Dion Y M, Gaillard F, Demalsy J C, Gracia C R
Department of Surgery, Hôpital Saint-François d'Assise, Quebec.
Can J Surg. 1996 Dec;39(6):451-5.
To describe a totally laparoscopic technique for aortobifemoral bypass to treat aortoiliac atheromatous occlusive disease.
A feasibility study.
A university teaching hospital.
Six piglets weighing between 70 and 80 kg were submitted to a totally laparoscopic retroperitoneal aortobifemoral bypass, performed through six trocar sites, with abdominal suspension and a gasless technique. No minilaparotomy was performed. After systemic heparinization, the infrarenal aorta was cross-clamped and the aortic bifurcation stapled. An end-to-end aorto-prosthetic anastomosis was performed. Retroperitoneal tunnels were created to allow each limb of the graft to join its corresponding femoral artery by a conventional anastomosis.
Totally laparoscopic aortobifemoral bypass.
Duration of the procedure, intraoperative blood loss and operative complications, bleeding in the immediate postoperative period. Evaluation of the aortic anastomosis at autopsy.
All aortobifemoral bypasses were completed in less than 4 hours. Intraoperative blood loss did not exceed 250 mL. No intraoperative complication was encountered except occasional bleeding at the aortic anastomosis upon releasing the arterial clamp. This was controlled with a collagen sponge (three cases) or extra stitches (two cases). The animals were observed for 15 minutes before sacrifice. Autopsy revealed a normal aortic anastomosis in all cases and a normal progression of the limbs of the graft under the ureters in the retroperitoneal tunnels.
This animal model demonstrates the feasibility of the aortobifemoral bypass through a laparoscopic approach. The retroperitoneal anatomy of the piglet is similar to that of man. Aortic surgery can be conducted as for the standard technique. We used a similar approach to perform the first human, totally laparoscopic aortobifemoral bypass with an end-to-end anastomosis.
描述一种用于治疗主髂动脉粥样硬化闭塞性疾病的全腹腔镜主动脉双股动脉旁路移植术技术。
一项可行性研究。
一所大学教学医院。
6只体重在70至80千克之间的仔猪接受了全腹腔镜腹膜后主动脉双股动脉旁路移植术，通过6个套管针穿刺点进行，采用腹部悬吊和气腹技术。未进行迷你剖腹手术。全身肝素化后，肾下腹主动脉被夹闭，主动脉分叉处用吻合器吻合。进行端到端主动脉-人工血管吻合。创建腹膜后隧道，使移植物的每个肢体通过传统吻合与相应的股动脉相连。
全腹腔镜主动脉双股动脉旁路移植术。
手术时间、术中失血和手术并发症、术后即刻出血情况。尸检时对主动脉吻合口进行评估。
所有主动脉双股动脉旁路移植术均在4小时内完成。术中失血不超过250毫升。除松开动脉夹时主动脉吻合口偶尔出血外，未遇到术中并发症。这通过胶原海绵（3例）或额外缝线（2例）得以控制。在处死动物前观察15分钟。尸检显示所有病例的主动脉吻合口正常，移植物肢体在腹膜后隧道中输尿管下方的走行正常。
该动物模型证明了通过腹腔镜途径进行主动脉双股动脉旁路移植术的可行性。仔猪的腹膜后解剖结构与人相似。主动脉手术可按标准技术进行。我们采用类似方法进行了首例全腹腔镜端到端吻合的主动脉双股动脉旁路移植术人体手术。
