Jones D B, Thompson R W, Soper N J, Olin J M, Rubin B G
Department of Surgery, Washington University School of Medicine, St. Louis, MO 63100, USA.
J Vasc Surg. 1996 Mar;23(3):466-71. doi: 10.1016/s0741-5214(96)80012-7.
Transperitoneal and retroperitoneal approaches to video-assisted aortofemoral bypass were developed and compared using gasless laparoscopic techniques in a porcine model.
Ten pigs were randomized to either a transperitoneal or retroperitoneal approach. Aortic clamp time, total operative time, and complications were recorded. Both operations used an external lift device to maintain the working space. Retroperitoneal operations first used serial balloon inflation to dissect the retroperitoneum. After exposure of the infrarenal aorta, a graft was tunneled under endoscopic visualization. End-to-side aortic and femoral anastomoses were created with conventional instruments through 4 cm incisions.
Mean +/- SEM aortic clamp time, operative duration, and graft patency rates were similar for both approaches (difference not significant by unpaired t test). Intraoperative complications related to the use of the laparoscopic technique included injury to the bladder and small bowel (n=2) and occurred only in the transperitoneal group.
The use of a gasless technique allowed direct visualization, standard instrumentation, and conventional anastomotic techniques. The retroperitoneal approach used the peritoneal sac to exclude the bowel, simplifying the aortic dissection. Gasless laparoscopic-assisted aortofemoral bypass can be performed by both transperitoneal and retroperitoneal approaches and holds promise as a minimally invasive treatment for aortoiliac occlusive disease.
在猪模型中，采用无气腹腔镜技术开发并比较经腹和腹膜后途径的电视辅助主动脉股动脉搭桥术。
将10头猪随机分为经腹组或腹膜后组。记录主动脉钳夹时间、总手术时间和并发症。两种手术均使用外部提升装置来维持工作空间。腹膜后手术首先使用系列球囊扩张来分离腹膜后间隙。暴露肾下腹主动脉后，在内镜直视下建立移植物隧道。通过4厘米切口，使用传统器械进行主动脉与股动脉的端侧吻合。
两种手术入路的平均±标准误主动脉钳夹时间、手术持续时间和移植物通畅率相似（经不成对t检验差异无统计学意义）。与腹腔镜技术使用相关的术中并发症包括膀胱和小肠损伤（n = 2），且仅发生在经腹组。
无气技术的应用实现了直接可视化、标准器械使用和传统吻合技术。腹膜后入路利用腹膜囊将肠管排除在外，简化了主动脉分离。无气腹腔镜辅助主动脉股动脉搭桥术可通过经腹和腹膜后两种途径实施，有望成为治疗主髂动脉闭塞性疾病的微创治疗方法。
