TOTALLY LAPAROSCOPIC AORTOBIFEMORAL BYPASS-GRAFTING IN AN EXPERIMENTAL-MODEL - DESCRIPTION OF TECHNIQUE WITH INITIAL SURGICAL RESULTS

Our aim was to examine the feasibility of a totally laparoscopic inser tion of a bifurcated aortofemoral bypass graft in a canine model and t o compare the surgical results with those in control animals undergoin g standard grafting and laparoscopic-assisted bypass procedures. Using a six-port approach, we exposed and cross clamped the aorta, tunneled a bifurcated Dacron graft, and performed an end-to-end aortic anastom osis while maintaining pneumoperitoneum by means of CO2. Proximal anas tomoses were performed with 4/0 double-ended continuous Prolene suture s and distal anastomoses were performed through standard groin incisio ns. Total operating and aortic cross-clamp times were measured as was the total blood loss for each procedure. Clinical outcome was also doc umented. Eight female laboratory-bred hounds underwent successful tota lly laparoscopic aortobifemoral bypass grafting, eight underwent ''ope n'' grafting, and eight underwent laparoscopic-assisted bypass. Mean o perating time was 193 minutes in the animals undergoing totally laparo scopic insertion vs. 156 minutes in the open group and 180 minutes in the laparoscopic-assisted group, Aortic cross-clamping time was also s ignificantly longer at 87 minutes vs. 43 minutes (p < 0.001) in the to tally laparoscopic group, but blood loss was less. All eight laparotom y and laparoscopic-assisted dogs were stilt alive with no complication s at 28 days, whereas three of the eight in the totally laparoscopic g roup showed evidence of temporary paraplegia. This experimental study demonstrates that a totally laparoscopic approach can be used to inser t a bifurcated aortofemoral bypass with a proximal end-to-end anastomo sis but currently does not save time and may increase the risk of neur ologic complications.