Totally Retroperitoneal Laparoscopic Aortobifemoral Bypass

Abstract

The classic procedure for aortobifemoral bypass is open surgery. Since the first totally laparoscopic aortobifemoral bypass reported in 1997 by Yves-Marie Dion, laparoscopy has been accepted by several authors as a possible minimally invasive alternative for aorto-iliac occlusive disease. The transperitoneal left retrocolic and retrorenal ways are generally used. The totally retroperitoneal laparoscopic procedure has been described as an alternative to the transperitoneal approach. We report here a totally laparoscopic retroperitoneal approach to performing aortobifemoral bypass. This approach was proposed to a 51-year-old man with aorto-iliac occlusive disease. There was no indication for endovascular revascularization. The patient suffered from 10 metres of bilateral intermittent claudication and lower limb ulcers. During the surgical procedure our patient was placed in a 30-degree right lateral decubitus position. The optical system was first placed in an intra-abdominal position to check the positioning of the trocars in the left retroperitoneal space. The dissection of the retroperitoneal space was performed by CO2 insufflation and by blunt dissection using laparoscopic forceps. The infrarenal aorta was exposed and clamped by laparoscopic clamps. A bifurcated graft was sutured on the left-hand side of the aorta by a running suture. Both prosthetic limbs were tunnelized retroperitoneally to the groin under optical control. The femoral anastomoses were performed by classic open surgery.

A minimally invasive approach for aortobifemoral bypass procedure

“…1 The lack of dependence on high-tech equipment, open construction of the vascular anastomosis within a short aortic clamping time with good control, and rush achievement of hemostasis, as well as avoidance of high intraabdominal pressures makes this technique superior to the endoscopic methods. [8][9][10] The ease and simplicity of the method prove the superiority of the transperitoneal exposure in comparison to other hybrid minimally invasive, endoscopic retroperitoneal approaches. 11,12 Smaller risk for perioperative complications like rupture, dissection, and embolization combined with the short operation time, avoidance of radiation, and significantly less endangering of the renal function represent clear advantages of this minimally invasive approach compared with the endovascular procedures.…”

“…5 The goal of evolving technologies such as endoscopic surgery to the abdominal aorta 7,8 attempted to reduce trauma to the patient, however, without optimally preserving the quality and safety of conventional surgical approaches. 8,9 A minimally invasive method of open surgical repair would allow low-risk treatment not only for young patients but also for patients with high-operative risk due to comorbidities (high comorbidity untreated risk factors).This report presents and evaluates a minimally invasive technique for aortoiliac revascularization that avoids extensive retroperitoneal exposure of the infrarenal aorta and injury of the nervous plexus and abdominal wall, gives the patient a significantly shorter period of recovery and maintains the quality and safety of the standard open surgical procedure. …”

“…5 The goal of evolving technologies such as endoscopic surgery to the abdominal aorta 7,8 attempted to reduce trauma to the patient, however, without optimally preserving the quality and safety of conventional surgical approaches. 8,9 A minimally invasive method of open surgical repair would allow low-risk treatment not only for young patients but also for patients with high-operative risk due to comorbidities (high comorbidity untreated risk factors).…”

Mediastinal surgery in connective tissue tunnels using flexible endoscopy

“…Controlled CO 2 insufflation can be used to provide atraumatic dissection of desired spaces in the mediastinum under direct visualization through the flexible endoscope [27,28]. This type of dissection of potential spaces in surgery of the retroperitoneum and preperitoneum, as in laparoscopic hernia repair or retroperitoneal adrenalectomy, has been shown to be safe and feasible and, in fact, the positive-pressure CO 2 makes the dissection and exposure better than traditional approaches and may provide some added hemostasis.…”

Epidémiologie et facteurs de risque des complications respiratoires majeures après chirurgie de l'aorte abdominale au CHU Ibn Sina, Maroc

“…L'intérêt préventif d'une incision transversale ou retro-péritonéale est cependant controversé [18]. Les techniques d'angioplastie endoluminales pour les AAA seraient responsables de moins de complications respiratoires [19–22].…”