Retroperitoneal "Mini" Approach for Aortoiliac Reconstructive Surgery

The large vertical midline or transverse transperitoneal approaches used in the conven tional aortoiliac reconstruction are accompanied with a relatively high postoperative morbidity and mortality rate (2% to 5%), even in patients who are good risks under going aortic surgery. The purpose of this study was develop a new technique for aorto bifemoral bypass operation to minimize the operative stress on these patients. Methods: The recommended left paramedian or transmuscular retroperitoneal approach, using 5-6 cm skin incision and a special retractor with three-dimensional vision and with modified surgical instruments directly under eye control, offers the possibility of decreasing the operative stress significantly and of sufficiently controlling the serious bleeding that might occur. If necessary, this exposure can be immediately converted to a conventional approach by simple enlargement of the incision. Results: In the authors' first cases the functional results were very good, and conse quently, hospitalization time and the convalescence period were short. Conclusion: This minimal access approach appears to diminish the catabolic response, and it is hoped that it will be associated with accelerated recovery and virtual abolition of large wound-related complications. It could become the procedure of choice for selected patients with obstructive or aneurysmal aortoiliac disease.