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Totally Laparoscopic Aortic Surgery: Comparison of the Apron and Retrocolic Techniques in a Porcine Model

University of Montréal, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada

Stephane Elkouri, MD, MSc

Vascular Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada, stephane.elkouri{at}umontreal.ca

Nathalie Beaudoin, MD

Vascular Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada

Luc Bruneau, MD

Vascular Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada

Cathie Guimond

University of Montréal, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada

Véronique Daniel

Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada

Jean-François Blair, MD

Vascular Surgery Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada

This study evaluated the learning curve for a second-year general surgery resident and compared 2 totally laparoscopic aortic surgery techniques in 10 pigs: the transretroperitoneal apron approach and the transperitoneal retrocolic approach. Five end points were compared: success rate, percentage of conversion, time required, laparoscopic anastomosis quality, and learning curve. The first 3 interventions required an open conversion. The last 7 were done without complications. Mean dissection time was significantly higher with the apron approach compared with the retrocolic approach. The total times for operation, clamping, and arteriotomy time were similar. All laparoscopic anastomoses were patent and without stenosis. The initial learning curve for laparoscopic anastomosis was relatively short for a second-year surgery resident. Both techniques resulted in satisfactory exposure of the aorta and similar mean operative and clamping time. Training on an ex vivo laparoscopic box trainer and on an animal model seems to be complementary to decrease laparoscopic anastomosis completion time.

Key Words: laparoscopy • aortic aneurysm • vascular surgical procedures • arterial occlusive diseases • animal model • surgical learning curve • surgical education

Vascular and Endovascular Surgery, Vol. 41, No. 3, 230-238 (2007)
DOI: 10.1177/1538574407299800


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