TECHNIQUE AND EARLY RESULTS OF VIDEOSCOPIC LUMBAR SYMPATHECTOMY

The authors describe their technique of videoscopic (VS) lumbar sympat hectomy (LSE), compared to the open LSE. From 1992 to 1994, 21 open an d 19 VS LSE were performed. The indication was reflex sympathetic dyst rophy in 17 and arterial insufficiency in 23 patients. In the open LSE the mean duration of anaesthesia was 80 min (55-115) and of surgery 3 7 min (25-65). The length of the chain removed varied from 1 to 3 gang lia (6-7 cm). Complications were noted in 5 patients: 1 pneumonia, 2 s uperficial wound problems and 2 cases of post-sympathectomy neuralgia. Hospital stay of patients with RSD varied from 2 to 5 days. Of the 19 attempts to perform a VS LSE 4 had to be converted to the open techni que. The duration of anesthesia was 150 min (90-280) and of surgery 92 min (45-240). Lengths of chain removed varied from I to several gangl ia (6-7 cm). A pneumoperitoneum was present in 10 procedures, but a Ve ress needle was placed in only 4 of these. Complications were present in 9 patients : 1 important subcutaneous emphysema, 1 severe costal pa in, 2 neuralgia, 1 temporary psoas dysfunction, 1 haemorrhage from a l umbar vein with conversion to the open technique and 3 minor superfici al wound problems. The hospital stay ranged from 2 to 5 days. This stu dy suggests that the VS LSE has no benefit over the open technique as far as the operative and early results are concerned. Whether this tec hnique avoids some of the late disadvantages of a lumbotomy remains to be seen.