LAPAROSCOPIC AORTOFEMORAL BYPASS - INITIAL EXPERIENCE IN AN ANIMAL-MODEL

Objective The study objective was to evaluate the feasibility of lapar oscopic aortofemoral bypass in a porcine model. Summary Background Dat a Laparoscopic techniques have been applied to numerous general and th oracic surgical procedures. Their application to vascular surgery has been virtually nonexistent. Open surgery for aortoiliac occlusive dise ase is accompanied by significant morbidity rates, and minimally invas ive procedures have the disadvantage of reduced patency rates. Laparos copic aortofemoral replacement has the theoretical advantage of long-t erm patency with reduced postoperative complications. Methods Between January and September 1993, laparoscopic surgery was performed on 16 p igs: 6 underwent transperitoneal laparoscopic aortic dissection and ve ssel control alone; 7 underwent complete transperitoneal laparoscopic aortofemoral bypass; and 3 underwent a retroperitoneal approach. The a ortic anastomosis was performed using a combination of sutures and tit anium clips in an end-to-side fashion in five pigs, and a custom-made nonsutured graft was secured with use of an end-to-end method in five pigs. Femoral anastomoses were performed with the standard open techni que. Results Technical success was achieved in all 10 animals and with no major complications. Mean blood loss was 20 mi (range, 5-50 mi), a nd mean operative time was 2.45 hours (range, 2-4 hrs). On aortic-clam p release, 2 of the end-to-side anastomoses required additional suture s to stop bleeding between oversized staples, and 2 of the end-to-end anastomoses required additional ties to reinforce loose ties. All 10 g rafts and anastomoses were patent and free of leaks after completion o f the procedure. Conclusions Laparoscopic aortofemoral bypass is techn ically feasible in a porcine model. Further experimental work with new instrumentation and technical refinement will make laparoscopic surge ry feasible for the treatment of vascular disease in humans.