Bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access

Abstract

Purpose: Hyperhidrosis is a condition characterized by hyperactivity of the eccrine glands, causing an uncontrollable and excessive sweating, especially on the hands, plantar foot and groin, which can be confused with urinary incontinence. Standard treatment for plantar hyperhidrosis is the laparoscopic lumbar sympathectomy and the urologists are the besttrained surgeons to perform this procedure because they are familiar with the retroperitoneal anatomy. The goal of this video is to show our own technique of bilateral lumbar sympathectomy by unilateral access for plantar hyperhidrosis. Methods: The sample consisted of ten female patients who presented with plantar hyperhidrosis and were submitted to bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access technique. All patients had already been submitted to a previous thoracic sympathectomy with no improvement of the plantar hyperhidrosis. Results: Ten procedures were performed with this technique. In only one case, the bilateral retroperitoneal approach was required because of difficulty in locating the right nerve. Mean operative time and mean estimated blood loss were 68 minutes and 54 cc, respectively. We had no intraoperative complications and patients were discharged home 19.6 hours after surgery. Immediate warming of the feet was observed at the end of all procedures. On follow-up consultations, all patients referred complete resolution of the plantar hyperhidrosis. Only one patient developed compensatory hyperhidrosis in her back. Conclusions: Retroperitoneoscopic lumbar sympathectomy by unilateral access seems to be feasible when performed by a surgeon with experience on advanced laparoscopy. Larger series comparing unilateral to bilateral access are necessary to establish the real benefits and potential disadvantages of this new technique.