Newly designed retraction devices for intestine control during laparoscopic aortic surgery

Barbera, L.; Ludemann, R; Grossefeld, M; Welch, Lawrence S.; Mumme, A.; Swanström, Lee L.

doi:10.1007/s004649900013

Cited by 31 publications

(8 citation statements)

References 10 publications

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“…Despite recent reports describing the feasibility of the laparoscopic approach for the management of aortic occlusive and aneurismatic disease [5–8] these studies focused on the surgical technique and its technical feasibility, without assessing hemodynamic and ventilatory stability or the patient's recovery from the procedure.…”

Section: Introductionmentioning

confidence: 99%

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Martín-Cancho

Crisóstomo

Soria

et al. 2008

Anesthesiology Research and Practice

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The aim of this study was to compare the hemodynamic and ventilatory effects of prolonged infrarenal aortic cross-clamping in pigs undergoing either laparotomy or laparoscopy. 18 pigs were used for this study. Infrarenal aortic crossclamping was performed for 60 minutes in groups I (laparotomy, n = 6) and II (laparoscopy, n = 6). Group III (laparoscopy, n = 6) underwent a 120-minute long pneumoperitoneum in absence of aortic clamping (sham group). Ventilatory and hemodynamic parameters and renal function were serially determined in all groups. A significant decrease in pH and significant increase in PaCO2 were observed in group II, whereas no changes in these parameters were seen in group I and III. All variables returned to values similar to baseline in groups I and II 60 minutes after declamping. A significant increase in renal resistive index was evidenced during laparoscopy, with significantly higher values seen in Group II. Thus a synergic effect of pneumoperitoneum and aortic cross-clamping was seen in this study. These two factors together cause decreased renal perfusion and acidosis, thus negatively affecting the patient's general state during this type of surgery.

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Section: Introductionmentioning

confidence: 99%

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Martín-Cancho

Crisóstomo

Soria

et al. 2008

Anesthesiology Research and Practice

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“…The main technical difficulties are the exposure of the abdominal aorta hampered by the small intestine, which blinds the operative field, and the performance of laparoscopic anastomoses. [5][6][7][8] We have described a transperitoneal laparoscopic approach, which allows a simple and reproducible exposure of the infrarenal abdominal aorta. 9 Taking advantages of our previous experience in laparoscopic surgery for aortoiliac occlusive disease (AIOD), we used this new total laparoscopic technique for AAA repair.…”

mentioning

confidence: 99%

Total laparoscopic infrarenal aortic aneurysm repair: Preliminary results

Coggia

Javerliat

Centa

et al. 2004

Journal of Vascular Surgery

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These preliminary results show that total laparoscopic AAA repair is feasible and worthwhile for patients once the learning curve is overcome. However, prior training and experience in laparoscopic aortic surgery are needed to perform total laparoscopic AAA repair. Despite these encouraging results, a greater experience and further evaluation are required to ensure the real benefit of this technique compared with open AAA repair.

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“…The difficulties of aortic exposure during laparoscopic procedures have been lessened by the apron technique 16 and by applying different types of retractors. 17,18 However, videoscopic suturing of the aortic anastomosis remains a major limitation to wider application of these techniques. Videoscopic aortic suturing increases aortic crossclamp time even in the hand of an experienced laparoscopic surgeon.…”

Section: Discussionmentioning

confidence: 99%

Stapled Aortic Anastomoses: A Minimally Invasive, Feasible Alternative to Videoscopic Aortic Suturing?

Elkouri¹,

Noel²,

Gloviczki³

et al. 2004

Vasc Endovascular Surg

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Widespread applications of totally laparoscopic aortic reconstructions have been limited by the long cross-clamp time required to suture the aortic anastomosis despite improvement in instrumentation. The authors' hypothesis was that a "one-step anastomosis concept" using an intraluminal stapler would allow shorter cross-clamp time but similar patency and imperviousness as videoscopic suturing techniques. An intraluminal stapler (Endopath-ILS, Ethicon) with a modified anvil was used to perform videoscopic-assisted thoracic aorta-to-iliac artery bypass with a 21 mm by 8 mm polytetrafluoroethylene (PTFE) graft in 22 sheep through a minimally invasive approach using a 5 cm thoracotomy. The graft-to-iliac artery anastomoses were hand sutured through a flank incision. Twelve sheep were used to establish the technique and 10 subsequent animals constituted the study group. Aortic cross-clamp time, imperviousness, and need for additional sutures were recorded and compared to previously reported data using videoscopic suturing in pigs. Patency was assessed by comparing lower limb arterial pressures. Macroscopic and microscopic examinations of the anastomoses were performed at different time-points within the first 3 months. Videoscopic-assisted stapled anastomoses were also performed on atherosclerotic aortas of 3 human cadavers. Stapled anastomoses between the thoracic aorta and PTFE graft were completed in 8 of 10 animals. Two animals were euthanized after stapler failure and anastomotic bleeding. Sutures to strengthen the anastomosis had to be used in 4 cases. Mean aortic cross-clamp time in 8 successful cases was 4.3 +/-2.9 minutes (range 2-11 minutes) and was significantly shorter than clamp time of videoscopic suturing technique (48.7 +/-9.4 minutes, p < 0.0001). Imperviousness was good or excellent in 4 animals and fair in 4 animals. All anastomoses were patent at the end of the procedure. Examination of the anastomosis of the 2 failed interventions showed medial aortic tear surrounding the anastomosis in 1 case and misfired staples in the other. No graft occlusion was noted during follow-up ranging from 0 to 12 weeks. At the time of harvest, no bleeding was noted after epinephrine and volume infusion to increase mean arterial pressure to 200 mm Hg for 15 minutes. Macroscopic examination of the anastomoses revealed adequate healing with circumferential stapling of the prosthesis to the aortic wall and no stenosis or thrombus except in 1 false aneurysm (1/7, 14%). Surface electron microscopy showed cells coverage of the anastomosis surface. When applied on human cadaver thoracic and abdominal aorta with atherosclerotic changes, clamping times of less than 5 minutes were achieved. However, imperviousness tested with saline was poor. An automatic stapling device allows performance of a graft-to-aorta anastomosis through a minimally invasive approach with shorter clamping time than a videoscopic suturing technique. However, the current technique of aortic stapling is unreliable and further improvements are needed.

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Newly designed retraction devices for intestine control during laparoscopic aortic surgery

Cited by 31 publications

References 10 publications

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

Total laparoscopic infrarenal aortic aneurysm repair: Preliminary results

Stapled Aortic Anastomoses: A Minimally Invasive, Feasible Alternative to Videoscopic Aortic Suturing?

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