The first experience with minimally invasive phlebectomy using the TriVex system

Presented herein is the first experience gained in Russia with endoscopic transillumination phlebectomy (ETP). The aim of the study was to evaluate the clinical effectiveness and advantages of ETP versus traditional combined phlebectomy (TCP). Altogether 94 patients with different forms of lower extremity varicosis were operated on. Before operation the patients underwent Doppler ultrasound and duplex scanning. The main group included 47 patients who were operated on by ETP. The control group comprised 47 patients provided TCP. The ETP technique is based on hydraulic dissection of varicose veins which is attained by injection of a special solution under a pressure of 400-500 mm Hg, using an illumination irrigator inserted to subcutis via 2-3 mm punctures. Besides ETP is based on the effect of transillumination allowing to determine not only a precise location of varicose veins but also to control their drastic ablation by means of a special resector. To compare the above-indicated two techniques, the following parameters were studied: the time of operation, the number of incisions, the intensity of postoperative painful syndrome and the cosmetic effect according to the analog scales. The results obtained have shown that the use of ETP considerably decreased the time of operation; there was a substantial lowering of the number of incisions and punctures due to which the duration of postoperative painful syndrome decreased. Since the operation is performed via minipunctures which are closed by surgical plaster, an excellent cosmetic result is obtained. The first experience with ETP has demonstrated that this technique compares very favourably with TCP. The labor intensity of operation is minimized. Permanent visual control over vein extraction during operation makes it possible to appreciably raise the radicalness of intervention. The possibility of performing operation via minipunctures guarantees a more uneventful postoperative course and an excellent cosmetic result. So, ETP is a modern promising and a minimally invasive method for the treatment of varicose veins of the lower extremities. It requires extensive application with referral to one-day hospital.