EXPERIMENTAL LAPAROSCOPIC AORTOBIFEMORAL BYPASS

The goal of the present study is to develop a technique for laparoscop ic aortobifemoral bypass. Piglets weighing between 60 and 78 kg were a nesthetized with halothane. The lateral retroperitoneal approach was p referred to the more familiar anterior transperitoneal approach and wa s successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four othe r trocars were placed in the retroperitoneum after balloon inflation h ad allowed creation of a space which permitted visualization of the ao rta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained us ing an abdominal lift device and a retractor. Using this approach, we performed four aortobifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less tha n 4 h. Blood loss did not exceed 250 ml and the hematocrit remained st able. Postmortem evaluation of the grafts revealed they were positione d as in a conventional bypass, their limbs having followed in the crea ted retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that th is first performed series of totally retroperitoneal laparoscopic aort obifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region.