Introduction
Anterior transperitoneal or antero-lateral retroperitoneal approaches are commonly used for lumbar disc surgery, but they involve specific drawbacks. We attempted to improve and simplify the approach of the lumbar spine with adjunction of retroperitoneoscopy.

Purpose of the study
The aim of this work is to describe a new non invasive operative technique for anterior lumbar and lumbosacral fusion, using an anterior extraperitoneal approach, optimized by a video assistance.

Methods
A small vertical 4-5 cm incision is made on the midline of the abdomen, centered on the ombilicus for the approach of L4-L5, and between ombilicus and public symphysis for L5-S1 approach. The peritoneum is gently dissected from the left abdominal wail, it may be easier to progress in front of the posterior sheath of the rectus abdominis and to divide the sheath from the linea arcuata. The next landmarks are the psoas muscle and the iliac vessels. The endscope is laterally introduced. It gives an excellent vision on the prevertebral area and a precise perception of the anatomical structures. The anterior aspect of the spine is progressively exposed under both direct vision and endscopic vision. A specially designed retractor allows cranial retraction of the iliac vessels for L4-L5 and caudal retraction for L5-S1. After removal of the intervertebral disc, a spreader allows to insert the autogenous iliac graft.

Material
Thirty patients were operated on. There were 10 men and 20 females. Age at operation ranged from 18 to 58. There were 23 monosegmental discopatias and 7 spondylolisthesis. The fused levei was L4-L5 (17 patients) and L5-S1 (13 patients). Mean hospitalization time was 6 days. No operative nor post-operative complication were obseved.

Discussion
A middle anterior approach preserves the abdominal wall innervation and allows disc resection and grafting in a strict midline position. The extraperitoneal approach simplifies the post-operative course and avoids digestive and septic complications of the transperitoneal approach. With video assistance a short incision is possible and the prevertebral dissection is facilitated. Surgery by video-assistance is performed with ordinary instrument under both direct visual and endscopic control, it should be differentiated from the true endscopic surgery which is performed under COZ insufflation in a closed cavity, with exclusive endscopic vision, and with instruments manipulated through trocards.

Conclusion
Video-assistance allows to approach the lumbar and lumbo-sacral spine by an anterior non invasive extraperitoneal approach, with low morbidity, increasing the possibilities of anterior fusion in the treatment of lumbar discopatias and instability.