Laparoscopically Assisted Retroperitoneal Spinal Surgery

BACKGROUND: Laparoscopically assisted spinal surgery has been reported in several series to be safe and effective. We completed a retrospective chart review of patients who underwent laparoscopically assisted retroperitoneal spinal surgery. METHODS: Between April 1996 and June 2004, 124 patients underwent laparoscopically assisted anterior spinal fusion with a retroperitoneal and gasless approach with a variety of orthopedic devices. Sixty patients were male, 64 were female, and the mean age was 40. Access to the retroperitoneal space is obtained using a balloon dissector and midline trocars, similar to that for TEP hernia repairs. An additional trocar is placed laterally to complete the dissection along the anterior spine. The procedure is then converted to a gasless technique using wound protectors in the midline and laterally. The laparoscope, a balloon retractor, and a lifting device are placed through the lateral incision. The orthopedic instrumentation is placed through the midline incision. RESULTS: Mean operative time and estimated blood loss were 165 minutes and 205 mL, respectively. The conversion rate was 8.9% (6/11 occurred in the first 20 cases). Mean length of stay was 3.0 days. The complication rate was 5.6%, and included iliac vein injury (3), postoperative ileus (2), and need for posterior fusion during the same hospital stay (2). CONCLUSION: Laparoscopically assisted retroperitoneal spinal surgery is safe and reproducible. This technique allows for the benefits of a minimally invasive approach, but also for multi-level exposure, complete discectomy, endplate removal, and placement of conventional orthopedic devices.