Laparoscopy-assisted aneurysm resection as a minimal invasive alternative in patients unsuitable for endovascular surgery

Objective: So far, endovascular surgery has been the only minimal invasive way to treat patients with abdominal aortic aneurysms (AAAs). With hand-ass isted laparoscopic surgery (HALS), laparoscopic transperitoneal endoaneurys m repair can be performed through a 6-cm mini-incision only. We wanted to e valuate whether this laparoscopic technique can be offered as a minimal inv asive alternative in patients unsuitable for endovascular AAA repair. Material and Methods: Forty patients were referred for endovascular AAA rep air. Three patients had to be excluded from the study. Endovascular AAA exc lusion was finally performed in 13 patients. Laparoscopic AAA resection was performed in 24 patients. Hand-assisted laparoscopic surgery with transper itoneal access and endoaneurysm repair was accomplished in all patients uns uitable for an endovascular procedure. The outcome after endovascular repai r was compared with the outcome of patients who underwent laparoscopy. Results: In the laparoscopic group, conversion to an open procedure was nec essary in one case. One patient in this group died (4.1%) postoperatively. There were four complications in each group. In the endovascular group we h ad one endoleak type II and one graft thrombosis, which required a reoperat ion. After endovascular treatment, patients were transferred significantly less frequently to the intensive care unit, and they could resume oral feed ing earlier. Mobilization and postoperative hospital stay did not differ si gnificantly between the groups. Conclusion: Laparoscopic AAA resection with the use of the technique descri bed can be routinely offered to patients unsuitable for endovascular AAA ex clusion with excellent long-term results similar to open surgery. A control led study is clearly indicated to evaluate the role of laparoscopic techniq ues in aneurysm surgery.