Laparoscopy-assisted aneurysm resection as a minimal invasive alternative in patients unsuitable for endovascular surgery

Objective: So far, endovascular surgery has been the only minimal invasive way to treat patients with abdominal aortic aneurysms (AAAs). With hand-assisted laparoscopic surgery (HALS), laparoscopic transperitoneal endoaneurysm repair can be performed through a 6-cm mini-incision only. We wanted to evaluate whether this laparoscopic technique can be offered as a minimal invasive alternative in patients unsuitable for endovascular AAA repair. Material and Methods: Forty patients were referred for endovascular AAA repair. Three patients had to be excluded from the study. Endovascular AAA exclusion was finally performed in 13 patients. Laparoscopic AAA resection was performed in 24 patients. Hand-assisted laparoscopic surgery with transperitoneal access and endoaneurysm repair was accomplished in all patients unsuitable for an endovascular procedure. The outcome after endovascular repair was compared with the outcome of patients who underwent laparoscopy. Results: In the laparoscopic group, conversion to an open procedure was necessary in one case. One patient in this group died (4.1%) postoperatively. There were four complications in each group. In the endovascular group we had one endoleak type II and one graft thrombosis, which required a reoperation. After endovascular treatment, patients were transferred significantly less frequently to the intensive care unit, and they could resume oral feeding earlier. Mobilization and postoperative hospital stay did not differ significantly between the groups. Conclusion: Laparoscopic AAA resection with the use of the technique described can be routinely offered to patients unsuitable for endovascular AAA exclusion with excellent long-term results similar to open surgery. A controlled study is clearly indicated to evaluate the role of laparoscopic techniques in aneurysm surgery.