LAPAROSCOPIC SUBSTITUTION OF THE ABDOMINA L-AORTA - EXPERIMENTAL-STUDY IN THE PIG

Background. Progress in abdominal laparoscopy led us to study end-to-e nd anastomoses performed laparoscopically. Method. An experimental pro tocol in 10 castrated male pigs weighing 74-95 kg was approved by the ethics committee. After conventional anesthesia, each animal was posit ioned in lateral decubitus and a retropneumoperitoneum was created. CO 2 inflation was maintained at 14 mmHg for insertion of 3 trocars, 5 to 10 mm width. The entire infrarenal aorta was dissected and resected w ith insertion of a 6 mm dacron prosthesis. Postoperative arteriography was performed in all cases. The animal was sacrificed for direct exam ination. Results. One animal died during anesthesia induction and the entire protocol was conducted in 9 animals. Mean operative time was 39 7 min (305-535 min) including a mean 123 min (65-150) for aortic disse ction, 82 min (30-155) for proximal anastomosis and 70 min (45-105) fo r distal anastomosis. Total blood loss varied from 100 to 450 cc (mean 252 cc). Mean difference between pre-and postoperative hematocrits wa s 4% (0-6 %). Among the 18 aortic anastomoses performed, arteriography showed one with moderate leakage and one anastomotic thrombus. Stenos is > 50 % was found in 4 cases and < 50 % in 4 cases. Analysis of the different operative parameters showed a learning curve with decreasing operative time and improved quality of the anastomoses. Conclusion. T his study demonstrates the feasibility of aortic reconstruction via re troperitoneal laparoscopy in the animal. This procedure could be intro duced in man.