Laparoskopische Aortenchirurgie

Gefässchirurgie (Impact Factor: 0.24). 01/2008; 13(1):17-23. DOI: 10.1007/s00772-007-0563-7


The following article describes our technique and results with total laparoscopic aortic aneurysm repair. A distinction must be made between laparoscopic-assisted procedures requiring a mini-incision to perform an anastomosis and total laparoscopic operations where the whole procedure is performed laparoscopically. In addition to aorto-femoral or ileo-femoral bypass procedures, total laparoscopic techniques can be used to perform abdominal aortic aneurysm resections. A transperitoneal left retrorenal access is preferred in most cases. Special laparoscopic clamps, often in combination with balloon catheters are used to occlude the aorta and if necessary the renal arteries. Exactly the same techniques as used in open surgery are transferred to a laparoscopic setting. Either a tube graft repair or a bifurcated graft anastomosed with the iliac bifurcation or the femoral artery is performed to exclude the aneurysm. Laparoscopic techniques can also be used to treat patients with type II endoleakage after EVAR or cases with endotension. Lumbar arteries or the IMA are clipped and if necessary downsizing of the aneurysm can be accomplished by opening the sac of the AAA, evacuating the thrombus material and stitching lumbar arteries from the inside. More recently laparoscopic techniques have been used to reduce the access trauma in debranching procedures. The learning curve of total laparoscopic aortic procedures is still steep, but new instruments, staplers or robotic devices will probably shorten this learning curve in the future. In an increasing number of European countries laparoscopic aortic surgery is becoming a third way to perform aortic repair. In contrast to EVAR it can offer to aneurysm patients the same definitive outcome and long lasting results as open surgery.

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    ABSTRACT: Die Fast-track-Chirurgie ist ein therapeutisches Konzept, das durch die Anwendung bestimmter Behandlungsmaßnahmen allgemeine Komplikationen nach operativen Eingriffen vermeiden soll. Es wurde Ende der 1990er Jahre von dem dänischen Chirurgen Prof. Kehlet entwickelt und erprobt. Ziel ist die Vermeidung allgemeiner und operationsspezifischer Komplikationen und eine optimierte Rehabilitation. Fester Bestandteil der Fast-track-Rehabilitation ist eine zeitnahe Mobilisation des Patienten noch am Operationstag. Anfangs heftig umstritten, etabliert sich die Methode seit 2004 in Deutschland. In der Gefäßmedizin sind bis dato nur wenige Fast-track-Konzepte aus der Literatur bekannt. Fast-track surgery is a therapeutic concept for minimizing perioperative complications by strictly controlling preoperative and postoperative risk factors. This concept was introduced in the 1990s by the Danish surgeon Prof. Kehlet and the aim is to avoid general and specific drawbacks and an optimized rehabilitation. A core part of the fast-track concept is mobilization of the patient beginning on the same day as surgery. Although strongly disputed during the first years after introduction, this method has now become established in general surgery in Germany since 2004. However, there is still a lack of data in the literature on fast-track concepts in vascular surgery. SchlüsselwörterFast-track-Konzept-Gefäßmedizin-Minimal-invasive Gefäßchirurgie KeywordsFast-track concept-Vascular medicine-Minimally invasive vascular surgery
    No preview · Article · May 2010 · Gefässchirurgie

  • No preview · Article · Aug 2009 · Zentralblatt für Chirurgie
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    ABSTRACT: Zur Hybridtherapie des thorakoabdominalen Aortenaneurysma wird für das Debranching der abdominalen Aorta eine Y-Bypass-Revaskularisationtechnik mit Auswahl der linken Beckenarterienachse als Spendergefäß beschrieben. Durch retroperitoneale Prothesenführung werden ein Kontakt zum Intestinuum und dessen deletäre Folgen für die Prothesenrekonstruktion verhindert. Die Operationstechnik beschränkt sich auf möglichst wenige Anastomosen und jeweils kurze, tolerable Organischämiezeiten. Die Bypassprothesenführung berücksichtigt die Vermeidung eine Prothesenabknickung. Eine obligatorische intraoperative angiographische Kontrolle gewährleistet einen hohen Sicherheitsgrad für die Funktionstüchtigkeit der Gefäßrekonstruktion von vital unverzichtbaren Zielorganen. Der Eingriff kann von älteren Patienten mit relevanten Komorbiditäten toleriert werden. Das Rekonstruktionsprinzip stellt ferner neben anderen eine Alternative in der Revaskularisation arteriosklerotischer Verschlussprozesse der Viszeralarterien bei Anginaabdominalis dar. A debranching operation using a Y-bypass from the left iliac artery is described as a part of the hybrid procedure in the treatment of thoracoabdominal aneurysms. By implantation of the bifurcated bypass graft into the retroperitoneum contact to the gastrointestinal tract is avoided and possible associated deleterious complications can be prevented. Regarding the operation technique is limited to the lowest possible number of anastomoses and short and tolerable time periods of organ ischemia. When planning a bypass alignment, possible kinking of the prosthesis should be considered. Mandatory intraoperative angiography ensures high grade evidence of successful vessel reconstruction in vital and indispensable tissue. This operative intervention can be tolerated by patients with relevant comorbidites. Furthermore the concept of vessel reconstruction illustrates an alternative method in revascularization of atherosclerotic occlusive visceral arteries causing abdominal angina. SchlüsselwörterDebranching–Aortenaneurysma–Bifurkationsprothese–Viszeralarterien–Angina abdominalis KeywordsDebranching–Aortic aneurysm–Bifurcated graft–Abdominal angina–Visceral artery
    Full-text · Article · Mar 2010 · Gefässchirurgie
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