GASLESS VIDEOENDOSCOPIC IMPLANTATION OF AN AORTOBIFEMORAL VASCULAR PROSTHESIS VIA A TRANSPERITONEAL VERSUS EXTRAPERITONEAL APPROACH - AN EXPERIMENTAL-STUDY

Purpose: To report progress in the development of a new minimally inva sive surgical technique for aortobifemoral grafting utilizing gasless videoendoscopy. Methods: In an experimental study, aortobifemoral Dacr on vascular prostheses were implanted in 20 human cadavers using video endoscopic techniques in both transperitoneal and extraperitoneal appr oaches. Rather than inducing pneumoperitoneum, the abdominal wall was elevated with an electrically powered lifting system. Results: Each ap proach was utilized in 10 cadavers for implantation of 20 aortobifemor al grafts under endoscopic guidance in a gasless field. Average operat ive time for the transperitoneal approach was 3.8 hours (range 3.0 to 5.5), slightly less than the average 4.1 hours (range 3.0 to 6.0) for the extraperitoneal access. Both access routes provided adequate visua lization of the operative field. Conclusions: Advantages of gasless en doscopy include the use of conventional instruments and the potential benefits associated with a minimally invasive approach. Optical magnif ication facilitates suturing of the femoral anastomosis, improves exam ination of the vascular walls, and allows a more accurate suturing tec hnique.