Surgical Endoscopy

, Volume 14, Issue 10, pp 915–919 | Cite as

Intestinal retractor for transperitoneal laparoscopic aortoiliac reconstruction

Experimental study on human cadavers and initial clinical experience
  • Y. S. Alimi
  • O. Hartung
  • C. Cavalero
  • C. Brunet
  • J. Bonnoit
  • C. Juhan
Original Articles



We set out to design a bowel retractor for use during laparoscopic transperitoneal reconstruction of the infrarenal aorta and of both iliac axes.


This study was performed on five cadavers. After the insertion of four trocars, a pneumoperitoneum was created, and the bowels were gathered to the right flank. On each cadaver, the following four measurements were made: the distance between the Treitz angle and the aortic bifurcation (L1), the distance between the aortic bifurcation and the right internal inguinal ring (L2), the angles between L1 and L2 in the axial plane (A1), and the angles between them in the sagittal (A2) plane. These measurements enabled us to create a bowel retractor. The device was composed of a malleable metallic rod with a 2.5-mm diameter that was fixed to the operating table and whose intraabdominal section was designed to follow the outline of the mesenteric root in addition, a 25×12 cm polypropylene net was slipped around the rod. The infrarenal aorta and both iliac axes were then dissected. Secondarily, the bowel retractor was used in eight patients (seven men and one woman; mean age, 56 years; range 44–76) during laparoscopic aortoiliac reconstruction for occlusive (n=6) or aneurysmal (n=2) disease.


The statistical analysis of the measurements performed on cadavers showed a significant correlation between body height and L1 (r=0.8769; p<0.05) and L2 (r=0.9706; p<0.01) distances. It was then possible to design the shape of two metallic rods (one small and one large) so that they would be adaptable to the height of the patients (<1.65 m and >1.65 m). During our clinical experience, all laparoscopic procedures were completed in a mean operative and clamping time of 266 min (range, 215–360) and 54 min (range, 18–90), respectively. Mean postoperative hospital stay was 6 days (range, 3–13).


Our experimental study allowed us to develop a bowel retractor that can make it easier to perform laparoscopic transperitoneal aortoiliac reconstruction in humans.

