Minilaparoscopic lumbar sympathectomy with 3 mm instruments for plantar hyperhidrosis.

Marcelo Loureiro,Arlindo Nascimento De Lemos Junior,Paolo Rogerio Oliveira Salvalaggio,Mohammad Alwazzan

doi:10.1590/1677-5449.180072

Abstract

Severe palmoplantar hyperhidrosis affects about 1.5-2.8% of the general population. Plantar hyperhidrosis (PHH) is related to foot odor, cold feet, skin lesions and infections, and even instability when walking. Endoscopic Lumbar Sympathectomy (ELS) is the treatment of choice for this condition. However, few surgeons have used this technique over the past 20 years because of its technical difficulty. Two and 3 mm instruments, rather than the standard 5 mm instruments, have been used to improve the results of several standard laparoscopic procedures. Use of these minilaparoscopic instruments to perform ELS so far has not yet been published. We describe a technique for ELS using minilaparocopic instruments, which we have used for our last 70 cases and has become our standard technique. The aim of this study is to demonstrate the feasibility of this technique and its advantages compared to the conventional technique.

Highlights

Severe palmoplantar hyperhidrosis affects about 1.5%-2.8% of the general population.[1,2]
Palmar hyperhidrosis is obviously much more noticeable in affected individuals than plantar hyperhidrosis (PHH), but the latter can be just as socially and functionally disturbing as palmar hyperhidrosis, because it affects an area covered by shoes and other garments
A table is prepared with the set of 3mm instruments (Figure 1)

Summary

Introduction

Severe palmoplantar hyperhidrosis affects about 1.5%-2.8% of the general population.[1,2] Palmar hyperhidrosis is obviously much more noticeable in affected individuals than plantar hyperhidrosis (PHH), but the latter can be just as socially and functionally disturbing as palmar hyperhidrosis, because it affects an area covered by shoes and other garments. Many options for treatment of PHH have been tried (oral oxybutynin, iontoforesis, topical agents, and botulin toxin injections), but without long term success for the majority of patients. None of these options compare to the effectiveness of surgical resection of the lumbar sympathetic chain to achieve complete control of excessive plantar sweating.[3,4]. From the outset of video laparoscopic surgery, in the late 1980s, many previously open abdominal operations were performed using the new technique. From 2002 to the present, many endoscopic (laparoscopic) approaches were developed for treatment of plantar hyperhidrosis in a number of European and some South American countries

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