The roof-top approach, part 1: patient’s position

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.

1. 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.
2. The left arm is secured on a standing stool across the patient’s body
3. An axillary roll is placed under the patient’s right axilla
4. Another roll is placed under the right kidney area
5. The operating table is backwards extended at a reverse-jackknife position.
6. The beanbag is suction deflated and the patient is secured. 

Next: The skin incision

The roof top approach to the suprarenal aorta