Key words

Aortiliac reconstruction Transperitoneal approach Viscera retraction Experimental study Human cadavers Clinical experience 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ahn SS, Clem MF, Braithwaite BD, Concepcion B, Petrik PV, Moore WS (1995) Laparoscopic aortofemoral bypass: initial experience in an animal model. Ann Surg 222: 677–683CrossRefGoogle Scholar
  2. 2.
    Alimi Y, Hartung O, Lonjon T, Barthares P, Cador L, Juhan C (2000) Laparoscopic abdominal aortic replacement with left renal artery reimplantation: experimental study on pigs. Ann Vasc Surg (in press)Google Scholar
  3. 3.
    Alimi YS, Hartung O, Orsoni P, Juhan C (1999) Abdominal aortic laparoscopic surgery: retroperitoneal or transperitoneal approach? Eur J Vasc Endovasc Surg 19: 21–26CrossRefGoogle Scholar
  4. 4.
    Alimi Y, Orsoni P, Hartung O, Berdah S, Lonjon T, Cador L, Picaud R, Juhan C (1998) Laparoscopic substitution of the abdominal aorta: experimental study in the pig. J Mal Vasc 23: 191–194PubMedGoogle Scholar
  5. 5.
    Barbera L, Mumme A, Mentin S, Zumtobel V, Kemen M (1998) Operative results and outcome of 24 totally laparoscopic vascular procedures for aortoiliac occlusive disease. J Vasc Surg 28: 136–142CrossRefGoogle Scholar
  6. 6.
    Bosch JL, Hunning MGM (1999) Meta-analysis of the results of percutaneous transluminal angioplasty and stent placement for aortoiliac occlusive disease. Radiology 204: 87–96CrossRefGoogle Scholar
  7. 7.
    Bruns CJ, Wolfgarten B, Kasper M, Zenner D, Walter M, Mannich B (1998) Gasless videoendoscopic implantation of aortobifemoral vascular prostheses via transperitoneal versus extraperitoneal approach in an animal model. Surg Endosc 12: 137–141CrossRefGoogle Scholar
  8. 8.
    Dion YM, Gracia CR (1997) A new technique for laparoscopic aortobifemoral grafting in occlusive aortoiliac disease. J Vasc Surg 26: 685–692CrossRefGoogle Scholar
  9. 9.
    Dion Y-M, Hartung O, Gracia CR, Doillon CJ (1999) Laparoscopic end-to-end aortobifemoral bypass with reimplantation of the inferior mesenteric artery: an experimental study. Surg Endosc 13: 449–451CrossRefGoogle Scholar
  10. 10.
    Dion YM, Katkouda N, Rouleau C, Aucoin A (1993) Laparoscopically assisted aortobifemoral bypass. Surg Laparosc Endosc 3: 425–429PubMedGoogle Scholar
  11. 11.
    Edoga JK, Asgarian K, Singh D, James KV, Romanelli J, Merchaur S, Romano D, Joostema B, Street J (1998) Laparoscopic surgery for abdominal aortic aneurysm: technical elements of the procedure and a preliminary report of the first 22 patients. Surg Endosc 12: 1064–1072CrossRefGoogle Scholar
  12. 12.
    Fabiani JN, Mercier F, Carpentier A, Le Bret E, Renaudin JM, Julia P (1997) Video-assisted aortofemoral bypasses: results in seven cases. Ann Vasc Surg 11: 273–277CrossRefGoogle Scholar
  13. 13.
    Hartung O, Alimi Y, Lonjon T, Barthares P, Cador L, Juhan C (2000) Thoracoscopic descending thoracic aorta to femoral artery bypass: an experimental study. Ann Vasc Chir (in press)Google Scholar
  14. 14.
    Jobe BA, Duncan W, Swanstrom LL (1999) Totally laparoscopic abdominal aortic aneurysm repair. Surg Endosc 13: 77–79CrossRefGoogle Scholar
  15. 15.
    Kline RG, D’Angelo AJ, Chen MHM, Halpern VJ, Cohen JR (1998) Laparoscopically assisted abdominal aortic aneurysm repair: first 20 cases. J Vasc Surg 27: 81–88CrossRefGoogle Scholar
  16. 16.
    Kolvenbach R, Delling O, Schwierz E, Landers B (1998) Reducing the operative trauma in aortoiliac reconstructions—a prospective study to evaluate the role of video-assisted vascular surgery. Eur J Vasc Endovasc Surg 15: 483–488CrossRefGoogle Scholar
  17. 17.
    Nevelsteen A, Lacroix H, Suy R (1991) Aortofemoral Dacron reconstruction for aortoiliac occlusive disease: a 25-year survey. Eur J Vasc Surg 5: 179–186CrossRefGoogle Scholar
  18. 18.
    Said S, Mall J, Peter F, Müller JM (1999) Laparoscopic aortofemoral bypass grafting: human cadaveric and initial clinical experiences. J Vasc Surg 29: 639–648CrossRefGoogle Scholar
  19. 19.
    Zucker KA, Pitcher DE, Martin DT, Ford RS (1994) Laparoscopic-assisted colon resection. Surg Endosc 8: 12–18CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2000

Authors and Affiliations

  • Y. S. Alimi
    • 1
  • O. Hartung
    • 1
  • C. Cavalero
    • 2
  • C. Brunet
    • 2
  • J. Bonnoit
    • 2
  • C. Juhan
    • 1
  1. 1.Department of Vascular SurgeryHôpital Universitaire NordMarseille Cedex 20France
  2. 2.Laboratory of Applied Biomechanics, Unit of Research Associated with INRTSFaculté de Medecine-Secteur Nord Université de la MéditerranéeMarseille Ledex 20France

Personalised recommendations