GASLESS VIDEOENDOSCOPIC IMPLANTATION OF AORTOBIFEMORAL VASCULAR PROSTHESES VIA TRANSPERITONEAL VERSUS EXTRAPERITONEAL APPROACH IN AN ANIMAL-MODEL

Background: The goal of this acute experimental study was to demonstra te the practicability and reproducibility of aortobifemoral bifurcatio nal prosthesis implantations via either a transperitoneal or extraperi toneal approach using gasless videoendoscopic instrumentation. The end oscopically sutured end-to-side aortic anastomoses were also examined for fluid tightness. Methods: Eighteen of the 20 domestic pigs in this experimental study received aortobifemoral vascular prostheses in a g asless videoendoscopic procedure. Bursting pressures and leakage (ml/m in) were compared for the endoscopically sutured aortic end-to-side an astomoses versus those sutured in conventional techniques using 6-h-ol d porcine aortas and 6-mm prostheses. Results: The surgical procedures averaged 4 h for the transperitoneal approach (n = 9) and 4.5 h for t he extraperitoneal approach (n = 9). However, these times were signifi cantly reduced with increasing routine. Average aortic occlusion times were 1 h for the transperitoneal approach and 1 h 15 min for the extr aperitoneal approach; the average iliacofemoral occlusion time ranged from 1 h 45 min with the transperitoneal approach to 1 h 15 min with t he extraperitoneal approach, depending on which side was involved. The re were no significant differences in in vitro bursting pressure or le akage amounts between endoscopic and conventionally sutured aortic end -to-side anastomoses. Conclusions: Gasless videoendoscopic implantatio n of aortobifemoral vascular prostheses in animal subjects is both pra cticable and reproducible using either a transperitoneal or extraperit oneal approach. The extraperitoneal approach has proven advantages ove r the transperitoneal approach. The in vitro fluid tightness achieved with endoscopically sutured aortic end-to-side anastomoses is comparab le to conventionally sutured anastomoses.