GASLESS VIDEOENDOSCOPIC IMPLANTATION OF AORTOBIFEMORAL VASCULAR PROSTHESES VIA A TRANSPERITONEAL APPROACH - AN ANIMAL-EXPERIMENT

Background: Standard approach for aortobifemoral vascular prostheses i s the transperitoneal approach, following median laparorotomy and bila teral inguinal incision. The goal of this animal experiment was the de velopment of a new minimal-invasive surgical technique utilizing a les s-traumatic approach for aortobifemoral bypass. Methods: The gasless v ideoendoscopic implantation of 6 x 6 mm diameter aortobifemoral-bifurc ation prostheses in transperitoneal approach was tested at the Surgica l Department of the University of Cologne in 10 domestic pigs. Gasless videoendoscopic surgery is performed with a laparolift-laparfan-syste m. After videoendoscopic implantation of aortobifemoral prostheses, al l animals underwent laparotomy and resection of the aortobifemoral pro sthetic segment. The quality of the endoscopically sutured aortic end- to-side anastomoses was examined under artificial in-vitro circulation glycerol/ringer-lactate solution for evaluation of possible leakage a nd bursting pressures. Moreover, the anastomoses were compared to conv entionally sutured end-to-side anastomoses of six-hour old porcine abd ominal aortas and 6 mm diameter protheses. The maximum bursting pressu re of all endoscopically sutured anastomoses averaged 450 mmHg, whereb y the minimum bursting pressure mounted to 100 mmHg mean pressure. Res ults: Aortobifemoral prostheses were successfully implanted in 9 out o f 10 animals, one animal dying during preparation for the surgery succ umbing to massive coronary infarctions. Surgical durations for the tra nsperitoneal approach averaged four hours, whereby surgical durations were reduced with increasing experience to a minimum of 3 hours 30 min utes. Dissection of the infrarenal aorta until occlusion, required 35 minutes. Average aortic occlusion duration amounted to 1 hour; iliacof emoral occlusion duration amounted to 1 hour for each side. The leakag e per minute at the beginning achieved a maximum of 80 ml/min and syst olic pressure values of 350 mmHg in consideration of all flow levels, 60 ml/min for systolic pressure values of 200 mmHg and 20 ml/min for s ystolic pressure values of 120 mmHg. The minimum level leakage per min ute was less than 10 ml/min for systolic pressure values between 120-3 50 mmHg. Conclusions: Gasless videoendoscopic implantation of aortobif emoral vascular prostheses in transperitoneal approach is practicable in animal experiments. All endoscopically sutured aortic endo-side ana stomoses were comparable to conventionally sutured anastomoses In in-v itro evaluation of bursting pressure and leakage per minute.