Reducing the operative trauma in aortoiliac reconstructions--a prospective study to evaluate the role of video-assisted vascular surgery.

Abstract

To evaluate the role of the surgical access with regard to the generation of proinflammatory proteins in patients with aortoiliac occlusive disease. Non-random, prospective study of patients undergoing an aortobifemoral bypass procedure. Twenty-six patients were divided into three groups. In the first group of eight patients, a transperitoneal median laparotomy was used. The second group comprised 10 patients in whom a laparoscopically assisted extraperitoneal minilaparotomy was performed and, in the third group, eight patients were operated on using a retroperitoneal access. Biochemical analysis of acute phase proteins and the cytokines interleukin-6 (Il 6), interleukin-8 (Il 8) and tumour necrosis factor (TNF). Aortic cross-clamp and total operative time were significantly longer in the laparoscopic group. After 24 h Il-6 concentrations were significantly higher in the transperitoneal (p < 0.05) and the retroperitoneal group (p < 0.006). After 6 h there was a reduced Il-8 concentration in the laparoscopic group compared to patients with a standard retroperitoneal access. Neither TNF nor acute phase proteins showed any significant alterations. Laparoscopic-assisted vascular surgery allows for a smaller incision and reduces the surgical trauma, as it is reflected by interleukin levels.