REDUCING THE OPERATIVE TRAUMA IN AORTOILIAC RECONSTRUCTIONS - A PROSPECTIVE-STUDY TO EVALUATE THE ROLE OF VIDEO-ASSISTED VASCULAR-SURGERY

Objective: To evaluate the role of the surgical access with regard to the generation of proinflammatory proteins in patients with aortoiliac occlusive disease. Design: Non-random, prospective study of patients undergoing an aortobifemoral bypass procedure. Materials: Twenty-six p atients were divided into three groups. In the first group of eight pa tients, a transperitoneal median laparotomy was used. The second group comprised 10 patients in whom a laparoscopically assisted extraperito neal minilaparotomy was performed and, in the third group, eight patie nts were operated on using a retroperitoneal access. Methods: Biochemi cal analysis of acute phase proteins and the cytokines interleukin-6 ( Il 6), interleukin-8 (Il 8) and tumour necrosis factor (TNF). Results: Aortic cross-clamp and total operative time were significantly longer in the laparoscopic group. After 24 h Il-6 concentrations were signif icantly higher in the transperitoneal (p < 0.05) and the retroperitone al group (p < 0.006). After 6 h there was a reduced Il-8 concentration in the laparoscopic group compared to patients with a standard retrop eritoneal access. Neither TNF nor acute phase proteins showed any sign ificant alterations. Conclusion: Laparoscopic-assisted vascular surger y allows for a smaller incision and reduces the surgical trauma, as it is reflected by interleukin levels.