First experience with total laparoscopic reconstructive operations in occlusive lesion of the aortoiliac arterial segment

Mozgovoi P.V., Spiridonov E.G., Mandrikov V.V., Lukovskova A.A., Moiseev D.V., Pirozhenko P.A., Ufimtsev V.S., Korotkova A.I., Isaev A.V., Zharkin F.N.

Chair of Faculty Surgery with the Course of Endoscopic Surgery and with the Course of Cardiovascular Surgery of the Faculty for Advanced Medical Training, Volgograd State Medical University of the RF Health Ministry, Russia

According to the TASC II and the Russian National Guidelines on management of patients with lower limb arterial diseases, in patients with type C and D lesions of the arterial bed performing aortofemoral bifurcation bypass grafting is preferable. Laparoscopic technique makes it possible to combine advantages of minimally invasive surgery with well-known remote results of open reconstructive operations on the aortoiliac segment. The study included a total of 54 patients undergoing treatment at the Cardiosurgical Department of Clinic No 1 of the Volgograd State Medical University over the period from January 2012 to September 2015. The examined patients were subdivided into two groups. Group One was composed of the initial 26 patients operated on during the period from January 2012 to April 2014. Group Two comprised the remaining 28 patients operated on during the period from April 2014 to September 2015. Safety of performing the intervention was determined by prediction of the postoperative lethality and complications rates by means of the V-POSSUM scale. The predicted lethality and complications rates for both groups amounted to 2.3 and 23.5%, respectively. We carried out a comparative analysis of intraoperative data such as duration of the operative intervention, duration of mobilization of the aortoiliac segment, time of aortic cross-clamping, volume of intraoperative blood loss, intraoperative complications rate, conversion in the open access. In the early postoperative period we analysed the level of lethality, complications rate and indices of postoperative rehabilitation of the patient. For demonstrativeness of the dynamics of alterations of intraoperative indices, as well as for plotting the "learning curve" the moving average method was used.

Analysing the obtained findings revealed that implementation of total laparoscopic aortofemoral reconstructive operations was not accompanied by either high lethality or great number of complications, not exceeding the predicted indices by the V-POSSUM scale. The average duration of the operation in Group I amounted to 346±18.3 min, and in Group II to 316±13.3 min, with the time of aortic cross-clamping averaging 80±10.3 and 61±4.2 min and the volume of blood loss 898±23.5 ml, respectively. As experience was gained in performing laparoscopic reconstructive operations in Group Two patients the "learning curve" demonstrated a statistically significant decrease of these intraoperative values, as well as a decrease in the complication rate and parameters of the patient’s state in the postoperative period. Due to absence of extensive laparotomic or retroperitoneal accesses, the early postoperative period was characterised by rapid restoration of the passage along the intestine, early activation of patients, short length of stay in the intensive care unit and hospital stay.

KEY WORDS: aortic occlusion, aortofemoral bifurcation bypass grafting, laparoscopy, Leriche syndrome, "learning curve".

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