Totally laparoscopic aortobifemoral bypass grafting in an experimental model: description of technique with initial surgical results.

Our aim was to examine the feasibility of a totally laparoscopic insertion of a bifurcated aortofemoral bypass graft in a canine model and to compare the surgical results with those in control animals undergoing standard grafting and laparoscopic-assisted bypass procedures. Using a six-port approach, we exposed and cross clamped the aorta, tunneled a bifurcated Dacron graft, and performed an end-to-end aortic anastomosis while maintaining pneumoperitoneum by means of CO2. Proximal anastomoses were performed with 4/0 double-ended continuous Prolene sutures and distal anastomoses were performed through standard groin incisions. Total operating and aortic cross-clamp times were measured as was the total blood loss for each procedure. Clinical outcome was also documented. Eight female laboratory-bred hounds underwent successful totally laparoscopic aortobifemoral bypass grafting, eight underwent "open" grafting, and eight underwent laparoscopic-assisted bypass. Mean operating time was 193 minutes in the animals undergoing totally laparoscopic insertion vs. 156 minutes in the open group and 180 minutes in the laparoscopic-assisted group. Aortic cross-clamping time was also significantly longer at 87 minutes vs. 43 minutes (p < 0.001) in the totally laparoscopic group, but blood loss was less. All eight laparotomy and laparoscopic-assisted dogs were still alive with no complications at 28 days, whereas three of the eight in the totally laparoscopic group showed evidence of temporary paraplegia. This experimental study demonstrates that a totally laparoscopic approach can be used to insert a bifurcated aortofemoral bypass with a proximal end-to-end anastomosis but currently does not save time and may increase the risk of neurologic complications.