Laparoscopic aortoiliac surgery: lessons learned from the first 80 patients

Purpose : To analyze the results of our experimental and clinicalexperience of these new techniques.Methods : Experimental studies began in 1996 on living animalsand on cadavers. The aim was to:- learn how to teach these laparoscopic techniques ;- study the various approaches of the abdominal and thoracicaorta ;- develop specific laparoscopic instrumentation.After approval of the Ethics Committee of our University, a laparoscopicabdominal aortoiliac restoration was performed in 80 patients(76 men ; mean age: 62 years, range: 42 to 84 years), betweenJanuary 1998 and September 2002. These interventions were performedfor aortoiliac occlusive disease (AIOD, n = 45) and for infrarenalabdominal aortic aneurysm (AAA, n = 35), on the basis ofnon emergent conventional surgical indications. The restoratio nperformed was an aortic endarterectomy with closure by patch (n =1), an aorto-aortic tube (n = 16), an aorto-uni (n = 5) or bifemoral (n= 53) bypass, an aortobiiliac bypass (n = 3) or an aortoiliofemoralbypass (n = 2).Results : Experimental studies have made possible to design anddevelop:- laparoscopic aortic clamps ;- a laparoscopic intestinal retractor.Analysis of our clinical results shows that, compared with a totallylaparoscopic technique, performing a minilaparotomy in our patientsoperated on for AIOD significantly reduces operating andclamping durations (p < 0.001) and the length of hospitalization (p<0.001). These same parameters decreased significantly (p < 0.006)with the appearance of a learning curve in patients operated on forAAA.During a mean follow-up of 20.3 months (1 to 42 months), 3 latevascular reinterventions (5.7 %) were performed for occlusion ofone prosthetic limb due to intimal hyperplasia (n = 2) and for occlusionof an aortobifemoral bypass (n=1). No late redo surgery wasperformed on patients who underwent AAA repair.Conclusion : These preliminary results show the feasibility oflaparoscopic aortic restorations. This series reveals improved post -operative comfort, a reduction in the length of hospitalization andstable mid-term results.