Abstract
Purpose
: To verify the technical feasibility of laparoscopic aortorenal bypass in a porcine model and to evaluate renal pathologic findings after a short survival time.
Materials and Methods
: Laparoscopic aorta-to-left-renal artery bypass using an interposition Gore-Tex® graft was performed in five animals. Renal function was assessed 1 week postoperatively and euthanasia performed after 14 days for histologic examination.
Results
: The median surgical time was 210 minutes (range 160-260 minutes). The median time needed to perform the aorta-to-graft anastomosis was 65 minutes (range 50-75 minutes), and the median time required to create the graft-to-renal artery anastomosis was 50 minutes (range 45-60 minutes). No conversion to open surgery was needed. Two intraoperative complications were observed: one large-bowel perforation, which was managed laparoscopically, and one obstruction of the aorta-to-graft anastomosis caused by clots, which was managed by removal of clots with a balloon catheter. No major postoperative complications were observed. The mean preoperative and postoperative serum creatinine concentrations were 0.8 ± 1.2 and 0.7 ± 1.6 mg/dL, respectively. At autopsy, all but one of the pigs were found to have a patent aortorenal bypass. In one pig, we found a partially clotted graft. Histologic examination demonstrated an unremarkable kidney in four cases and a kidney showing aspects of coagulative necrosis with viable cells in the animal with the partially clotted graft.
Conclusions
: Laparoscopic aortorenal bypass is feasible. The short-term effect of the bypass on kidney vascularization seems promising, as demonstrated by pathologic findings. Laparoscopic aortorenal bypass could extend the indications for renal revascularization surgery.
Get full access to this article
View all access options for this article.