Endoscopic fusion of the lumbar vertebrae

: For certain indications, anterior fusion of the lumbar spine is a standard operation. The surgeon specializing in operations on the vertebral column needs to learn to utilize the advantages of laparoscopic surgery. However, an absolute must before employing the technique in patients is adequate training in its use in living animals. For this purpose, the pig is a highly suitable model. The surgical team comprises a surgeon experienced in spinal procedures, an abdominal surgeon with skills in laparoscopic surgery and an experienced camera assistant. In the animal model and in clinical trials, a change in position-organ preparation from the cranial direction, a suprasym-physial approach to the vertebrae-has proved expedient. The use of a special instrumentarium for maintaining the pneumo-peritoneum, for protecting the spinal cord and for exact centering, including the application of a special dowel (ESKA-spacer and instruments) is essential. The greater technical effort may be expected to result in shorter hospitalization (2-3 days) in the future.