Subcutaneous Endoscopic Varicose Vein Surgery Laparoscopic innovation in surgical management of varicose veins

Varicose vein is a disorder characterised by elongated, dilated and tortuous veins primarily affecting the lower extremities. This condition typically involves malfunctional venous valves which results in pooling of blood in lower extremities and venous insufficiency. Venous hypertension not only causes cosmetic concerns but can also lead to discomfort, pain and complications such as skin discoloration, venous ulcers, bleeding and thrombophlebitis. Over the years, an array of treatment modalities has been developed, encompassing a spectrum from conservative management strategies to more invasive surgical approaches and endovenous interventions. Open surgical approaches involving saphenofemoral junction (SFJ) ligation, vein stripping and ambulatory phlebectomy are frequently associated with postoperative sequelae such as pain, discomfort, wound infections and paraesthesia Endovenous procedures (RFA, EVLA, EVTA etc) are globally acknowledged as primary treatment modalities for managing varicose veins or addressing clinical manifestation of venous pathology. Nevertheless, a significant constraint of these interventions lies in their applicability in highly tortuous veins, requisite availability of specialised equipment, necessary expertise and associated cost. While subfascial endoscopic perforator surgery (SEPS) has an established role in laparoscopic management of incompetent perforators, there is presently no laparoscopic technique articulated for simultaneous treatment of saphenofemoral junction (SFJ) incompetence and perforator incompetence in a single operative session. We propose a fully laparoscopic approach for comprehensive management of varicose veins encompassing both precise identification and targeted treatment of venous incompetence, thereby optimizing patient outcome.