Introduction and Aim of the work: The formation of a laparoscopic aortic anastomosis represents the main obstacle responsible for the delay in making use of the laparoscopic techniques in vascular surgery. This study is concerned with presenting choreographed and pre-planned steps of executing the anastomosis to get, at the end of the learning curve, an acceptable range of time and leakage.Material and methods: A pocrine aorta was connected at its two ends to a roller hemopump with side tubing for priming and pressure setting recording. A 2.5cm aortotomy was done and an end (graft) to side (aorta) anastomosis was performed with 4/0 polypropylene suture. Two main groups were studied; the open group (control group; CG=20) and videoendoscopic group (VEG =40). The VEG was further subdivided into a top view group (TVG =20) and a side view group (SVG=20). The same way of anastomosis was repeated in every case of the VEG using the “flawless technique” with intracorporeal knotting at the beginning and at the end. We stick to the strict guidelines of arterial suturing. In every case, we studied the time of he procedure, incidence and site of leakage, test for patency and any faulty placement of sutures, length of suture material, incidence and site of laxity, number of sutures incorporated in the suture line, the tensile strength (TS) of the suture using a tensilometer and histological examination was done for wall integrity and microscopic trauma.Results: The duration of the procedure was 41.25±13.26 min in the VEG vs. 13±3.44 min in the CG; 48.95±13.694 min in the TVG vs. 33.55±6.97 min in the SVG with a statistically significant difference. Time came down from 75min in the 1st case to as low as 25min. The slope of the leaning curve was steeper in the TVG than the SVG, with a plateau reached in the last 20 cases. The mean length of suture material in the short limb was significantly shorter in the CG than the VEG, while no statistically significant difference was found in the long limb. The mean total number of suture throws was 19.00±2.326 in the CG vs. 18.975±2.326 in the VEG. The mean values of the TS in both the short and long limbs of the suture line were not significantly different between the CG and the VEG. Leakage occurred in 18 cases (45%); 12/18 in the TVG and 6/18 in the SVG. NO correlation was found between leakage and length of suture material or number of suture throws or the TS of suture material. A positive correlation was found with incidence of suture material laxity at a specific suture bite. Histological examination revealed partial wall affection in only 7.5% of cases, denoting the safety of the approach.Conclusion: Laparoscopically performed anastomosis is sound, safe and feasible. We emphasize the importance of the choreographed, pre-planned and detailed “flawless technique” in the execution of the anastomosis. This took the time down after 20 cases to a plateau around 30 min., which is quite acceptable. From this study, we found that it is most appropriate to use Dacron graft, polypropylene suture, 30˚ optic, ergonomic handle needle holder, curved tip assisting grasper, a suture hook and a ratio of 1 (aortotomy length) to 5.6 (length of the suture material required in each limb).