos especializados, com treinamento em simuladores e animais, e desde que busquem constante aprimoramento a fim de conseguir resultados similares aos obtidos com a cirurgia convencional.Palavras-chave: Cirurgia videoassistida, aorta, doenças vasculares, aprendizagem, modelos animais. AbstractBackground: Laparoscopic aortic surgery (LAS) is evolving as a minimal invasive alternative technique for the treatment of abdominal aortic aneurysms and peripheral aortoiliac arterial disease. Few articles have objectively evaluated the technique learning curve in vascular surgery.

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“…Dion et al pioneered towards the first total laparoscopic approach of the aortoiliac tract in 1993, by performing a laparoscopy assisted aortobifemoral bypass (Dion et al, 1993). Several open minded surgeons followed into his footsteps and several techniques for a total laparoscopic approach of aortoiliac disease were developed (Ahn et al, 1997;Alimi et al, 2000;Kolvenbach et al, 2001;Coggia et al, 2002). One-and-a-half decade later minimally invasive surgery of the aortoiliac vessels is performed only in a few centers around the globe.…”

Section: Introductionmentioning

confidence: 99%

“…The most demanding parts of the total laparoscopic approach for aortoiliac disease are the creation of sufficient and stable exposure, and suturing of the aortic anastomosis. Various techniques are described to approach the abdominal aorta, such as a retro-peritoneal approach, use of the "apron" technique (a peritoneal 'flap' which is used to suspend the bowel), or a total transabdominal approach with extreme lateral rotation of the patient (Ahn et al, 1997;Alimi et al, 2000;Wisselink et al, 2000;Kolvenbach et al, 2001;Coggia et al, 2002;Dion et al, 2003). Creation of the anastomosis requires a lot of skill, exercise and dexterity.…”

Section: Introductionmentioning

confidence: 99%

Robot Assisted Laparoscopic Surgery for Aortoiliac Disease: A Systematic Review

Diks¹,

Nio²,

Wisselink³

et al. 2008

Medical Robotics

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Robotic systems have been used to overcome the technical difficulties in laparoscopic aortoiliac surgery. In this chapter the outcomes of clinical and experimental studies using a robotic surgical system for treatment of aortoiliac disease are reviewed. MethodsA computerized search was conducted in the medical databases Medline (from January 2000 to July 2007), Embase (from January 2000 to July 2007) and the Cochrane Database of Systematic Reviews. Operative times, ICU-stay, clamping time, blood loss, anastomosis time, time to resume to solids, hospital stay, mortality and conversion rates were described. Experimental studies reporting on the creation of an aortic anastomosis with the robotic system were included. ResultsExperimental studies on vascular anastomoses showed equal results when compared to laparoscopy using the Zeus system, whereas the da Vinci robot showed better anastomosistimes and more precise anastomoses when compared to laparoscopic surgery. Five clinical studies were identified, with in total 70 patients. Operative time varied from 188 to 480 minutes, anastomosis time was 27 to 40.8 minutes. Total hospital stay differed between 4 and 7.3 days. An overall conversion rate of 7 (10%) was reported.

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Laparoscopic aortobifemoral bypass

Abstract: The benefits of a laparoscopic approach to aortobifemoral bypass grafting in terms of financial savings and earlier rehabilitation in this patient was significant. This less-invasive procedure warrants further investigation.

Cited by 39 publications

References 5 publications

Robot-assisted laparoscopic surgery of the infrarenal aorta

Robot-assisted laparoscopic surgery of the infrarenal aorta

Curva de aprendizado em cirurgia aórtica videolaparoscópica: estudo experimental em porcos

Robot Assisted Laparoscopic Surgery for Aortoiliac Disease: A Systematic Review

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