Laparoscopic aortorenal bypass using a PTFE graft: Survival study in the porcine model

Purpose: To verify the technical feasibility of laparoscopic aortorenal byp ass in a porcine model and to evaluate renal pathologic findings after a sh ort survival time. Materials and Methods: Laparoscopic aorta-to-left-renal artery bypass using an interposition Gore-Tex graft was performed in five animals. Renal funct ion was assessed 1 week postoperatively and euthanasia performed after 14 d ays for histologic examination. Results: The median surgical time was 210 minutes (range 160-260 minutes). The median time needed to perform the aorta-to-graft anastomosis was 65 min utes (range 50-75 minutes), and the median time required to create the graf t-to-renal artery anastomosis was 50 minutes (range 45-60 minutes). No conv ersion to open surgery was needed. Two intraoperative complications were ob served: one large-bowel perforation, which was managed laparoscopically, an d one obstruction of the aorta-to-graft anastomosis caused by clots, which was managed by removal of clots with a balloon catheter. No major postopera tive complications were observed. The mean preoperative and postoperative s erum creatinine concentrations were 0.8 +/- 1.2 and 0.7 +/- 1.6 mg/dL, resp ectively. At autopsy, all but one of the pigs were found to have a patent a ortorenal bypass. In one pig, we found a partially clotted graft. Histologi c examination demonstrated an unremarkable kidney in four cases and a kidne y showing aspects of coagulative necrosis with viable cells in the animal w ith the partially clotted graft. Conclusions: Laparoscopic aortorenal bypass is feasible. The short-term eff ect of the bypass on kidney vascularization seems promising, as demonstrate d by pathologic findings. Laparoscopic aortorenal bypass could extend the i ndications for renal revascularization surgery.