Total laparoscopic juxtarenal abdominal aortic aneurysm repair

Drawing shows the patient position, sites of trocar insertion, and basic setup of operating room equipment and personnel. Personnel are the operating surgeon, A; assistant for the laparoscope, B; assistant for instrumentation, C; and nurse, D. Trocar sites are for the 45° laparoscope, 1; operator instruments, 2 and 3; assistant instrumentation, 4 and 5; laparoscope and assistant instrumentation, 6; endoretractor, 7; and proximal aortic clamp, 8.

Drawing shows the positioning of suprarenal laparoscopic clamp through a port introduced in the left flank. A retractor maintains the viscera in the right part of the abdomen.

Operative view shows preparation of the infrarenal aorta for proximal anastomosis under suprarenal clamping. The arrow is pointing to the left renal artery.

(A), Operative view shows the proximal anastomosis with a Teflon cuff to reinforce the suture line and (B) after unclamping. The arrow points to the left renal artery.