Vascular surgery has been one of the last fields in surgery to incorporate laparoscopy. This may largely be the result of the fact that laparoscopic control of bleeding remains challenging and vascular procedures inherently involve bleeding. However, recent improvements in laparoscopic approach, exposure, and instrumentation have resulted in an increase in the number of surgeons performing laparoscopic vascular surgery (LVS). Here, we present an overview of the current advantages, disadvantages, and special considerations of LVS and provide a description of the laparoscopic technique for aorto-bifemoral bypass.

CURRENT INDICATIONS AND LIMITATIONS

Laparoscopy is a surgical approach and must not change the indications or contraindications for surgery. This means that the same type of operation is performed laparoscopically as it is performed conventionally (e.g., the proximal and distal targets of a bypass are independent of the surgical approach). Currently, LVS is mainly performed for the treatment of aorto-iliac occlusive disease and abdominal aortic aneurysms. For aorto-iliac occlusive disease, LVS has become complementary to endovascular repair. The Transatlantic Society Consensus (TASC) has described the respective indications for conventional and endovascular repair for occlusive diseases. From these guidelines, patients not amenable to endovascular repair (TASC types C and D), and with non-massive aortic calcifications, represent the most suitable candidates for LVS.