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Totally extraperitoneal laparoscopic lumbar sympathectomy: an initial case report
S Wattanasirichaigoon1, N Katkhouda, U Ngaorungsri
1Department of Surgery, Srinakharinwirot University, Bangkok, Thailand.
Summary
Buerger's disease patients with severe limb ischemia can benefit from laparoscopic lumbar sympathectomy. This minimally invasive procedure offers a safe and effective alternative for managing vasospastic symptoms.
Area of Science:
- Vascular Surgery
- Minimally Invasive Surgery
- Neurology
Background:
- Buerger's disease is a rare condition causing inflammation and clotting in blood vessels, primarily affecting the extremities.
- Vasospastic symptoms, such as coldness and pain, indicate severe peripheral vascular compromise.
- Traditional surgical sympathectomy carries risks; minimally invasive approaches are sought for improved patient outcomes.
Observation:
- A 27-year-old male with Buerger's disease presented with critical ischemia of the right foot, including absent pulses and dry gangrene.
- The patient had a history of significant abdominal surgery.
- Physical examination revealed signs of severe peripheral vascular disease in the affected limb.
Findings:
- A totally extraperitoneal laparoscopic lumbar sympathectomy was successfully performed.
- The procedure involved identifying and dissecting the L2, L3, and L4 sympathetic ganglia.
- The laparoscopic approach facilitated safe access to the sympathetic trunk between the psoas muscle and inferior vena cava.
Implications:
- Laparoscopic lumbar sympathectomy appears to be a safe and feasible technique for Buerger's disease.
- This minimally invasive approach may become the preferred method for managing severe vasospastic symptoms in the future.
- Further research is warranted to establish long-term efficacy and compare outcomes with traditional sympathectomy.