PMID- 17638563
OWN - NLM
STAT- MEDLINE
DCOM- 20070905
LR  - 20161018
IS  - 0892-7790 (Print)
IS  - 0892-7790 (Linking)
VI  - 21
IP  - 6
DP  - 2007 Jun
TI  - Laparoscopic aortorenal bypass in an acute porcine model under warm ischemia: 
      feasibility study and resident training module.
PG  - 645-51
AB  - BACKGROUND AND PURPOSE: Laparoscopic aortorenal bypass (LARB) in a human being 
      has never been reported. Both the skills required and the concern over preserving 
      renal parenchyma by minimizing ischemia time has limited laparoscopic renal 
      revascularization. The limit of safe renal warm ischemia is 30 minutes, which, it 
      may be argued, is too short to permit laparoscopic anastomosis by those who have 
      never performed the procedure. We sought to demonstrate the feasibility of LARB 
      by determining whether it can be performed under warm ischemia and entirely by a 
      resident after sufficient training. We describe our training program and 
      experience with LARB. MATERIALS AND METHODS: An LARB was performed in four pigs. 
      There were no practice pigs, as data were collected on the first pig, which was 
      intentionally euthanized postoperatively, while the remaining three were allowed 
      to survive for 24 hours. All procedures were performed by a resident with limited 
      previous training after a regimented program in a "dry laboratory," beginning 
      with basic skills and progressing to LARB modeling using cadaver pig kidneys. 
      RESULTS: The mean time needed for the graft-to-aorta anastomosis was 30.5 minutes 
      (range 21-47 inutes). The renal arterial anastomosis was completed within 30 
      minutes in three of the four animals, including the first animal attempted (24, 
      32, 19, and 15 minutes, respectively). The mean total operative time was 3.1 
      hours. CONCLUSIONS: With continuing refinements in technique, LARB under warm 
      ischemia is feasible and not only for an elite few surgeons with advanced skills. 
      We believe any surgeon can become capable of performing this procedure. In 
      addition, LARB provides a porcine model for training that includes both advanced 
      skill and time endpoints.
FAU - Abaza, Ronney
AU  - Abaza R
AD  - Department of Urology, University of Toledo College of Medicine, Toledo, Ohio 
      43614, USA. rabaza@meduohio.edu
FAU - Wiegand, Catherine S
AU  - Wiegand CS
FAU - Martinez, Bernardo D
AU  - Martinez BD
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Endourol
JT  - Journal of endourology
JID - 8807503
SB  - IM
MH  - Anastomosis, Surgical
MH  - Animals
MH  - Endpoint Determination
MH  - Feasibility Studies
MH  - Intraoperative Period
MH  - Kidney/surgery
MH  - Laparoscopy/*methods
MH  - Renal Artery/surgery
MH  - Swine
MH  - Urologic Surgical Procedures/*education/*methods
MH  - Warm Ischemia/*methods
EDAT- 2007/07/20 09:00
MHDA- 2007/09/06 09:00
CRDT- 2007/07/20 09:00
PHST- 2007/07/20 09:00 [pubmed]
PHST- 2007/09/06 09:00 [medline]
PHST- 2007/07/20 09:00 [entrez]
AID - 10.1089/end.2006.0139 [doi]
PST - ppublish
SO  - J Endourol. 2007 Jun;21(6):645-51. doi: 10.1089/end.2006.0139.