Laparoscopic lumbar sympathectomy

Lumbar sympathectomy retains a role in the treatment of patients with causalgia, Symptomatic vasospasm, and nonreconstructable arterial occlusive disease. Open surgical sympathectomy, with its attendant morbidities, remains the standard. Chemical sympathectomy has been introduced as a less invasive means of achieving sympatholysis. However, this has been associated with incomplete and transient denervation. We present a series of five lumbar sympathectomies performed laparoscopically. All patients sustained symptomatic relief and no postoperative complications were noted. Postoperative skin thermometry and resistance measurements confirmed adequacy of sympatholysis. We conclude that lumbar sympathectomy can be performed laparoscopically. Our preferred technique is now the extraperitoneal approach. Such an approach combines the durability and reliability of standard open sympathectomy with the minimal invasiveness of laparoscopic surgery.