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The purpose of this study is to investigate the potential advantages and complications of a minimally invasive laparoscopic approach for anterior spinal exposure as compared with the open technique and to quantify differences in operative time, blood loss, transfusion requirements, analgesia, and morbidity. A retrospective review was performed on all patients undergoing access for anterior spinal procedures. Demographics, operation-related variables, complications, and estimated cost were analyzed. Categorical data were analyzed using the Fisher's exact test and continuous variables were analyzed with the Mann-Whitney U test. We performed a total of 65 anterior spinal access procedures between February 1997 and April 2001 at our institution. Forty-five operations were performed at the L5-S1 level: 31 using transperitoneal laparoscopic techniques and 14 using an open minilaparotomy. Mean follow-up was 12 months (range 1-50). No significant differences between the groups were found when comparing analgesia requirements, time to resumption of oral intake, length of hospitalization, and complication rates. Statistical analysis showed that laparoscopic procedures were associated with shorter operating room times (P = 0.08) and less intraoperative blood loss (P = 0.029). The laparoscopic approach was estimated to cost $1,374 more than the open technique. Transperitoneal laparoscopic techniques for anterior spinal exposure are comparable to the standard open approach and offer no substantive advantages. The overall cost of laparoscopic spinal surgery is higher compared with conventional open procedures.