MINIMALLY INVASIVE SURGERY OF THE INFRARENAL AORTA

Maksimov A.V., Feiskhanov A.K.
Vascular Surgery Department Republican Clinical Hospital of the Public Health Ministry of the Republic of Tatarstan,
Kazan, Russia

Over five decades having passed since the first report of J. Oudot on grafting of the abdominal aorta, reconstructive operations on the aortofemoral segment have become amongst the methods most commonly used in angiosurgery. However, despite the progress achieved in anaesthesiology, critical care medicine and surgical techniques, the traumatic nature of these interventions is still high, which predetermines the perioperative lethality rate amounting to 25%. Certain progress has been related to the introduction of endovascular methods of treatment. However, these techniques have failed to solve the problem because of the presence of certain contraindications and limitations thereof. Further search for ways aimed at improving the outcomes of management of patients presenting with pathology of the infrarenal aorta has led to the introduction of minimalaccess surgery (MAS) widely used since the 1980's in various areas of surgery.

The present article reviews the history and state of the art of minimally invasive surgery of the infrarenal aorta, giving a comparative evaluation of the three main techniques currently used, i.e., an open minimal access, "total" endovideosurgery, and a videoassisted minimal access. Also reflected herein are the main technical problems arising and encountered during these operations, and disadvantages of each of the methods. Special attention is paid to the problem concerning technical support of the minimally invasive operations, and limitations to the application thereof.

KEY WORDS: minimally invasive surgery, abdominal aorta.

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