Specific Laparoscopic Instruments for Vascular Laparoscopy

Specific laparoscopic instruments for vascular surgery include the following:

• Potts laparoscopic scissors (Fig. 5.6.9)

• Two releasable clamps (Clamps B/Braun) for occlusion of the iliac arteries (Fig. 5.6.10)

• Two laparoscopic clamps with 10-mm DeBakey-type jaws and safety ratchet for proximal and distal aortic clamping (B/Braun-Aesculap or Storz-France) (Fig. 5.6.11)

Fig. 5.6.9 Potts laparoscopic scissors (B/Braun-Aesculap)
Vascular Instruments

5.6.5.1 Intraoperative Complications Vessel Lesions [2, 12]

Fig. 5.6.10 Releasable clamps (B/Braun-Aesculap) for occlusion of the iliac arteries and inferior mesenteric artery

Fig. 5.6.12 Curved jaws and axial handle needle holder for making totally coelioscopic aortic anastomosis

Fig. 5.6.12 Curved jaws and axial handle needle holder for making totally coelioscopic aortic anastomosis

One needle holder with curved jaws (Microfrance-Xomed) and axial handle used to fashion the endo-anastomoses (Fig. 5.6.12)

Two 10-mm endoscopic retractors (Endoretract, Ethi-con-France)

3/0 gauge polypropylene suture for endoanastomoses and haemostasis

Endosuture material; the most suitable suture material for endoanastomosis is an 18-cm-long segment attached to a pledget to avoid having to tie the first knot.

5.6.5 Complications

5.6.5.1 Intraoperative Complications Vessel Lesions [2, 12]

Fig. 5.6.10 Releasable clamps (B/Braun-Aesculap) for occlusion of the iliac arteries and inferior mesenteric artery

Fig. 5.6.11 Aortic clamp with DeBakey-type jaws and safety ratchet (B/Braun-Aesculap) for proximal and distal aortic clamping

This is a common complication. Haemostasis can be difficult since the lumbar veins quickly retract behind the spine. Bleeding can be minimized by videoendoscopy with high insufflation pressure. Great care is necessary when exposing the lumbar veins.

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