Endoscopic Single-Port Lumbar Sympathectomy: Preliminary Experience

Introduction:

Retroperitoneoscopic lumbar sympathectomy was first described in 1973. ¹ For its minimal invasiveness, the technique was then widely accepted for various conditions like plantar hyperhydrosis, nonreconstructive peripheral vascular disease (PVD), and reflex sympathetic dystrophy. ^{2 –4} The novel technique endoscopic single-port surgery (laparoendoscopic single-site surgery [LESS]) has been performed in various operations that aim at performing laparoscopic surgery by consolidating all ports within a single skin incision. The most obvious advantage of LESS is its cosmetic outcome compared with conventional laparoscopic procedure (one port vs. at least three ports). To date, the feasibility and safety of LESS lumbar sympathectomy have not been reported in the literature. Here, we report our preliminary experience in LESS lumbar sympathectomy.

Materials and Methods:

Between March 2010 and July 2010, four consecutive LESS lumbar sympathectomies were performed in two cases. Surgical indications were refractory nonreconstructable PVD and plantar hyperhidrosis. LESS lumbar sympathectomy was performed with a homemade single port created using an Alexis wound retractor through a 2-cm incision beneath the tip of 12th rib. ⁵ Standard 5-mm 30° laparoscope and straight laparoscopic instruments were used for subsequent manipulation. The video includes a brief review of a patient with refractory nonreconstructable PVD that operated with the same technique.

Results and Conclusions:

The procedure was completed without multiport laparoscopic or open conversion. The mean operative time was 67 minutes (range 55–110). The histological analysis of the resected ganglions revealed ganglion cells and nerve tissues. The skin temperature of the sole of the foot increased immediately after ganglion resection. The case of hyperhidrosis had anhidrosis of both feet at 1 month of follow-up and the case of PVD had significant relive of pain postoperatively. The mean hospital stay was 2.5 days. There was no operation-related complication. The potential benefit of single-port surgery that could only be concluded in this study is its cosmetic effect. According to our unpublished randomized study, the average final scar length of three 5-mm trocars is 3 cm for a standard laparoscopic surgery. Thus, the cosmetic advantages of single-port surgery are not only reduced number of incisions but also the reduced final total scar length. However, further prospective study is warranted to provide the evidence concerning the clinical benefits of single-port surgery other than cosmetic effect. In conclusion, our preliminary experience revealed that endoscopic single-port lumbar sympathectomy is a safe, feasible, and reproducible procedure.

Shiu-Dong Chung, M.D., Tin-Chou Li, M.D., and Ta-Chung Shen, M.D., contributed equally to this work.

No competing financial interests exist for any of the authors.

Runtime of video: 7 mins 8 secs