GASLESS VIDEOENDOSCOPIC IMPLANTATION OF A ORTOBIFEMORAL VASCULAR PROSTHESES USING AN EXTRAPERITONEAL APPROACH - AN ANIMAL-EXPERIMENT

The gasless videoendoscopic implantation of GELSOFT aortobifemoral vas cular prostheses times 6x6 mm in diameter using an extraperitoneal app roach was tested in ten porcine experimental models at the Surgical De partment of the University of Cologne, Germany. Gasless videoendoscopi c surgery is performed with a laparolift-laparofan system. Aortobifemo ral GELSOFT prostheses were successfully implanted in nine of ten anim als, whereby one animal died during preparations for surgery of massiv e coronary infarctions. Average surgical durations using the extraperi toneal approach were 270 min. Dissection of the infrarenal aorta until occlusion took 45 min, average aortic occlusion 75 min, and iliacofem oral occlusion 45 min for the left side and 75 min for the right side. After successful videoendoscopic implantation of aortobifemoral GELSO FT prostheses all nine animals underwent laparotomy and resection of t he aortobifemoral prosthetic segment. The quality of the endoscopicall y sutured aortic end-to-side anastomoses was examined in vitro under a rtificial circulation of glycerol/Ringer's lactate solution for evalua tion of possible leakage and bursting pressures and then compared to c onventionally sutured end-to-side anastomoses of 6-h-old porcine abdom inal aorta and GELSOFT prostheses 6 mm in diameter. The maximum bursti ng pressure of all endoscopically sutured anastomoses was 480 mmHg mea n pressure; the minimum was 140 mmHg mean pressure. The minimum leakag e per minute was less than 10 ml/min for systolic pressure values betw een 120 and 350 mmHg. All endoscopically sutured aortic end-to-side an astomoses were comparable to conventionally sutured anastomoses concer ning in vitro evaluation of bursting pressure and leakage per minute.