Asian Annals
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Hitoshi Ogino
Masahiko Matsumoto
Takaaki Sugita
Junichiro Nishizawa
Katsuhiko Matsuyama
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ogino, H.
Right arrow Articles by Tokuda, Y.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Ogino, H.
Right arrow Articles by Tokuda, Y.
Related Collections
Right arrow Minimally invasive surgery
Asian Cardiovasc Thorac Ann 2001;9:347-348
© 2001 Asia Publishing EXchange Pte Ltd

HOW TO DO IT

Mini-Incision Midline Approach for Infrarenal Abdominal Aortic Aneurysms

Hitoshi Ogino, MD, Masahiko Matsumoto, MD, Takaaki Sugita, MD, Junichiro Nishizawa, MD, Katsuhiko Matsuyama, MD, Tatsuya Yoshioka, MD, Yoshiyuki Tokuda, MD

Department of Cardiovascular Surgery Tenri Hospital Tenri, Nara, Japan
For reprint information contact: Hitoshi Ogino, MD Tel: 81 6 6833 5012 Fax: 81 6 6872 7486 email: hogino{at}hsp.ncvc.go.jp Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.

   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 TECHNIQUE
 DISCUSSION
 REFERENCES
 
A small (13.1 ± 1.3 cm) anterior midline incision is described for graft replacement of infrarenal abdominal aortic aneurysms. Stoney vasculature retractors were employed to achieve sufficient exposure. The operative outcome was satisfactory in 33 elective cases.


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
TECHNIQUE
 DISCUSSION
 REFERENCES
 
Surgical approaches for abdominal aortic aneurysm (AAA) repair may be transperitoneal or retroperitoneal.1–5 The advantages of the former are rapid access and easy detection of intraabdominal problems; the drawbacks are delayed gastrointestinal recovery and a greater incidence of pulmonary complications. The retroperitoneal approach allows rapid recovery of bowel function, but there is limited exposure of the contralateral renal artery and the iliac arteries, difficulty in exposing the AAA, and postoperative wound bulging. The use of a "mini-incision" midline transperitoneal approach in surgery for infrarenal AAA is described.


   TECHNIQUE
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
DISCUSSION
 REFERENCES
 
Under general anesthesia combined with supplementary epidural anesthesia, a vertical mini-incision targeted at a length of 10 to 15 cm is made in the midline of the abdomen around the navel. The site and length of the incision depends on the location and size of the AAA, which is detected by palpation, the condition of the iliac arteries, and the patient's body size. The incision can be expanded by a few centimeters (the final length is within 15 cm) if necessary for a proximally or distally extended AAA or in large-built or obese patients. A Stoney vasculature retractor (Omni-Tract Surgical, Minneapolis, MN, USA) is set up. The proximal neck of the AAA is exposed using 2 of the small retractors contained in the set. Aortic taping is not needed. The distal parts around the common iliac arteries are exposed using the other 2 small retractors. After heparinization (1 mg•kg–1), the abdominal aorta and the bilateral common iliac arteries are controlled. The aneurysmal sac is incised, and prosthetic graft replacement is performed using a straight or bifurcated knitted Dacron graft. During proximal anastomosis, the surgical field is retracted upwards using the 2 proximal retractors while the distal retractors are released. Conversely, for distal anastomosis, the distal site is exposed by retracting downwards.


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
 DISCUSSION
REFERENCES
 
Between February 1997 and September 1999, this tech-nique was used for elective operations in 30 men and 3 women, aged 69.1 ± 7.2 years, with a mean AAA diameter of 51.7 ± 9.9 mm. Four of the patients also had iliac artery aneurysms. All were true aneurysms of atherosclerotic etiology; dissecting or false aneurysms were not included. The operative outcome was satisfactory (Table 1Go). The mean (± standard deviation) length of the mini-incision in 24 patients was 13.1 ± 1.3 cm (Figure 1Go); the precise length was not recorded in the other 9. Individual reconstruction of the internal and external iliac arteries was required in 6 patients using separate grafts; 2 needed bilateral iliac artery reconstruction. The inferior mesenteric artery was reconstructed in 23 cases. Only 2 patients required blood transfusions of 400 mL and 1,200 mL.


View this table:
[in this window]
[in a new window]
  		Table 1. Results of the Mini-Incision for Aortic Aneurysms in 33 Patients
 


View larger version (147K):
[in this window]
[in a new window]
  		Figure 1. Postoperative appearance of the midline mini-incision.

 
Although the length of the incision is mainly determined by patient variables, it also depends to some extent on the surgeon's skill and experience. Stoney vasculature retractors are crucial for adequate surgical exposure with this mini-incision; use of the small retractors is particularly recommended. It is also important to shift the surgical field proximally or distally by retracting or releasing the retractors, which requires some experience and technical expertise. This approach is not indicated for the more difficult suprarenal AAA or a ruptured AAA. We believe that the mini-incision AAA repair is a viable option in response to patients' requests for less invasive surgery.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 TECHNIQUE
 DISCUSSION
 REFERENCES
 

  1. Cambria RP, Brewster DC, Abbott WM, Freehan M, Megerman J, LaMuraglia G, et al. Transperitoneal versus retroperitoneal approach for aortic reconstruction: a randomized study. J Vasc Surg 1990;11:314–25.[Medline]

  2. Podore PC, Throop EB. Infrarenal aortic surgery with a 3-day hospital stay: a report on success with a clinical pathway. J Vasc Surg 1999;29:787–92.[Medline]

  3. Williams GM, Ricotta J, Zinner M, Burdick J. The extended retroperitoneal approach for treatment of extensive atherosclerosis of the aorta and renal vessels. Surgery 1980;88:846–55.[Medline]

  4. Shepard AD, Scott GR, Mackey WC, O'Donnel TF Jr, Bush HL, Callow AD. Retroperitoneal approach to high-risk abdominal aortic aneurysms. Arch Surg 1986; 121:444–9.[Abstract/Free Full Text]

  5. Sicard GA, Reilly JM, Rubin BG, Thompson RW, Allen BT, Flye W, et al. Transabdominal versus retroperitoneal incision for abdominal aortic surgery: report of a prospective randomized trial. J Vasc Surg 1995;21: 174–83.[Medline]





This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Hitoshi Ogino
Masahiko Matsumoto
Takaaki Sugita
Junichiro Nishizawa
Katsuhiko Matsuyama
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ogino, H.
Right arrow Articles by Tokuda, Y.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Ogino, H.
Right arrow Articles by Tokuda, Y.
Related Collections
Right arrow Minimally invasive surgery

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS