laparoscopic aortic surgery
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- 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. 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. 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. 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. A LESS INVASIVE PROCEDURE !
- 6. LAPAROSCOPIC REVOLUTION ?LAPAROSCOPIC REVOLUTION ?
- 7. TOTAL LAPAROSCOPY Coggia et al. Eur J Vasc Endovasc Surg. 2002;24:274-5.
- 8. RETROCOLIC PRERENAL APPROACH
- 9. AORTIC OCCLUSIVE DISEASE-TASC D
- 10. AORTIC OCCLUSIVE DISEASE
- 11. LEFT RENAL ARTERY RESTENOSIS
- 12. AORTIC ANEURYSM
- 13. JUXTA RENAL AORTIC ANEURYSM
- 14. LUMBAR ARTERY PLUG
- 15. A NEW SURGICAL EXPERTISE ?A NEW SURGICAL EXPERTISE ?
- 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. 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. 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. (*) 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