Introduction Since the first operations by Dubost, DeBakey and later Creech, (1-3) the surgery of abdominal aor- ta aneurysms (AAA) has witnessed enormous pro- gress in the anaesthesiological, technic-instrumental and organizational fields (4). There have been only sli- ght changes in the surgical technique, which has re- mained more or less the same as that of its pioneers. The last decade has seen the development and confir- mation of the endovascular method (5, 6), which aro- se out of the need to find, as for other surgical specia- lities (7), a mini-invasive approach to aortic surgery, although, at a distance, the complications following this methodology are beginning to have a limiting ef- fect on its indications (8-10). Therefore from January 2002, our team has turned its attention to alternative mini-invasive techniques (MIS) and in particular to minilaparotomy (MLP) and to Hand Assisted Lapa- roscopic Surgery (HALS), since we consider the to- tally laparoscopic technique too demanding. We have therefore evaluated the efficacy and the possible ad- vantages of mini-invasive aortic surgery versus tradi- tional surgery. Materials and Methods Surgical technique. Our aortic approach by means of minilaparotomy is not very different from that de- scribed by Cerveira and Turnipseed (11, 12): the pa- tient is positioned so as to achieve a hyperextension of the lumbar rachis, thus exposing the aneurysm; he is placed in a slightly anti-Trendelenburg position and turned on his right side. Once the anaesthesia has been induced and the patient curarised, the Mini-invasive aortic surgery: a 2 year experience Pierfranco Salcuni, Matteo Azzarone, Lucla Biasi, Federico Mosso, Elisa Orlandelli, Tiziano Tecchio Unit of Vascular Surgery- University of Parma, Parma, Italy Abstract. The aim of this study was to evaluate a less invasive technique for the exposure of the infrarenal aorta and its impact on the treatment of patients with abdominal aortic aneurysms (AAA). Fortyfour pa- tients with AAA were prospectively selected for minilaparotomy aortic exposure and repair using a small periumbilical midline incision, intra-abdominal nondisplaced retraction of the small bowel and convention- al hand-sewn vascular anastomosis. Perioperative comparisons with a contemporary group of AAA patients treated with long, open midline incision and extracavitary small bowel retraction were made. There were no significant differences between the minilaparotomy and open surgical control group concerning operating room time, intraoperative and perioperative morbidity or mortality. Significant differences were shown be- tween the two groups regarding intensive care unit stay; the return to a general diet and the length of hos- pitalization. Minilaparotomy exposure is safe and effective for the treatment of infrarenal AAA. This tech- nique maintains quality outcome while reducing postoperative ileus, hospital stay and resource utilization. Key words: Vascular surgery, aortic surgery, abdominal aortic aneurysm, AAA, mini-invasive surgery, mini- laparotomy O R I G I N A L A R T I C L E ACTA BIO MED 2005; 76; 28-32 © Mattioli 1885