Endoscopic versus open lumbar sympathectomy

ABSTRACT

There have been increasing reports of early experiences with endoscopic lumbar sympathectomy. Most of these reports mentioned a small number of cases and non compared this minimal invasive procedure to the standard open approach. Thirty-one patients with inoperable critical limb ischemia attended our hospital over 32 months, were randomized to either open or endoscopic approach for lumbar sympathectomy. We used the standard technique for the open approach and used the aid of two different purpose balloons for the endoscopic approach. Data regarding operative time, complications, operative success, operative wound pain control and hospital stay were compared in both groups. Operative time was initially longer in the endoscopic approach, but toward the end of the study, it was nearly the same in both groups. The aid of the dissecting and retracting balloons helps to have a safe endoscopic approach with no intraoperative complications. Patients who had endoscopic approach significantly required fewer painkillers for the operative wound and had shorter hospital stay than those who had the open approach. Endoscopic lumbar sympathectomy is a safe and feasible procedure. It has a better outcome when compared to the open approach: