laparoscopic aortic surgery

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  1. 1. J.-B Ricco, J. Cau, A. Valagier, G Rgnault de la Mothe University hospital, Poitiers, France XV. ULUSAL VASKLER CERRAHi KONGRES No conflict of interest to declare LAPAROSCOPIC AORTIC SURGERY AORTOiLiAK TIKAYICI HASTALIKLAR iiN LAPAROSKOPiK CERRAHi A Failed Innovation ?
  2. 2. PURPOSE The purpose of laparoscopic vascular surgery is to replicate the good and durable results of the classical open approach in patients with TASC D lesions or with AAA not amenable to endovascular treatment
  3. 3. FEASIBILITY 1993: Dion et al. in Surg Laparosc Endosc First laparoscopy-assisted aortobifemoral bypass 1993-2011: 45 publications (29 from EU) 1244 patients 830 for occlusive disease 414 for aneurysm
  4. 4. STUDY QUALITY All studies were observational, no RCTs Heterogeneity of the studies Inadequate description of the study population Suspected selection bias of patients Nio et al. Eur J Vasc Endovasc Surg 2007
  5. 5. A LESS INVASIVE PROCEDURE !
  6. 6. LAPAROSCOPIC REVOLUTION ?LAPAROSCOPIC REVOLUTION ?
  7. 7. TOTAL LAPAROSCOPY Coggia et al. Eur J Vasc Endovasc Surg. 2002;24:274-5.
  8. 8. RETROCOLIC PRERENAL APPROACH
  9. 9. AORTIC OCCLUSIVE DISEASE-TASC D
  10. 10. AORTIC OCCLUSIVE DISEASE
  11. 11. LEFT RENAL ARTERY RESTENOSIS
  12. 12. AORTIC ANEURYSM
  13. 13. JUXTA RENAL AORTIC ANEURYSM
  14. 14. LUMBAR ARTERY PLUG
  15. 15. A NEW SURGICAL EXPERTISE ?A NEW SURGICAL EXPERTISE ?
  16. 16. CLINICAL STUDY This study was planned by a group of vascular surgeons trained in laparoscopic aortic surgery to identify potential differences in the 30-day complication rate of total laparoscopic vs. open approach for aortic surgery. Cau J, Ricco JB et al. Total laparoscopic aortic repair for occlusive and aneurysmal disease: first 95 cases. Eur J Vasc Endovasc Surg. 2006 Cau J, Ricco JB. Laparoscopic aortic surgery: Techniques and results. J Vasc Surg 2008 Cau J, Ricco JB. Total laparoscopic renal artery bypass. J Vasc Surg. 2011
  17. 17. METHODS January 2006 to December 2009 228 consecutive patients with AAA or occlusive disease Total laparoscopic aortic surgery =83 open repair =145 Prospective study with propensity scoring Endpoint : composite adverse event at 30-day: Death, bleeding, graft thrombosis, MI, respiratory failure, colon ischemia, evisceration.
  18. 18. VARIABLES OPEN REPAIR (n=145) LAPAROSCOPY (n=83) p Female gender 19 (13.1) 11 (13.3) 0.97 Body mass index 25.64.1 25.14.4 0.38 COPD 45 (31.0) 24 (28.9) 0.74 Diabetes 12 (8.3) 7 (8.4) 0.97 Dyslipidemia 96 (66.2) 55 (66.3) 0.99 Coronary disease 54 (37.2) 26 (31.3) 0.39 Values in parentheses are percentages BASELINE CHARACTERISTICS
  19. 19. (*) All variables included in a regression model for propensity score VARIABLES OPEN REPAIR (n=145) LAPAROSCOPY (n=83) p * Age (years) 67.59.8 59.511.1