Abordaje aórtico transperitoneal retrorrenal para el bypass aortobifemoral totalmente laparoscópico

Summary. Introduction. The main obstacle that laparoscopic aortic surgery has to overcome is the approach to and exposure of the abdominal aorta. Today, the preferred path that makes this technique possible is the transperitoneal retrorenal approach. We report the first two cases in Spain of totally laparoscopic aortofemoral bypasses performed using this approach. Case reports. Case 1: a 40-year-old male with bilateral disabling claudication. Vascular examination of the lower limbs: absence of pulses in the right lower limb (LL); weak left femoral pulse, with absence of the others. Aortoarteriography, Doppler ultrasound of the LL: right iliac occlusion and iliofemoral stenosis in the left axis. Surgical intervention: totally laparoscopic aortobifemoral bypass. Right lateral decubitus 80°. Dissection parallel to Toldt's fascia. Deep dissection through the retrorenal fascia. End-to-side aortoprosthetic suture, two 3/0 polypropylene hemisutures. Total surgery time: 8 hours. Extubation at 4 hours. Oral tolerance: 2nd day. Discharge: 4th day with bilateral distal pulses. Case 2: a 53-year-old male with disabling claudication of the calf at 20 m in the right LL. Vascular examination: absence of pulses at all levels in right LL. In left LL, femoral bruit, the others positive. MR angiography, Doppler ultrasound: right iliofemoral occlusion and left mild iliofemoral stenosis. Surgical intervention: totally laparoscopic right aortofemoral bypass. Right lateral decubitus 80°. Retrorenal dissection with retraction of the spleen and left kidney. Dissection from the left common iliac, and along the aortic edge as far as the overturned left renal artery. End-to-side aortoprosthetic anastomosis with 3/0 PTFE, two hemisutures. Total surgery time: 4 hours and 20 minutes. Extubation at 3 hours. Oral tolerance: 2nd day. Discharge: 4th day with bilateral distal pulses. [ANGIOLOGIA 2008; 60: 255-62]