Laparoscopic-transperitoneal and lumboscopic-retroperitoneal surgery of the spine. Developments from animal experiments for application in clinical practice

With the use of an in vivo porcine training model we established the transp eritoneal laparoscopic approach for the instrumentation of anterior lumbar spine fusion with Bagby-and-Kuslich (BAK) interbody implants as well as "Br antigan" cages. The transperitoneal laparoscopic approach caudally from the aortic bifurcation allows the spine fusion procedure of the caudal but not of the cranial part of the lumbar spine. Because ventral stabilization of the upper lumbar spine is frequently necessary, in particular in trauma pat ients with spine body fractures, an additional retroperitoneal minimal-inva sive (lumboscopic) approach was established using again the in vivo porcine training model. We demonstrate that via this approach spine fusion can eas ily be performed including the Th12 segment after fenestration of the diaph ragm. With the experience from the in vivo experiments, both techniques cou ld safely and successfully be transferred to clinical practice with the adv antage of markedly reducing the extent of operative trauma compared with th e corresponding open approaches.