UC Surgeons Add Laparoscopic Bypass to List of Tristate Firsts

CINCINNATI—Vascular Surgeons at the University of Cincinnati (UC) have performed the Tristate’s first completely laparoscopic bypass procedure to treat blockages in the arteries that supply the lower body.

Joseph Giglia, MD, assistant professor and interim director of UC’s vascular surgery division, performed the operation on May 22 at University Hospital.

Laparoscopic (minimally invasive) surgery is a method of operating inside the abdomen through small ports using a fiber-optic light source, camera and specialized instruments.

This procedure—known as a laparoscopic aortobifemoral bypass—is used to treat aortoiliac arterial occlusive disease, a type of peripheral arterial disease (PAD) that causes large blood vessels in the abdomen and pelvis to become narrowed and restrict blood flow.

According to the American Vascular Association (AVA), as many as 12 million people in the United States suffer from PAD. The condition is caused by a buildup of plaque on the arterial walls, which decreases the flow of nutrient-rich blood to muscles and tissues in the lower body. Patients with PAD usually experience squeezing pain or tightening in the legs and buttocks during exertion.

“Laparoscopic surgery eliminates the need to make a major incision to access the body cavity,” explains Giglia. “Because it is minimally invasive, we can also reduce the patient’s post-surgery pain and expedite the patient’s recovery.”

Traditional open bypass surgery requires a large incision (12 to 16 inches) between the breastbone and the tip of the pubic bone. Giglia’s laparoscopic technique requires only seven small (1 cm) incisions.

To surgically bypass a blockage, the blood is redirected through an inverted Y-shaped graft made of synthetic material sewn to the existing artery. By attaching the single end of the Y to the aorta, and the split ends below the narrowed areas of the femoral arteries, the blood can travel around the diseased area and restore proper flow.

“Minimally invasive vascular surgery techniques are regularly used in Europe in Canada,” adds Giglia, “but only a handful of centers are performing them in the United States.”

Earlier this month, Giglia received the American Vascular Association’s annual E.J. Wylie Traveling Fellowship Award, a professional development grant that will allow him to visit established vascular centers across the world. This experience and resulting collaborations will help Giglia create a laparoscopic vascular surgery center at UC.