Biomedical subjects

O Deling

Publications and source records attributed to O Deling.

6 recordsLinked to original sources

PubMed2001

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.

Aortic Aneurysm, Abdominal↗

PubMed2000

Video-assisted aortic surgery.

BACKGROUND: There are several laparoscopic techniques that can be used to perform a total or video-assisted aorto-femoral bypass grafting procedure. Major drawbacks of laparoscopic aortic surgery are the long operating times and the steep learning curve required for these procedures. Hand-assisted laparoscopy is a novel technique that allows surgeons to use their hands and laparoscopic instruments in the operative field while maintaining a pneumoperitoneum. STUDY DESIGN: A prospective nonrandomized study was conducted in a community medical center. Any patient with aortoiliac occlusive disease or an abdominal aortic aneurysm who was determined to be suitable for a laparoscopic aorto-femoral bypass grafting procedure was included in the study. The main outcomes measured were: operating time, aortic cross-clamp time, incision size, complications, conversion rate to an open procedure, length of stay in the ICU, and postprocedural hospital stay. A concurrent control group of 20 patients was compared with the minimally invasive group. RESULTS: Forty-one consecutive patients were scheduled for the laparoscopic operation. Conversion to an open procedure was necessary in three patients. There were two major complications, including the development of renal failure in one patient who died 28 days postoperatively. The mean postprocedural hospital stay was 4.5 +/- 2.5 days (range 2 to 15 days). The mean operating time was 163.1 +/- 38.7 minutes, including an aortic cross-clamp time of 38.3 +/- 9.7 minutes. Postoperative hospital stay and the time required in the ICU were significantly shorter after the laparoscopic procedure compared with a conventional bypass grafting procedure. CONCLUSIONS: Hand-assisted laparoscopy is a minimally invasive technique with operating times and outcomes similar to those of conventional procedures. The possibilities of this technique in patients with aortoiliac disease should be evaluated in a prospective randomized study.

Aged↗

PubMed2000

Descending aorta-to-femoral artery bypass: preliminary experience with a thoracoscopic technique.

Descending aorta-to-femoral artery bypass is a durable procedure with excellent long-term patency rates. The operation is usually performed using a lateral thoracotomy combined with retroperitoneal tunneling of the graft. Assuming that a smaller incision would reduce the operative trauma, minimally invasive video endoscopic techniques were used to perform a thoracoscopic bypass operation. In all patients, exposure of the descending aorta was obtained using thoracoscopy. This was accomplished with a maximum of four ports. For placing the conventional side-biting aortic clamp, a 3- to 4-cm incision was necessary. Using this incision as an access port, the proximal anastomosis was sutured endoscopically. Retroperitoneal tunneling was performed using laparoscopically guided balloon dissection. Eleven consecutive patients underwent surgery. In two patients, conversion to a standard thoracotomy was necessary because of extensive intrathoracic adhesions. There were no major complications, except for one hematoma. After a mean follow-up of 9.5 months, all bypass grafts were still patent. Patients could be discharged after a mean postprocedural hospital stay of 7.4 days (range, 5-12). Thoracoscopic descending aorta-to-femoral artery bypass is an operation with excellent patency rates; however, it is a novel technique that still requires further technical improvements. Clinical studies are needed to prove the safety and efficacy of this minimally invasive technique.

Abdomen↗

PubMed1998

[Dependence of surgical trauma in aortic interventions on the approach chosen. A prospective study].

Transabdominal aortic replacement is the most widely accepted approach for aortic surgery. Several controlled studies report a more favorable outcome after an extraperitoneal incision, yet there are an equal number of papers with contradictory results. The aim of our study was to assess operative trauma after aortic surgery, depending on whether transperitoneal or extraperitoneal access was used. As a parameter for the extent of the surgical trauma the concentration of Interleukin 6 and acute phase proteins (CRP) was measured pre-, 6 h and 24 h after aortic surgery. One group consisted of 34 patients scheduled for aortic surgery for exclusion of an abdominal aortic aneurysm. The second group consisted of 26 patients who were operated on for aorto-iliac occlusive disease. Each group was subdivided into an equal group of patients operated on either extra- or transperitoneally. In the retroperitoneal aneurysm patients, a posterolateral access was favored, and in patients with occlusive disease an extraperitoneal anterolateral approach was chosen. As a result patients with an extraperitoneal incision and aorto-iliac occlusive disease required less postoperative respiratory support than those operated on transperitoneally. In this subgroup of patients there was a significantly reduced synthesis of Interleukin 6 and CRP. When a retroperitoneal posterolateral approach was required in aneurysm patients, there was no difference between groups. We conclude from our data that only patients with limited infrarenal aortic access can benefit, from the retroperitoneal incision in terms of a reduced immunological reaction.

Acute-Phase Proteins↗

PubMed1998

Reducing the operative trauma in aortoiliac reconstructions--a prospective study to evaluate the role of video-assisted vascular surgery.

OBJECTIVE: To evaluate the role of the surgical access with regard to the generation of proinflammatory proteins in patients with aortoiliac occlusive disease. DESIGN: Non-random, prospective study of patients undergoing an aortobifemoral bypass procedure. MATERIALS: Twenty-six patients were divided into three groups. In the first group of eight patients, a transperitoneal median laparotomy was used. The second group comprised 10 patients in whom a laparoscopically assisted extraperitoneal minilaparotomy was performed and, in the third group, eight patients were operated on using a retroperitoneal access. METHODS: Biochemical analysis of acute phase proteins and the cytokines interleukin-6 (Il 6), interleukin-8 (Il 8) and tumour necrosis factor (TNF). RESULTS: Aortic cross-clamp and total operative time were significantly longer in the laparoscopic group. After 24 h Il-6 concentrations were significantly higher in the transperitoneal (p < 0.05) and the retroperitoneal group (p < 0.006). After 6 h there was a reduced Il-8 concentration in the laparoscopic group compared to patients with a standard retroperitoneal access. Neither TNF nor acute phase proteins showed any significant alterations. CONCLUSION: Laparoscopic-assisted vascular surgery allows for a smaller incision and reduces the surgical trauma, as it is reflected by interleukin levels.

Acute-Phase Proteins↗

PubMed1997

[Laparoscopy-assisted aortoiliac reconstructions].

Five patients underwent an aortobifemoral bypass using a laparoscope-assisted procedure. With the help of a wall-lifting device, balloon dissection of the retroperitoneum was performed. A total number of five ports were inserted and the aorta was dissected out from the bifurcation to the renal arteries under the guidance of a laparoscopic video camera. A 5-cm incision was required for suturing the proximal anastomosis of the bifurcated graft. Tunneling from the groin to the aorta was performed either video-assisted or with the help of the balloon dissector with a camera inside. All patients could be fully mobilized on the first postoperative day and were discharged after a mean hospital stay of 7.6 days. Mean length of the operation was 250 min. Originally, seven patients were scheduled for the video-assisted procedure. In two cases, we had to change to a conventional technique: in one case because we could not achieve adequate exposure of the aorta in an obese patient using a transperitoneal access, and in the second case owing to extensive adhesions after a bowel resection. Both patients had a regular, uneventful postoperative course. Gasless laparoscopy allowed us to use standard surgical instruments and most importantly a regular aortic clamp, which proved to be beneficial in a heavily calcified aorta. In conclusion, retroperitoneal gasless laparoscopic procedures can be safely performed in infrarenal aortoiliac reconstructions. Further clinical studies are required to prove the usefulness of this new technique.

Aged↗