Total laparoscopic aortobifemoral bypass.

Abstract

To assess the feasibility of aortobifemoral bypass by a laparoscopic approach. During November 2002 through July 2003 a total of 21 patients with aorto-iliac occlusive disease underwent total laparoscopic aortobifemoral bypass surgery. The median operative time was 240 (range 150-420) min with a median aortic cross-clamp time of 60 (30-120) min. Operating time was reduced with experience. The median blood loss was 500 (100-2500) ml. One conversion to open surgery for acute dilation of the small bowel was necessary. Post-operative complications occurred in five patients (coagulation problems, disseminated intravascular coagulation secondary to thrombosis of the left limb, cerebro-vascular accident, dyspnoea, lymph leak) and there was no peri-operative death. Median hospital stay was 7 (5-30) days. Aorto-bifemoral bypass using a total laparoscopic approach can be performed safely. As all new techniques, a learning curve is observed. This new technique should be evaluated in a larger randomised trial to assess its clinical value in comparison to conventional surgery.