Retroperitoneoscopic lumbar sympathectomy for plantar hyperhidrosis: surgical technique

Primary hyperhidrosis is a common disease that affects about 5% of the population in which plantar damage exists in 40% of cases responsible for significant social, professional and psychological repercussions. The most effective and sustainable treatment is surgery by thoracic or lumbar sympathectomy depending on the location. Lumbar sympathectomy has long been practiced for the treatment of non-revascularizable obliterating arteriopathy of the lower limbs, and retains a bad reputation, in particular due to sexual dysfunction. However, it is extremely effective for the treatment of plantar hyperhidrosis with 98 to 100% efficiency and thanks to laparoscopy, the operative risks are low and the sexual dysfunction almost nil. Initially described in 1995, since 2002 many teams have improved the technique around the world. The purpose of this article is to describe the technique of retroperitoneoscopic lumbar sympathectomy in 2021 and to discuss its results.