EXPERIMENTAL LAPAROSCOPIC AORTOBIFEMORAL BYPASS FOR OCCLUSIVE AORTOILIAC DISEASE

OBJECTIVE: To describe a totally laparoscopic technique for aortobifem oral bypass to treat aortoiliac atheromatous occlusive disease. DESIGN : A feasibility study. SETTING: A university teaching hospital. SUBJEC TS: Six piglets weighing between 70 and 80 kg were submitted to a tota lly laparoscopic retroperitoneal aortobifemoral bypass, performed thro ugh six trocar sites, with abdominal suspension and a gasless techniqu e. No minilaparotomy was performed. After systemic heparinization, the infrarenal aorta was cross-clamped and the aortic bifurcation stapled . An end-to-end aorto-prosthetic anastomosis was performed. Retroperit oneal tunnels were created to allow each limb of the graft to join its corresponding femoral artery by a conventional anastomosis. INTERVENT ION: Totally laparoscopic aortobifemoral bypass. MAIN OUTCOME MEASURES : Duration of the procedure, intraoperative blood loss and operative c omplications, bleeding in the immediate postoperative period. Evaluati on of the aortic anastomosis at autopsy. RESULTS: All aortobifemoral b ypasses were completed in less than 4 hours. Intraoperative blood loss did not exceed 250 mL. No intraoperative complication was encountered except occasional bleeding at the aortic anastomosis upon releasing t he arterial clamp. This was controlled with a collagen sponge (three c ases) or extra stitches (two cases). The animals were observed for 15 minutes before sacrifice. Autopsy revealed a normal aortic anastomosis in all cases and a normal progression of the limbs of the graft under the ureters in the retroperitoneal tunnels. CONCLUSIONS: This animal model demonstrates the feasibility of the aortobifemoral bypass throug h a laparoscopic approach. The retroperitoneal anatomy of the piglet i s similar to that of man. Aortic surgery can be conducted as for the s tandard technique. We used a similar approach to perform the first hum an, totally laparoscopic aortobifemoral bypass with an end-to-end anas tomosis.