You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2010V322 TRANSPERITONEAL LAPAROSCOPIC BILATERAL LUMBAR SYMPATHECTOMY: A TREATMENT OPTION FOR PLANTAR AND GENITAL HYPERHIDROSIS Dana Weiss, Timothy Tseng, and Marshall Stoller Dana WeissDana Weiss More articles by this author , Timothy TsengTimothy Tseng More articles by this author , and Marshall StollerMarshall Stoller More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.387AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Plantar and genital hyperhidrosis resulting in profuse perspiration of the soles of the feet and groin is a debilitating disease that causes significant social, physical, and psychological effects. There is currently no standard treatment that is both effective and durable for the treatment of this condition. We demonstrate that laparoscopic lumbar sympathectomy, as performed by the urologist who is well-versed in retroperitoneal anatomy, is a minimally invasive, feasible, and time-efficient approach that achieves effective and potentially durable results for plantar and genital hyperhidrosis. METHODS Four laparoscopic lumbar sympathectomies were performed in two sisters. The patients were positioned and intraperitoneal access was obtained in the same manner as for laparoscopic nephrectomy. Approximately 2 cm of one lumbar sympathetic chain was ligated and removed at the level of the L2 vertebral body. The port sites were closed and the procedure was repeated on the contralateral side. Post-operatively, the positions of the titanium clips used to ligate the sympathetic chains were confirmed and documented with plain x-ray films of the abdomen. RESULTS Each lumbar sympathetic chain ligation was completed in approximately 45 to 60 minutes. The lumbar sympathetic chain on the right side was noted to be in a position slightly posterior to the inferior vena cava, and required medial retraction of the IVC during dissection. The lumbar sympathetic chain on the left side was noted to be more lateral to the aorta. There were immediate objective and subjective responses to the procedures. Both patients' reported that their feet felt warm and both patients' feet were indeed warm and dry to the touch. One of the patients experienced self-limited mild right shoulder pain and nausea attributed to the insufflation. The other patient did not experience any significant post-operative pain or discomfort. CONCLUSIONS Bilateral laparoscopic transperitoneal lumbar sympathectomy can be performed in a safe and efficient manner in a single anesthetic setting. The retroperitoneum is familiar territory to urologists who routinely perform retroperitoneal procedures including nephrectomy, pyeloplasty, and retroperitoneal lymphadenectomy. As such, urologists are uniquely poised to provide this potentially durable treatment option for plantar and genital hyperhidrosis. San Francisco, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e127-e128 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dana Weiss More articles by this author Timothy Tseng More articles by this author Marshall Stoller More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...