Mini invasive aortic surgery by transverse mini laparotomy. Early results.

Aim : The aim of this study was to present our mini invasive aorticsurgery experience and to describe the transverse mini laparotomytechnique we used to avoid disadvantages related to video assistedprocedure.Patients and method : From January 2001 to March 2002, 13 consecutivenon-randomized infra renal aortic reconstructions wereperformed, using transverse laparotomy. One woman and twelvemen were included in this group. Mean age was 63 (48 to 78). Surgicalindications were infra renal aortic aneurysm (AAA. n=6);occlusive aorto-iliac impairments (LIAO. n=7).Operative technique : A lumbar padded support is set beneath theprone patient. A 5 to 8 cm long transverse cutaneous section is performed,two finger width above umbilicus. For operating field expositionpurpose, a specific Denis Brown type circular low profiledretractor is used. Aortic aneurysm opening and anastomosis areperformed in a conventional way. Using this mini laparotomy technique,6 aorto aortic and 7 aorto femoral grafts were performed.Results : There was no operative death in this group. No failur e ofthe mini laparotomy i.e. no need to widen the cutaneous section.Mean dissection and aortic control duration was 17 min. (10 to 27min.) Mean aortic clamping duration was 43 min. (15 to 78 min.):29 min. for grafts, 59 min. for aneurysms. Mean total operativeduration was 152 min. (88 to 249 min.). In 5 patients, removal ofthe naso-gastric suction catheter occurred at the end of the operation.Mean feeding delay was 48 hours and mean hospitalizationduration was 6 days (5 to 7). Mean follow-up was 4 month (1 to13). All patients were asymptomatic with patent grafts at the time ofthe study.Conclusion : Mini laparotomy without laparoscopic help allowsocclusive aortic and infra renal aortic aneurysms treatment. Aorticcontrol is faster and global operative time is shorter compared toaortic video assisted surgery. Using a specific circular low profileretractor allows safe operating procedure with only one assistant.