European Surgery

, Volume 44, Issue 1, pp 10–13 | Cite as

Video-assisted retroperitoneoscopic lumbar sympathectomy*

  • Roman Rieger
Main Topic


BACKGROUND: Video-assisted retroperitoneoscopy is a relatively new surgical technique for performing lumbar sympathectomies and is used increasingly for the treatment of primary plantar hyperhidrosis. In this paper, we report on our clinical experience with this procedure. METHODS: Between December 2004 and August 2011, 306 retroperitoneoscopic lumbar sympathectomies have been performed on 154 patients with severe refractory plantar hyperhidrosis. The perioperative course as well as the postoperative results were analysed in a retrospective analysis. RESULTS: All 306 lumbar sympathectomies were performed in retroperitoneoscopic technique and in none of the cases a conversion to open surgery was necessary. Mortality was zero, and there were no serious intraoperative complications. In approx. 25% of the patients, the surgery was classified as technically difficult for a number of reasons. Postoperative complications occurred in 4 patients (2.6%) in the form of an abdominal wall haematoma, pneumonia, pulmonary embolism and a thrombosis of the right iliac vein. In all patients, the hyperhidrosis was eliminated immediately after surgery. 121 patients (79%) underwent follow-up controls 24 months after surgery on average. Three patients (2.5%) suffered a hyperhidrosis relapse. Adverse events occurred in form of compensatory sweating in 63 patients (52%) and in form of post-sympathectomy neuralgia in 47 patients (39%). Three men developed a temporary ejaculation disorder. CONCLUSIONS: Lumbar sympathectomy can be performed safely and effectively with retroperitoneoscopic surgical technique. Morbidity is low and the procedure is suited very well for the treatment of plantar hyperhidrosis. Since this surgery may be technically difficult because of the anatomic particularities of the retroperitoneum, high expertise with endoscopic surgical techniques is required.


Retroperitoneoscopic lumbar sympathectomy Plantar hyperhidrosis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Royle ND. A new operative procedure in the treatment of spastic paralysis and its experimental basis. Med J Aust 1924;1:77Google Scholar
  2. Adson A, Brown GE. Treatment of Raynaud's disease by lumbar ramisection and ganglionectomy and perivascular sympathectneurectomy. JAMA 1925;84:1908–10CrossRefGoogle Scholar
  3. Enjalbert A, Gedeon A, Castany R. Indications and results of lumbar sympathectomy. J Cardiovasc Surg 1968;9:146–9Google Scholar
  4. Lee BY, Da Silva MC, Aquino-Chu G, et al. Surgery of the sympathetic nervous system. J Spinal Cord Med 1996;19:20–6PubMedGoogle Scholar
  5. Simeone FA. The lumbar sympathetic. Anatomy and surgical implications. Acta Chir Belg 1977;1:17–26Google Scholar
  6. Wittmoser R. Die Retroperitoneoskopie als neue Methode der lumbalen Sympathektomie. Fortschritte der Endoskopie 1973;4:219–21Google Scholar
  7. Gill IS, Clayman RV, Albala DM, et al. Retroperitoneal and pelvic extraperitoneal laparoscopy: an international experience. Urology 1998;52:566–71PubMedCrossRefGoogle Scholar
  8. Beglaibter N, Berlatzky Y, Zamir O, et al. Retroperitoneoscopic lumbar sympathectomy. J Vasc Surg 2002;35:815–7PubMedCrossRefGoogle Scholar
  9. Hourlay P, Vangertruyden G, Verduyckt F, et al. Endoscopic extraperitoneal lumbar sympathectomy. Surg Endosc 1995;9:530–5PubMedCrossRefGoogle Scholar
  10. Rieger R, Pedevilla S, Pöchlauer S. Endoscopic lumbar sympathectomy for plantar hyperhidrosis. Br J Surg 2009;96:1422–8PubMedCrossRefGoogle Scholar
  11. Rieger R, Loureiro MP, Pedevilla S, et al. Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis. World J Surg 2011;35:49–53PubMedCrossRefGoogle Scholar
  12. Reisfeld R. Endoscopic lumbar sympathectomy for focal plantar hyperhidrosis using the clamping method. J Laparosc Endosc Percutan Tech 2010;20:231–6CrossRefGoogle Scholar
  13. Loureiro MP, Milanez De Campos JR, et al. Endoscopic lumbar sympathectomy for women: effect on compensatory sweat. Clinics 2008;63:189–96CrossRefGoogle Scholar
  14. Nicolas C, Grosdidier G, Granel F, et al. Endoscopic sympathectomy for palmar and plantar hyperhidrosis: results in 107 patients. Ann dermatol venereol 2000;127:1057–63PubMedGoogle Scholar
  15. Rieger R, Pedevilla S. Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: technique and preliminary findings. Surg Endosc 2007;21:129–35PubMedCrossRefGoogle Scholar
  16. Rose SS. An investigation into sterility after lumbar ganglionectomy. Br Med J 1953;1:247–50PubMedCrossRefGoogle Scholar
  17. Whitelaw GP, Smithwick RH. Some secondary effects of sympathectomy. With particular reference to disturbance of sexual function. N Engl J Med 1951;245:121–30PubMedCrossRefGoogle Scholar
  18. Gordon A, Zechmeister K, Collin J. The role of sympathectomy in current surgical practice. Eur J Vasc Surg 1994;8:129–37PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of SurgeryLandeskrankenhaus GmundenGmundenAustria

Personalised recommendations