Laparoscopic aortic reconstruction: early experience

BackgroundLaparoscopic reconstruction of the abdominal aorta has been described as early as 1993. The techniques used have varied but all have been labor intensive. With advances in laparoscopic technique and the available tools, the role in aortic reconstruction is expanding. The high cost of endovascular techniques as well as the morbidity of traditional open surgery has resulted in an increased focus on the laparoscopic approach. Our goal was to determine the feasibility of this technique.MethodsRetrospective review of the charts of patients undergoing laparoscopic aortobifemoral bypass grafting for chronic lower-limb occlusive disease.ResultsThirteen patients were selected for the procedure. Ten were completed successfully and form the basis of the report. The average length of stay was 6.7 days compared with a historic cohort of 12 days. The average operative time was 6.5 hours, more than twice as long as the open technique. There was a tendency to lower blood replacement and less abdominal pain. One patient suffered a stroke postoperatively; no deaths occurred.ConclusionThis procedure is technically challenging but can be performed safely and successfully with adherence to several key anatomic principles. More widespread adoption of this technique may lead to improvements in the instruments and other technologies. Our very early experience is encouraging. There appear to be benefits of reduced length of stay, but improved operative times will be required to make this technique truly valuable.