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Retroperitoneal laparoscopic bilateral lumbar sympathectomy.

B Segers¹, J Himpens, J P Barroy

¹Department of surgery, Clinic of vascular and thoracic surgery, CHU St Pierre, Brussels, Belgium. bernard_segers@stpierre-bru.be

Acta Chirurgica Belgica

|August 10, 2007

Summary

This study presents a novel unilateral laparoscopic retroperitoneal approach for bilateral lumbar sympathectomy. This minimally invasive technique offers a new option for treating peripheral arterial occlusive disease.

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Area of Science:

Vascular Surgery
Minimally Invasive Procedures
Surgical Innovation

Background:

Lumbar sympathectomy, historically performed via open surgery since 1924, aims to treat conditions like peripheral arterial occlusive disease.
Distal arterial occlusive disease can cause debilitating symptoms such as intermittent claudication and cold extremities.
Direct revascularization is not always indicated or feasible for all patients with severe peripheral arterial disease.

Observation:

A unilateral laparoscopic retroperitoneal approach was successfully employed to perform bilateral lumbar sympathectomy.
The procedure involved CO2 insufflation for retroperitoneal dissection, with careful manipulation of the inferior vena cava and aorta.
Bilateral sympathectomy was achieved by excising lumbar ganglia (L3-L4) on both sides using bipolar electro-coagulation.

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Findings:

The described laparoscopic technique allows for bilateral lumbar sympathectomy through a single-sided retroperitoneal access.
This approach was demonstrated in a patient with distal arterial occlusive disease presenting with severe claudication and cold legs.
The retro-aortic pre-vertebral dissection facilitated access to the contralateral sympathetic chain.

Implications:

This minimally invasive approach may offer an alternative to open surgery for lumbar sympathectomy, potentially reducing patient morbidity.
Further research is warranted to evaluate the long-term efficacy and safety of this laparoscopic technique compared to traditional methods.
This surgical innovation could expand treatment options for patients with peripheral arterial occlusive disease who are not candidates for revascularization.