Outpatient laparoscopic lumbar discectomy: description of technique and review of first twenty-one cases.

Economic and clinical factors have placed an increasing emphasis on minimally invasive surgical treatment of lumbar disc herniations. Percutaneous posterolateral techniques have been used increasingly over the last seven years but have definite technical limitations related to location of the disc herniation and its size. Dissatisfaction with percutaneous posterolateral lumbar discectomy (PPLD) led the senior author to explore the possibility of an anterior approach. Preliminary work included a "hands on" laparoscopy course and assisting experienced laparoscopists in the operating room. Before authorization from the Palomar Medical Center Investigational Review Board was obtained, dissection of the prevertebral space was performed in a human volunteer and a two level discectomy on a recently deceased patient was carried out in the operating room. The first operation was performed on February 4, 199I. Early in the series, patient selection was identical to that of percutaneous posterolateral discectomy, namely a soft posterolateral herniation contained within the posterior longitudinal ligament (PLL). As experience was gained, indications were expanded to include larger disc herniations. A description of the technique and our experience with the initial 21 consecutive cases form the basis of this report.