Objective: Hand-assisted laparoscopic surgery (HALS) was previously employed to treat patients with infrarenal abdominal aortic aneurysm (IAAA). The use of HALS for juxtarenal abdominal aortic aneurysm (JAAA) has never been validated. In this study, we report our experience with this technique to demonstrate its feasibility and prove its safety in dealing with JAAA. Methods: From October 2000 to October 2008, we have selectively treated 271 patients with abdominal aortic aneurysm with the HALS technique. Of these, 83 were JAAAs which required a suprarenal aortic clamping (group A), and 188 were IAAA (group B). General data of the two groups were analyzed for comparability purposes and operative and postoperative data were prospectively collected. Additionally, patients in group A were stratified in three classes according to their pre-existing degree of renal function impairment. Statistical significance was defined at the P < .05 level. Results: Mean operative time was 220 minutes (plus or minus) 66 in group A and 231 minutes (plus or minus) 64 in group B (P > .05). The mean duration of suprarenal clamping was 28 minutes (plus or minus) 6; whereas infrarenal clamping lasted an average of 25 minutes (plus or minus) 5 (P > .05). Mean intraoperative blood loss was 1023 (plus or minus) 584 mL for group A and 961 (plus or minus) 633 mL for group B (P > .05). No conversion or 30-day postoperative mortality was recorded in either group. Sixteen percent of the patients in group A developed a postoperative complication, vs 11% in group B (P > .05). Mean postoperative stay for group A and B was 4.2 (plus or minus) 1.5 and 4.2 (plus or minus) 1.9 days, respectively (P > .05). Postoperative kidney function significantly worsened in 5 patients in group A (6%). A prolonged warm ischemia time (>40), pre-existing renal dysfunction, and diabetes, correlated to the development of postoperative renal insufficiency. Follow-up of patients averaged 37.9 (plus or minus) 20 months. The incidence of incisional hernias in group A and B was 15.5% vs 11.1%, respectively (P > .05). Conclusion: The HALS technique proved to be feasible and safe not only for patients with IAAA, but also for the management of patients with JAAA. No significant difference could be shown in the comparison between the two groups, apart from the expected higher rate of postoperative renal dysfunction after suprarenal clamping. In view of the demonstrated benefit of this minimally invasive approach, we believe that it should be included among the alternative options of treatment for these patients. (copyright) 2009 Society for Vascular Surgery.
M., F., D., A., R., B., A., D. C., & A., P. (2009). Laparoscopic-assisted treatment of abdominal aortic aneurysm requiring suprarenal cross-clamping. Journal of Vascular Surgery, 50(5), 1006–1011. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L355526286