caa a22 4500 475780396 CHVBK 20180406123642.0 cr unu---uuuuu 170329e20001001xx s 000 0 eng 10.1007/s004640000260 doi (NATIONALLICENCE)springer-10.1007/s004640000260 Intestinal retractor for transperitoneal laparoscopic aortoiliac reconstruction [Elektronische Daten] Experimental study on human cadavers and initial clinical experience [Y. Alimi, O. Hartung, C. Cavalero, C. Brunet, J. Bonnoit, C. Juhan] Background: We set out to design a bowel retractor for use during laparoscopic transperitoneal reconstruction of the infrarenal aorta and of both iliac axes. Methods: 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. Results: 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). Conclusion: Our experimental study allowed us to develop a bowel retractor that can make it easier to perform laparoscopic transperitoneal aortoiliac reconstruction in humans. Springer-Verlag, 2000 Aortiliac reconstruction nationallicence Transperitoneal approach nationallicence Viscera retraction nationallicence Experimental study nationallicence Human cadavers nationallicence Clinical experience nationallicence Alimi Y. Department of Vascular Surgery, Hôpital Universitaire Nord, Chemin des Bourrelly, 13915, Marseille Cedex 20, France aut Hartung O. Department of Vascular Surgery, Hôpital Universitaire Nord, Chemin des Bourrelly, 13915, Marseille Cedex 20, France aut Cavalero C. Laboratory of Applied Biomechanics, Unit of Research Associated with INRTS, Faculté de Medecine-Secteur Nord Université de la Méditerranée, Boulevard Pierre Dramard, F-13916, Marseille Ledex 20, France aut Brunet C. Laboratory of Applied Biomechanics, Unit of Research Associated with INRTS, Faculté de Medecine-Secteur Nord Université de la Méditerranée, Boulevard Pierre Dramard, F-13916, Marseille Ledex 20, France aut Bonnoit J. Laboratory of Applied Biomechanics, Unit of Research Associated with INRTS, Faculté de Medecine-Secteur Nord Université de la Méditerranée, Boulevard Pierre Dramard, F-13916, Marseille Ledex 20, France aut Juhan C. Department of Vascular Surgery, Hôpital Universitaire Nord, Chemin des Bourrelly, 13915, Marseille Cedex 20, France aut Surgical Endoscopy Springer-Verlag 14/10(2000-10-01), 915-919 0930-2794 14:10<915 2000 14 464 https://doi.org/10.1007/s004640000260 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000260 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Alimi Y. Department of Vascular Surgery, Hôpital Universitaire Nord, Chemin des Bourrelly, 13915, Marseille Cedex 20, France aut NATIONALLICENCE 700 1- Hartung O. Department of Vascular Surgery, Hôpital Universitaire Nord, Chemin des Bourrelly, 13915, Marseille Cedex 20, France aut NATIONALLICENCE 700 1- Cavalero C. Laboratory of Applied Biomechanics, Unit of Research Associated with INRTS, Faculté de Medecine-Secteur Nord Université de la Méditerranée, Boulevard Pierre Dramard, F-13916, Marseille Ledex 20, France aut NATIONALLICENCE 700 1- Brunet C. Laboratory of Applied Biomechanics, Unit of Research Associated with INRTS, Faculté de Medecine-Secteur Nord Université de la Méditerranée, Boulevard Pierre Dramard, F-13916, Marseille Ledex 20, France aut NATIONALLICENCE 700 1- Bonnoit J. Laboratory of Applied Biomechanics, Unit of Research Associated with INRTS, Faculté de Medecine-Secteur Nord Université de la Méditerranée, Boulevard Pierre Dramard, F-13916, Marseille Ledex 20, France aut NATIONALLICENCE 700 1- Juhan C. Department of Vascular Surgery, Hôpital Universitaire Nord, Chemin des Bourrelly, 13915, Marseille Cedex 20, France aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/10(2000-10-01), 915-919 0930-2794 14:10<915 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer