LAPAROSCOPIC-ASSISTED ABDOMINAL AORTIC-ANEURYSM REPAIR

Since the advent of laparoscopy, the sweeping changes seen in general surgery have not been paralleled in vascular surgery. There have been case reports of laparoscopic-assisted aortobifemoral bypass for occlus ive disease. Because aneurysmal disease comprises the majority of aort ic surgery, we pursued animal and cadaveric feasibility studies for la paroscopic-assisted abdominal aortic aneurysm (AAA) repair. We present a case report of the first clinical case performed under Institutiona l Review Board protocol using this technique. The patient was a 62-yea r-old male with a 6-cm infrarenal AAA. After obtaining a pneumoperiton eum, a modified fish retractor was used to exclude the bowel. Ten 11-m m ports provided access to laparoscopically dissect the neck of the an eurysm and the iliac vessels. Then, a 10-cm minilaparotomy was perform ed and standard vascular clamps were inserted via the port incisions. Standard aneurysmorraphy was performed with a polytetrafluoroethylene (PTFE) tube graft. Laparoscopy conferred three major benefits: better visualization of the aneurysm neck, less bowel manipulation, and avoid ance of hypothermia. This case report illustrates the feasibility of l aparoscopic-assisted aneurysm repair. Controlled human studies will de fine the role of laparoscopy in AAA surgery.