Lumbar sympathectomy is a term used for a surgical procedure performed to treat excessive sweating of the feet, which is known as plantar hyperhidrosis. It belongs to a class of treatments for sweaty parts of the body and thus shares similarities with endoscopic thoracic sympathectomy (ETS), a procedure that treats excessively sweaty limbs. Lumbar sympathectomy can also be used to treat other conditions, including Raynaud's phenomenon.
Hyperhidrosis treatments like lumbar sympathectomy have been in existence since the mid-19th century. This was when physicians began to realize that the nerves of the autonomic nervous system (ANS) run to almost all of the body's organs and muscles. They subsequently deduced that the ANS is responsible for regulating organs and muscles, and that the body's functions could be altered by altering the ANS.
Lumbar sympathectomy describes the area of operation. "Lumbar" indicates the lower back and specifically the area between the ribs and the hip bones. The term "sympathectomy" refers to the sympathetic nervous system, or SNS. This is one of the three parts of the ANS, and the SNS in particular functions as a response system to stressful situations, a condition known as the fight-or-flight response. The SNS is responsible for inducing sweating, which is one of the reactions to stress.
To rectify the sweating problem at the feet, physicians turn to a minimally invasive surgical technique called retroperitoneoscopy. This involves inserting an inflated balloon with a video camera through a small incision in an area of the abdomen called the retroperitoneum without destroying the lining behind it, which is known as the peritoneum. Surgeons introduce instruments through another small incision to cut or clamp the nerves of the SNS while monitoring the operation with the video camera.
Lumbar sympathectomy is similar to ETS in that both procedures treat excessively sweating limbs. The difference is that lumbar sympathectomy focuses on sweaty feet. On the other hand, ETS is used to treat palmer hyperhidrosis, or sweaty hands. Also, with ETS, doctors focus on the upper part of the body's trunk, rather than the lower region.
Both lumbar sympathectomy and ETS are used for other conditions besides hyperhidrosis. Some surgeons rely on these methods to battle Raynaud's phenomenon. Named after 19th-century French physician Maurice Raynaud, this condition involves a lack of blood supply manifesting as discoloration of the toes and fingers. Lumbar sympathectomy in particular is used for the toes. ETS has a wider application and can additionally be used for conditions such as persistent headaches and excessive facial blushing.