Laparoscopic aortic surgery: Techniques and results
Received 2 July 2008; accepted 8 August 2008. published online 23 October 2008.
Objective
This review describes and evaluates the results of laparoscopic aortic surgery.
Methods
We describe the different laparoscopic techniques used to treat aortic disease, including (1) total laparoscopic aortic surgery (TLS), (2) laparoscopy-assisted procedures including hand-assisted laparoscopic surgery (HALS), and (3) robot-assisted laparoscopic surgery, with their current indications. Results of these techniques are analyzed in a systematic review of the clinical series published between 1998 and 2008, each containing >10 patients with complete information concerning operative time, clamping time, conversion rate, length of hospital stay, morbidity, and mortality.
Results
We selected and reviewed 29 studies that included 1073 patients. Heterogeneity of the studies and selection of the patients made comparison with current open or endovascular surgery difficult. Median operative time varied widely in TLS, from 240 to 391 minutes. HALS had the shortest operating time. Median clamping time varied from 60 to 146 minutes in TLS and was shorter in HALS. Median hospital stay varied from 4 to 10 days regardless of the laparoscopic technique. The postoperative mortality rate was 2.1% (95% confidence interval, 1.4-3.0), with no significant difference between patients treated for occlusive disease or for aneurysmal disease. Conversion to open surgery was necessary in 8.1% of patients and was slightly higher with TLS than with laparoscopy-assisted techniques (P = .07).
Conclusions
Analysis of these series shows that laparoscopic aortic surgery can be performed safely provided that patient selection is adjusted to the surgeon's experience and conversion is liberally performed. The future of this technique in comparison with endovascular surgery is still unknown, and it is now time for multicenter randomized trials to demonstrate the potential benefit of this type of surgery.
aVascular Surgery Department, University Hospital, Poitiers, France
bThoracic and Vascular Surgery Department, University Hospital, Lausanne, Switzerland
Correspondence: Jean-Baptiste Ricco, MD, PhD, Vascular Surgery Department, University of Poitiers, Jean Bernard Hospital, Poitiers, France
STATEMENT OF CONFLICT OF INTEREST: Dr Cau has been a paid consultant for BBraun/Aesculap, Tuttlingen, Germany.
ABSTRACT