Video-assisted aortic surgery at Ajaccio workshop


At the 2005 Ajaccio workshop, Dr Yves Alimi presented his experience in minimally invasive video-assisted aortic surgery and efforts to develop a new laparoscopic aortic instrumentation.

The presentation was based on more that 150 patients who underwent an abdominal aortic reconstruction for occlusive disease (n= 76), for AAA (n= 72) or thoraco-femoral bypasses (n= 5). To date Alimi, of the department of vascular surgery, Hospital Nord, Marseille, France, has developed two prototypes. The first is the SuDyn device – which offers a real alternative to the use of knots, thereby significantly reducing or even stopping its associated complications. It provides a technical solution to the problems linked to knots during anastomosis by laparoscopic approach and thereby the making of reliable and rapid anastomosis in all surgery, be it minimal invasive or robot assisted. Alimi is currently engaged in an animal study for this device.

The second device is the Retis, a laparoscopic intestinal retractor which allows a transperitoneal aortic approach, with three main benefits: direct abdominal aortic dissection with no necessity for a long retrocolic approach, decrease of the pneumoperitoneum pressure from 14 to 8mm Hg and patient positioning in a regular decubitus position (especially interesting in elderly patients). Alimi hopes to begin a clinical study at the beginning of 2006.

He has organised a three-day workshop on laparoscopic aortic surgery in the European Institute of TeleSurgery of Strasbourg, France. So far 18 workshops have been organised. During each session 34 vascular surgeons perform a laparoscopic aortic reconstruction (retroperitoneal, transperitoneal, or thoracic) on living pigs. More than 500 vascular surgeons have been trained during these workshops.

Alimi said, “I am convinced that this technique has important advantages, such as short hospital stay, the smallest cost, excellent long-term results with a minimal follow-up. However, it may also have important drawbacks, such as a long learning curve, long procedure and clamping durations. In my opinion, most of these difficulties may benefit from the development of a new laparoscopic instrumentation, since almost all of the instruments used during these procedures have been developed for other (GE) procedures. I already developed laparoscopic aortic clamps with the Aesculap company.

For this reason Alimi has established a research centre on minimally invasive surgery, consisting of an experimental lab with three operative tables totally equipped for video and radiological procedures (on pigs) and a private society, named Protomed, created with three biomechanical engineers. They are able to develop new prototypes and to test them on new benches, on cadavers and on living pigs.

In addition Alimi revealed that he is working on two other projects; a laparoscopic lumbar artery occluder to rapidly stop the back bleeding of these arteries after opening of the AAA and a combined laparoscopic and endovascular device for aortic bypasses.