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

For having anatomical support, this procedure can be safe pre-and trans-operatively, achieving high levels of satisfaction among patients, as reported after a retroperitoneoscopic lumbar sympathectomy 9 . In this study, there was one unsuccessful case due to the difficulty of dissecting the right-sided nerve; however, during a second intervention, the right lumbar sympathetic chain was sectioned without complications. Compensatory hyperhidrosis was the adverse effect observed in most patients submitted to laparoscopic superselective transperitoneal lumbar sympathectomy. Nonetheless, as it was less intense, it did not negatively affect satisfaction with the surgery. Several studies report that, despite compensatory sweating, the overall quality of life of these patients improves 5,6,10 . No cases of retrograde ejaculation, hemorrhage, visceral injury, infection, or death were recorded. Compensatory hyperhidrosis occurs in up to two-thirds of cases according to the literature 9-11 and can be exacerbated by the use of a surgical clip to interrupt the sympathetic chain. In these cases, the performance of a new procedure is recommended to remove the clip and section the sympathetic chain 12 . Reinnervation, although less frequent than after thoracic sympathectomy 12 , may also occur and require a new surgical intervention. The body anatomy in the supine position, the insertion of trocars, and camera positioning are well known by surgeons, making this approach advantageous. Moreover, the location of the lumbar sympathetic chain is anatomically constant and, in rare cases, it is not anatomically favorable. Extraperitoneal lumbar sympathectomy, on the other hand, is a technique that has a longer learning curve as it is not the most common route used by surgeons. Furthermore, it requires longer anesthetic time, as well as greater preparation of the team as a whole for the positioning of the patient 4,7 . For being performed with the patient in a commonly used position, the technique described in this study allows for access to the retroperitoneal cavity through an anterior approach to the spine. The main limitations of this study were the small number of cases, the difficulty in locating all patients, and the long time elapsed between the surgery and telephone interview in some cases. In contrast, this investigation provides data on long-term evolution cases. There seems to have been no preferential selection of women since the number of women is also higher in several other studies in the literature 5,10,13,14 . VI. C onclusion The treatment of plantar hyperhidrosis using the laparoscopic superselective transperitoneal lumbar sympathectomy technique proved to be effective and safe. In addition to sympathectomy, this direct approach to the retroperitoneum could also be used in difficult-to- access laparoscopic oncologic resections and treat anterior lumbar spine pathologies. Using a robot for this surgical approach is a possibility. Conflicts of Interest and Source of Funding The authors declare that there is no conflict of interest or funding sources. Author contributions - Elaboration and development of the technique Rodrigo Cadore Mafaldo Ozorio Sampaio Menezes Honório Sampaio Menezes - Project construction and development Rodrigo Cadore Mafaldo Leila Beltrami Moreira Danuza Dias Alves Gustavo RassierIsolan - Construction and development of the article Rodrigo Cadore Mafaldo Gabriella Andressa Marchesin de Castro - Editing and article submission Rodrigo Cadore Mafaldo Ozorio Sampaio Menezes Gabriella Andressa Marchesin de Castro references références referencias 1. Strutton DR., Kowalski JW., Glaser DA., et al. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J AmAcadDermatol, 2004; 51(2):241-8. Doi: 10.1016/j.jaad.2003.12.040. 2. Hasimoto EN, Caetano D, Reis TA, et al. Hyperhidrosis: prevalence and impact on quality of life. J. Bras. Pneumol, 2018; 44(4): 292-298. Doi: 10.1590/s1806-37562017000000379. 3. Rieger R, Pedevilla S, Pochlauer S. Endoscopiclumbarsympathectomy for plantar hyperhidrosis. Br J Surg. 2009. 4. Branco AW., Branco Filho AJ., Kondo W., et al. Bilateral retroperitoneoscopic lumbar sympathectomy by unilateral access. Braz J UrolInt, 2011; 27; 37(2): 292-293. Doi: 10.1590/S1677- 55382011000200032. 5. Lima SO, Santana VR, Valido DP, et al. Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis. Jor of Vas Surg, 2017; 66(6):1806-1813. Doi: 10.1016/j.jvs.2017.05.126. 6. Rieger R., Pedevilla S., Lausecker J. Quality of life after endoscopic lumbar sympathectomy for primary plantar hyperhidrosis. World J Surg, 2015 Apr; 39(4). 7. Loureiro M., Lemos Junior AN., Salvalaggio PRO., et al. Minilaparoscopiclumbarsympathectomywith 3 mm instruments for plantar hyperhidrosis, Jornal Vascular Brasileiro, 2020; 27; 19:e20190072. Doi: 10.1590/1677-5449.180072. 51 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