So you need to repair a suprarenal aortic aneurysm or even a type IV thoracoabdominal aortic aneurysm. There are mainly three options: a. a retroperitoneal approach on the 10th intercostal space. b. a left thoracoabdominal incision on the 8th intercostal space. c. a roof-top transabdominal approach. Each one has its benefits and its limitations. Let me speak about the third option: the roof-top approach.
First things first. The patient’s position.
- The patient is set on top of a beanbag on a modified right lateral decubitus position. The shoulders are rotated at a 60o – 80o from horizontal, and the hip at a 30o from the horizontal. In this way both groins are accessible.
- The left arm is secured on a standing stool across the patient’s body
- An axillary roll is placed under the patient’s right axilla
- Another roll is placed under the right kidney area
- The operating table is backwards extended at a reverse-jackknife position.
- The beanbag is suction deflated and the patient is secured.