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Electrophysiological evaluation of efficacy of clipping in thoracic sympathectomy: An experimental cadaveric study. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 28:669-673. [PMID: 33403141 PMCID: PMC7759042 DOI: 10.5606/tgkdc.dergisi.2020.19412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
Background
This study aims to examine the efficacy of clipping in thoracic sympathectomy based on electrophysiological evaluation and to investigate whether nerve conduction can be formed by collateral nerve extensions as a result of the clipping procedure to different levels of sympathetic nerve.
Methods
Newly sacrificed six sheep hemithoraces were studied between August 2016 and October 2016. Thoracic sympathectomy was performed by clipping at T2, T3, T4, and T5 sympathetic chain levels and their branches. Electrophysiological studies were performed with an electromyography device and the filter range was 1 Hz with 20 μV/D amplification. Signals were processed digitally; bipolar subdermal needle electrodes were used as stimulation and recording electrodes (Ø 0.75 mm); and the ground electrode was placed in the intercostal muscle where the thoracic sympathectomy procedure would be performed.
Results
Electrophysiological evaluations showed that clips placed on the main sympathetic chain branches and sympathetic nerve trunk prevented collateral impulse conduction and stimulated potentials were not recorded. However, sympathetic conduction continued at the same intensity after removal of the clips.
Conclusion
Clipping of different regions of the sympathetic nerve provides electrophysiological blockage of the sympathetic nerve, and conduction continues after removal of the clips. However, the shortand long-term postoperative electrophysiological results after removal of the clips over the sympathetic nerve is still a question mark.
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Huang L, Jiang H, Wei D, Xue Q, Ding Q, Hu R. A comparative study of thoracoscopic sympathectomy for the treatment of hand sweating. J Thorac Dis 2019; 11:3336-3340. [PMID: 31559036 DOI: 10.21037/jtd.2019.08.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To compare postoperative satisfaction, compensatory hyperhidrosis, and the quality of life between thoracoscopic T3 and T4 sympathectomy for the treatment of hand sweating. Methods From December 2010 to October 2014, 192 consecutive patients with hand sweating underwent a thoracoscopic bilateral sympathectomy with different planes (T3/T4). The patients were randomly divided into two groups, the T3 and the T4 groups, for those who underwent thoracoscopic T3 and T4 sympathectomy, respectively. All patients underwent double-lumen intubation during the thoracoscopic bilateral sympathectomy. The patients were followed up with by telephone for postoperative evaluation on the safety and effectiveness of the procedure, and the two groups (T3 versus T4) were compared to each other for any potential differences. Results All of the patients' sweating symptoms improved after the procedure. The incidence of compensatory hyperhidrosis and palm dryness in the T4 group was lower than that in the T3 group (P<0.05). The satisfaction rate and the rate of improvement in sweating and the incidence of palm moisture in the T4 group were higher than those in the T3 group (P<0.05). Conclusions Thoracoscopic T3 and T4 sympathectomy are safe and effective methods for the treatment of hand sweating. Lowering the sympathetic chain resection plane can increase patients' satisfaction and enhance improvements in sweating. It can also reduce the incidence of long-term compensatory hyperhidrosis and palm dryness, but it also increases the incidence of palm moisture.
