Total Laparoscopic Aortobifemoral Bypass

Lee, Teaseung; Ra, Hwan Do; Kim, Hyung Ho; Han, Ho Seoung; Ha, Jongwon; Chung, Jung Kee; Kim, Sang Joon

Abstract

Standard open surgery for aortoiliac occlusive disease has achieved excellent long-term patency, but is accompanied by postoperative morbidity, including ileus, pain and delayed functional recovery. A laparoscopic approach to the aorta may afford several advantages as a less invasive modality. Herein, our two experiences of a total laparoscopic aortobifemoral bypass (LABF) are reported. Two males, 57 and 73-years old, presented with a history of resting pain in both legs (especially right) and progressing severe claudication, respectively. The patients were positioned in right lateral decubitus, with their left side elevated between 70degrees to 80degrees using a pillow and tilted table. Five ports under the pneumoperitoneum were used for the procedure (five ports; 10 to 12 mm). The laparoscopic techniques consisted of aortic dissection, vascular control and intracorporeal anastomosis. The approach to the aorta in the transperitoneal left retrocolic plane was used for the first case, and in the transperitoneal left retrorenal plane for the second. Laparoscopic anastomosis was performed through two continuous running intracorporeal sutures and multiple interrupted sutures. The aortic clamping times were 178 and 185 minutes, respectively. The operative times were 415 and 530 minutes, with liquid diets initiated on the second and third postoperative days, respectively. Both patients suffered minimal postoperative pain, and were subsequently discharged. Total laparoscopic aortobifemoral bypass is more technically demanding than an open procedure. However, our experiences indicate that total laparoscopic aortic surgery is worthy of further development.