Transilluminated Powered Phlebectomy under Local Anesthesia

ABSTRACT

PURPOSE: Transilluminated powered phlebectomy (TIPP) has emerged as a very attractive surgical procedure for varicose vein because of it's many advantages. However, it also has some problems such as hematoma, and skin perforation, and needs general or spinal anesthesia and hospitalization. To overcome these shortcomings, we performed TIPP under only local anesthesia using the tumescent method. METHOD: Eleven (12 limbs) patients were operated and we prospectively estimated the operative complication, pain, duration of hospital stay, side effects and amounts of lidocaine. Lidocaine was infiltrated for groin dissection, and tumescent anesthesia was used on the calf area for TIPP. Great saphenous veins were stripped in 9 limbs, and closed suction drains were inserted in the calf area in 11 limbs. We calculated the amounts of lidocaine, according to the unit area of TIPP, body weight, and body surface area. RESULT: The mean age of the 11 patients was 55.4+/-10.7 years, and 3 patients (27.3%) had risk factors for general anesthesia. Mean operation time was 54.9+/-9.2 minutes, the number of incisions including groin was 4.7+/-0.6, and the area of TIPP was 272.6+/-85.3 cm2. The total lidocaine used was 495.4+/-167.5 mg (1.45 mg/cm2, 8.3 mg/kg, 302.1 mg/BSA m2). Except 2 patients (16.6%) who complained of mild pain and 2 of hematoma (16.6%), there were no side effects of lidocaine or operative complication. Mean hospital stay was 5.8+/-1.4 hours. CONCLUSION: TIPP under local anesthesia might be a relative safe method, and it could reduce the risks and complications of general or spinal anesthesia, hospital stay, and hesitancy to operation.