Global Journal of Medical Research, I: Surgeries and Cardiovascular System, Volume 22 Issue 2

Abstract- Background: Retroperitoneoscopic lumbar sympathectomy is the standard surgical treatment for plantar hyperhidrosis. However, it is rarely performed due to the technical complexity of the procedure. This study aimed to describe a modified video-assisted lumbar sympathectomy technique, the superselective transperitoneal lumbar sympathectomy. Methods: This is a retrospective study of 32 sympathectomies (16 patients) for plantar hyperhidrosis. The procedure is performed with the patient in the supine position and under general anesthesia. A video camera is introduced through the umbilical trocar, and the dissection forceps are introduced through trocars in the suprapubic area and right-and left-iliac fossa. The patient is placed in the Trendelenburg position at the level of the L3 vertebral body. Under the direct view of the endoscope and with the aid of dissection forceps, a small opening of the posterior peritoneum is made, through which the right and left sympathetic plexuses are reached for sectioning. Results: The cases of 16 patients were analyzed. Most of them were women (n = 12), had a higher education degree, and aged from 19 to 36 years (mean of 28.3 ± 4.5 years). Before the procedure, women reported wearing two or three different pairs of socks per day (mean 2.8 ± 1.1), while men, one or two (mean 1.6 ± 0.5; p = 0.039). 75 % of patients declared being very or extremely satisfied and no association between the level of satisfaction and the number of socks changed before the treatment was made (p = 0.78). Most patients had compensatory hyperhidrosis and no other adverse events. Conclusion: The modified lumbar sympathectomy technique proved to be safe and effective. Keywords: hyperhidrosis, excessive plantar sweating, lumbar sympathectomy, laparoscopic surgery. Corresponding Author α : Rua Doutor Guimarães Rosa, 155 - Boa Vista, Porto Alegre – Rio Grande do Sul/RS – Brasil. e-mail: nucleodepesquisa@clinicaleger.com.br Author σ Ѡ § : Physician, PhD, SCd. Author ρ : Physician, Specialist. Author ¥ : Physician. Author χ : Biomedical. I. I ntroduction lantar hyperhidrosis is characterized by excessive sweating of the feet mediated by sympathetic stimulation. In severe cases, patients may have gait disturbances, skin lesions, and cold feet. The prevalence of plantar hyperhidrosis is estimated to be from 2.9% 1 to 9% 2 . Retroperitoneoscopic lumbar sympathectomy is the standard surgical treatment. This procedure has been performed with a low rate of complications 3-5 and has improved the quality of life of patients affected by plantar hyperhidrosis 6 . However, the surgery requires that the patient be in a semi-lateral position with elevation of the flank and the use of intra- abdominal and retroperitoneal pneumoperitoneum 3 ,in addition to, sometimes, being performed in two stages. Some authors perform bilateral sympathectomy which uses a single-sided access and lasts just over an hour 7 . Compensatory hyperhidrosis is the most frequent adverse event and, although infrequent, sexual dysfunction may also occur 8,9 . This study aims to describe a modified video- assisted lumbar sympathectomy technique, called superselective transperitoneal lumbar sympathectomy, which allows the performance of the procedure using a single access with an easy abdominal approach. II. M aterials and M ethods This is a retrospective study of 32 sympathectomies performed in 16 patients with plantar hyperhidrosis treated by laparoscopic superselective transperitoneal lumbar sympathectomy. III. T echnical D escription For better anatomical orientation, considering that the surgery is performed with the patient in the supine position, a simple preoperative abdominal x-ray is performed. The x-ray imaging is done with the patient in the supine position and with the umbilicus marked with a metallic disk, which can be a coin. Thus, the location of the L4 vertebral body can be confirmed in a P 49 Year 2022 Global Journal of Medical Research Volume XXII Issue II Version I ( D ) I © 2022 Global Journals Laparoscopic Superselective Transperitoneal Lumbar Sympathectomy for Treating Plantar Hyperhidrosis Lumbar Sympathectomy for or Treating Plantar Hyperhidrosis Rodrigo Cadore Mafaldo α , Leila Beltrami Moreira σ , Ozorio Sampaio Menezes ρ , Honório Sampaio Menezes Ѡ , Danuza Dias Alves ¥ , Gustavo RassierIsolan § & Gabriella Andressa Marchesin de Castro χ