Totally videoscopic bilateral, simultaneous lumbar sympathectomy: original modification – preliminary report

Introduction: Lumbar sympathectomy seems to be technically a much more demanding procedure than thoracic sympathectomy. Nevertheless, some patients require this particular procedure. In our centre, the operation is performed no sooner than 12 months after initial thoracic sympathectomy as a simultaneous bilateral retro-peritoneoscopic procedure.
Aim: To evaluate early effectiveness of totally videoretroperitoneoscopic lumbar sympathectomy from a posterior approach.
Material and methods: Between June 2008 and June 2009, there were 12 patients operated on for primary plantar hyperhidrosis in the Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland. A bilateral procedure was performed in 6 patients, and in 6 other cases (initial ones) the procedure had to be split due to too slow progress of the procedure (learning curve).
Results: Mean operation time was 92.5 ±27.16 min (for 6 bilateral procedures) and 84 ±20.17 min (for the initial 12 unilateral procedures). There was no postoperative mortality. Morbidity involved post-sympathectomy syndrome presenting as moderate burning pain in the buttocks and thighs up to 4 weeks postoperatively. Postoperative stay was 1 day in 7 cases and 2 days in 3 cases (due to long train travel awaiting the patient on his/her way home). In the majority of patients, early postoperative results were very good, expressed by both the subjective opinion of the patient and gravimetric results. In one case dryness of the feet was so severe that the patient had to consult a dermatologist.
Conclusions: We believe that videoretroperitoneoscopic lumbar sympathectomy from a posterior approach is a good method of treatment for primary hyperhidrosis with plantar symptoms, but should be reserved for surgeons experienced in laparoscopic and retroperitoneoscopic surgery.