[Laparoscopic-transperitoneal and lumboscopic-retroperitoneal surgery of the spine. Developments from animal...

With the use of an in vivo porcine training model we established the transperitoneal laparoscopic approach for the instrumentation of anterior lumbar spine fusion with Bagby-and-Kuslich (BAK) interbody implants as well as "Brantigan" cages. The transperitoneal laparoscopic approach caudally from the aortic bifurcation allows the spine fusion procedure of the caudal but not of the cranial part of the lumbar spine. Because ventral stabilization of the upper lumbar spine is frequently necessary, in particular in trauma patients with spine body fractures, an additional retroperitoneal minimal-invasive (lumboscopic) approach was established using again the in vivo porcine training model. We demonstrate that via this approach spine fusion can easily be performed including the Th12 segment after fenestration of the diaphragm. With the experience from the in vivo experiments, both techniques could safely and successfully be transferred to clinical practice with the advantage of markedly reducing the extent of operative trauma compared with the corresponding open approaches.