Lumbar sympathectomy performed by means of videoscopy

Sympathetic denervation has fallen into disfavour for operations. Dorso-perivertebral, paravertebral or retroperitoneal approaches are only of historic importance. The oblique retroperitoneal approach is popular because it provides good visibility, at the expense of a long skin incision. A videoscopic procedure has now been developed for lumbar sympathectomy. A transverse skin incision of 3-4 cm is made in the hypochondrium, lateral to the rectus sheath. The abdominal muscles are split along their fibres. The transversalis fascia is opened and the peritoneum is carefully peeled back. A trocar is then introduced laterally from the skin incision, and under visual control the sympathetic trunk is exposed. After identifying the ganglia, L2 and L3 are coagulated together with the part of the sympathetic trunk that joins them. The suction drainage is not required nor are balloons to develop the operation field, which is not insufflated. Patients undergo rehabilitation much more easily because of reduced wound pain and they leave hospital quickly. The method only requires basic videoscopy instruments.