Totally Laparoscopic Aortic Surgery: Comparison of the Apron and Retrocolic Techniques in a Porcine Model

Abstract

This study evaluated the learning curve for a second-year general surgery resident and compared 2 totally laparoscopic aortic surgery techniques in 10 pigs: the transretroperitoneal apron approach and the transperitoneal retrocolic approach. Five end points were compared: success rate, percentage of conversion, time required, laparoscopic anastomosis quality, and learning curve. The first 3 interventions required an open conversion. The last 7 were done without complications. Mean dissection time was significantly higher with the apron approach compared with the retrocolic approach. The total times for operation, clamping, and arteriotomy time were similar. All laparoscopic anastomoses were patent and without stenosis. The initial learning curve for laparoscopic anastomosis was relatively short for a second-year surgery resident. Both techniques resulted in satisfactory exposure of the aorta and similar mean operative and clamping time. Training on an ex vivo laparoscopic box trainer and on an animal model seems to be complementary to decrease laparoscopic anastomosis completion time.

Animal Models in the Research of Abdominal Aortic Aneurysms Development

“…This patch often of vein or serosa origin, although synthetic patches have also been used. A significant number of modifications of the original protocol have been proposed, aiming in higher incidence of AAA induction with predictable results (Huynh et al 2007, Kajimoto et al 2008, Lerouge et al 2004, Murphy et al 2007, Scholz et al 2008, Mucke et al 2008, Allaire et al 2002, Soulez et al 2007. Despite many similarities existing between surgically induced AAA in animal models and human AAA development, such as main AAA morphological characteristics, there are noticeable differences, such as the increase of SMC and aortic fibroblasts in some animal models that come into contradictions with the human AAA development process (Molacek et al 2009, Scholz et al 2008, Mucke et al 2008.…”