Laparoscopic Aortic Surgery: Recent Development in Instrumentation

摘要

Beside conventional and endovascular techniques, laparoscopic surgery is becoming a third way to treat patients presenting with aortoiliac occlusive or aneurysmal diseases. Several different laparoscopic techniques have been described, but most authors are stressing on the need for development of a specific laparoscopic aortic instrumentation, in order to decrease the operative and clamping times and to reduce the learning curve. This article is presenting an overview of what is already available, as laparoscopic aortic clamps or laparoscopic intestinal retractor, and what is still experimental, like laparoscopic aortic staplers, anastomotic devices or robotic surgical systems. This important technologic challenge should lead to two major orientations: development of qualitative in vitro and in vivo experiments to test these new products and training courses to teach the manipulation of it. Minimally aggressive techniques are well adapted to a western population, which becomes older, and has access to constantly improving medical care; however, only a specific and ergonomic instrumentation will allow these new techniques to be widely embraced by the vascular surgical community.