Transverse minilaparotomy for open abdominal aortic aneurysm repair

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Transverse minilaparotomy for open abdominal aortic aneurysm repair Hany Hafez, MBBCh, PhD, FRCS, Mlotshwa Makhosini, MBChB, FCS, Nima Abbassi-Ghaddi, MBBS, MRCS, Robert Hill, MBBS, Mark Bentley, MBBS Journal of Vascular Surgery Volume 53, Issue 6, Pages 1514-1519 (June 2011) DOI: 10.1016/j.jvs.2011.02.013 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 Position and standard length of incision in a patient with aortic-right common iliac aneurysm. Journal of Vascular Surgery 2011 53, 1514-1519DOI: (10.1016/j.jvs.2011.02.013) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 Proximal exposure shows the aneurysm neck (I) and the retracted left renal vein (II). Distal wound retraction is not required at this stage. Journal of Vascular Surgery 2011 53, 1514-1519DOI: (10.1016/j.jvs.2011.02.013) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 The sac has been opened and the proximal aorta prepared for anastomosis. Iliac control is achieved by balloon occlusion catheters. Aortic neck is prepared for anastomosis (I). Stay sutures placed between aneurysm sac and abdominal wall (II) obviate the need for a sac retractor and create a barrier between the bowel and the operative field. The distal retractor is not necessary at this stage but is kept in place for demonstrative purposes. Note that the aortic bifurcation and the iliac vessels remain out of the field. Journal of Vascular Surgery 2011 53, 1514-1519DOI: (10.1016/j.jvs.2011.02.013) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 Proximal and left common iliac anastomoses have been completed. Intraoperative photo demonstrates left common iliac anastomosis at origin (I), the right common iliac aneurysm (II), and common iliac bifurcations (III). Note that the upper border of the incision is now almost at the level of the aortic bifurcation. Journal of Vascular Surgery 2011 53, 1514-1519DOI: (10.1016/j.jvs.2011.02.013) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 5 Distal anastomoses are complete. Intraoperative photo shows right common iliac aneurysm sac (I), the left common iliac anastomosis at the origin (II), and the right common iliac anastomosis at the bifurcation (III). Journal of Vascular Surgery 2011 53, 1514-1519DOI: (10.1016/j.jvs.2011.02.013) Copyright © 2011 Society for Vascular Surgery Terms and Conditions