Southerland S R, Remedios A M, McKerrell J G, Litwin D
Department of Surgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
Spine (Phila Pa 1976). 1995 Jul 15;20(14):1620-3. doi: 10.1097/00007632-199507150-00011.
This study described and compared retroperitoneal and transperitoneal laparoscopic approaches to the lumbar vertebrae in pigs. Technical and perioperative complications were evaluated for each approach.
The objective of this study was to develop a laparoscopic approach to the lumbar vertebrae that is associated with minimal technical and perioperative complications.
Laparoscopic techniques have been used extensively in many surgical fields. Recently, thoracoscopy has been used to perform a number of thoracic spinal procedures, including thoracic discectomy, and anterior osteotomy, release, and fusion. To date, there have been no published reports describing laparoscopic approaches to the lumbar vertebrae.
With all pigs positioned in left lateral recumbency, retroperitoneal and transperitoneal laparoscopic approaches to the lumbar vertebrae were performed in three pigs. Placement of the insufflation needles and trocar ports were determined for each approach. Dissection of the lumbar vertebrae were performed, and the technical and perioperative complications recorded. Radio-opaque markers were placed to identify the dissected lumbar intervertebral disc spaces, and intraoperative fluoroscopy was used to confirm marker placement. Gross anatomic dissections were performed after the pigs were killed.
Loss of pneumoretroperitoneum resulted in surgical termination in two of three pigs undergoing retroperitoneal laparoscopic approach to the lumbar vertebrae. In the remaining pig, difficulty was encountered in mobilization of the psoas major muscle from the lumbar vertebrae, and significant bleeding occurred. The transperitoneal approach to the lumbar vertebrae resulted in rapid mobilization of the psoas musculature and exposure of the lumbar vertebral bodies and discs of L1-L6/L7. Intraoperative complications included minimal bleeding and difficulty encountered in mobilization of the renal vascular pedicle.
The retroperitoneal approach was difficult because of the degree of muscle dissection required for exposure of the lumbar vertebrae. Complications associated with the retroperitoneal approach included loss of pneumoretroperitoneum because of entry into the peritoneal cavity, hemorrhage, and limited exposure of the lumbar vertebrae. The transperitoneal approach was easier technically, allowing identification and access to lumbar vertebral bodies and intervertebral discs from L1-L6/L7. Operative complications associated with the transperitoneal laparoscopic approach were minimal.
本研究描述并比较了猪腰椎的腹膜后和经腹腹腔镜手术入路。对每种入路的技术及围手术期并发症进行评估。
本研究的目的是开发一种与最少技术及围手术期并发症相关的腰椎腹腔镜手术入路。
腹腔镜技术已在许多外科领域广泛应用。最近，胸腔镜已用于进行多种胸椎手术，包括胸椎椎间盘切除术、前路截骨术、松解术和融合术。迄今为止，尚无关于腰椎腹腔镜手术入路的发表报告。
将所有猪置于左侧卧位，对三头猪进行腰椎的腹膜后和经腹腹腔镜手术入路。确定每种入路的充气针和套管针端口的放置位置。进行腰椎解剖，并记录技术及围手术期并发症。放置不透射线标记物以识别解剖的腰椎间盘间隙，并使用术中透视确认标记物位置。猪处死后进行大体解剖。
在接受腰椎腹膜后腹腔镜手术入路的三头猪中，有两头因腹膜后气体丧失导致手术终止。在其余的猪中，在从腰椎分离腰大肌时遇到困难，并发生大量出血。腰椎经腹手术入路可快速分离腰大肌，并暴露L1-L6/L7的腰椎椎体和椎间盘。术中并发症包括少量出血以及在分离肾血管蒂时遇到困难。
腹膜后入路因暴露腰椎所需的肌肉分离程度而困难。与腹膜后入路相关的并发症包括因进入腹腔导致的腹膜后气体丧失、出血以及腰椎暴露受限。经腹入路在技术上更简单，可从L1-L6/L7识别并进入腰椎椎体和椎间盘。与经腹腹腔镜手术入路相关的手术并发症极少。
