LAPAROSCOPIC AORTIC REPLACEMENT IN THE PORCINE MODEL - A FEASIBILITY STUDY IN PREPARATION FOR LAPAROSCOPICALLY ASSISTED ABDOMINAL AORTIC-ANEURYSM REPAIR IN HUMANS

BACKGROUND: Current laparoscopic vascular techniques have centered aro und aortofemoral bypass for the treatment of patients with aortic occl usive disease. However, the majority of aortic surgeries are performed for the treatment of aortic aneurysmal disease. With this mind, we un dertook this study to assess the feasibility of laparoscopic aortic re placement in the porcine model in preparation for laparoscopically ass isted abdominal aortic aneurysm (AAA) repair in humans. STUDY DESIGN: Twenty-three female pigs weighing between 35 and 40 kg underwent lapar oscopic aortic dissection by either a transabdominal or retroperitonea l approach. The infrarenal aorta was laparoscopically dissected, isola ted, and cross clamped. Then a custom designed cuffed polytetrafluoroe thylene graft was inserted. After reestablishing and confirming distal flow, the animals were sacrificed. RESULTS: Fifteen functioning aorti c grafts were placed in 21 animals who had the transabdominal approach . One functioning graft was placed in the retroperitoneal group. Compl ications included bladder, ureteral, inferior vena cava, renal vein, a nd aortic injuries. By the end of the study, the operative time was re duced from six to less than two hours; blood loss was reduced from 1,0 00 to 150 mL; and cross-clamping time was reduced from 60 to 15 minute s. CONCLUSIONS: In the porcine model, laparoscopic abdominal aortic re placement is associated with a significant learning curve. However, th is method of repair is technically feasible and warrants further inves tigation in the treatment of AAA in humans.