- Useful equipment
- Bean-bag
- Cell-saver
- Omintract retractor
- Patient position
- Right lateral position with the upper torso on an about 70o rotation while the lower part of the body (pelvis) on an as much as horizontal position is possible (usually something between 30-50o)
- The patient should be placed with his kidney area on a “breaking” point of the table so as a a lateral jackknife position is possible (this will increase the access to the operation site). Preservation of this position is achieved with the use a bean-bag under the patient’s body
- Surgical team position
- Surgeon: Left side of patient, posterior to the patient
- First assistant: Right side of patient, opposite to the surgeon
- Second assistant: Right side of patient, beside the first assistant
- Skin incision
- On the 10th intercostal space on the left side
- Anterior end of the incision on the edge of rectus abdominis.
- The longer posterior the incision the higher exposure to the aorta. Extending posteriorly the incision you will come to a point where you cut the lowest part of the diaphragm and enter the thoracic cavity. I think that generally, if you want to get high to the aorta and clamp the supraceliac part of it, it is better to go as much backwards until almost you get at this point. I occasionally stop the incision when I open the thoracic cavity and have to put some stitches to close the diaphragm.
- In the case of iliac aneurysm, the proximal edge of the incision, downwards along the lateral border of the rectus abdominis
- Enter the retroperitoneal space
- Through the yellow fat pad that you will meet on the posterior part of the incision. This is actually, the safest part to go as it is part of the perinephric fat. By putting the
Vascular & Endovascular Surgeon