Totally laparoscopic abdominal aortic aneurysm repair

On the basis of our previous animal and clinical experience with laparoscop ic intra-abdominal vascular reconstructions, and due to the prevalence of a bdominal aortic aneurysms (AAA), we have recently broadened our scope to ta ckle more difficult aortic surgery laparoscopically. We present a case repo rt of our first clinical experience with laparoscopic AAA repair using spec ialized laparoscopic vascular instrumentation. The patient was an 84-year-o ld hypertensive male with a 7-cm asymptomatic infrarenal abdominal aortic a neurysm that was discovered incidentally. He presented with postcoronary ar tery bypass grafting and had moderate chronic obstructive pulmonary disease (COPD). A spiral computed tomograph (CT) angiogram revealed an adequate in frarenal neck and aneurysmal involvement of the proximal iliac arteries. An eight-port transabdominal technique was used with the patient in the supin e position. Proximal and distal control was achieved without difficulty. Th e aneurysm was excluded using endoscopic stapling devices, and an aortobiil iac reconstruction was performed with a 16 x 9-mm bifurcated dacron graft. Estimated blood loss was 1000 ml, and the operative time was approximately 7 hours. The patient was ambulating without assistance on postoperative day 3. Total hospitalization was 7 days (delayed secondarily to postoperative ileus). Minimal quantities of narcotics were required for analgesia. At B-m onths follow-up, the patient has palpable peripheral pulses and no complica tions related to surgery. This case report shows that a completely laparosc opic approach to the abdominal aortic aneurysm is possible using instrument ation specifically designed for laparoscopic vascular surgery. The exact ro le that laparoscopic techniques will hold in vascular surgery remains to be determined because these procedures are time consuming and technically dif ficult.