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Affiliation(s)
- Lixia Huang
- Department of fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310000, China
| | - Hong Jiang
- Department of Cardiothoracic Surgery, Hangzhou First People's Hospital, Hangzhou 310000, China
| | - Dongshan Wei
- Department of Cardiothoracic Surgery, Hangzhou First People's Hospital, Hangzhou 310000, China
| | - Qingming Xue
- Department of Cardiothoracic Surgery, Hangzhou First People's Hospital, Hangzhou 310000, China
| | - Qingsong Ding
- Department of Cardiothoracic Surgery, Hangzhou First People's Hospital, Hangzhou 310000, China
| | - Runlei Hu
- Department of Cardiothoracic Surgery, Hangzhou First People's Hospital, Hangzhou 310000, China
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Wade R, Rice S, Llewellyn A, Moloney E, Jones-Diette J, Stoniute J, Wright K, Layton AM, Levell NJ, Stansby G, Craig D, Woolacott N. Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Health Technol Assess 2019; 21:1-280. [PMID: 29271741 DOI: 10.3310/hta21800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. OBJECTIVE To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. METHODS A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. RESULTS AND CONCLUSIONS Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. LIMITATIONS The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. FUTURE WORK Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses. STUDY REGISTRATION This study is registered as PROSPERO CRD42015027803. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Ros Wade
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Stephen Rice
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eoin Moloney
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Julija Stoniute
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Nick J Levell
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Gerard Stansby
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination, University of York, York, UK
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Du X, Zhu X, Wang T, Hu X, Lin P, Teng Y, Fan C, Li J, Xi Y, Xiao J, Liu W, Zhang J, Zhou H, Tian D, Yuan S. Compensatory hyperhidrosis after different surgeries at the same sympathetic levels: a meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:203. [PMID: 30023366 DOI: 10.21037/atm.2018.05.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Different techniques of video-assisted thoracoscopic sympathetic surgery have become the radical treatments for palmar and axillary hyperhidrosis (AH). However, there is no consensus over which technique can make a minimal incidence of compensatory hyperhidrosis (CH). This study was designed to compare the incidence of CH after different techniques at the same sympathetic levels in the treatment of upper limb and facial hyperhidrosis (FH). Methods The databases of PubMed, Web of Science, ScienceDirect, Ovid Medline, Embase, and Cochrane Library were searched to identify studies comparing different surgical techniques at the same sympathetic levels for upper limb and FH. The data was analyzed by Revman 5.3 software. Results A total of ten studies involving 896 patients were included, of whom 149 underwent sympathectomy, 435 underwent sympathicotomy, and 312 under endoscopic sympathetic clip (ESC). Meta-analysis showed that the difference of incidence of CH and patients' satisfaction was not significant between sympathectomy and sympathicotomy (P=0.05, 0.19, respectively). But, the incidence of CH is significant lower after ESC than after sympathicotomy (OR: 1.58, 95% CI: 1.04-2.38, P=0.03). However, the incidence of moderate/severe CH between these two groups is not significant different (OR: 1.49, 95% CI: 0.93-2.39, P=0.10). Conclusions If only CH and the same sympathetic levels concerned, sympathectomy and sympathicotomy is equal for upper limb hyperhidrosis and FH. And, ESC should be recommended for a lower incidence of CH, comparing with sympathicotomy.
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Affiliation(s)
- Xiaojun Du
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xu Zhu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Tao Wang
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Xiao Hu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Peng Lin
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yin Teng
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Chao Fan
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jianglun Li
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Yang Xi
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jiarong Xiao
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Wen Liu
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jian Zhang
- Department of Thoracic Surgery, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Dan Tian
- Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shizhang Yuan
- Department of Thoracic Surgery, Guiyang Public Health Clinical Center, Guiyang 550003, China
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Wolosker N, Milanez de Campos JR, Fukuda JM. Management of Compensatory Sweating After Sympathetic Surgery. Thorac Surg Clin 2016; 26:445-451. [DOI: 10.1016/j.thorsurg.2016.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sternbach JM, DeCamp MM. Targeting the Sympathetic Chain for Primary Hyperhidrosis. Thorac Surg Clin 2016; 26:407-420. [DOI: 10.1016/j.thorsurg.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yun SW, Kim YS, Lee Y, Lim HJ, Park SI, Jung JP, Park CR. Outcome of Limited Video-Assisted Lumbar Sympathetic Block for Plantar Hyperhidrosis Using Clipping Method. J Laparoendosc Adv Surg Tech A 2016; 27:36-42. [PMID: 27622702 DOI: 10.1089/lap.2016.0387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are many ways to treat focal hyperhidrosis, including surgeries for palmar and axillary hyperhidrosis. However, doctors and patients tend to be reluctant to perform surgery for plantar hyperhidrosis due to misconceptions and prejudices about surgical treatment. In addition, few studies have reported the outcome of surgeries for plantar hyperhidrosis. Therefore, the objective of this study was to determine the outcome (early and late postoperative satisfaction, complication, compensatory hyperhidrosis, recurrence rate, and efficiency) of surgical treatment for plantar hyperhidrosis. MATERIALS AND METHODS From August 2014 to October 2015, lumbar sympathetic block (LSB) was performed in 82 patients with plantar hyperhidrosis using clipping method. Limited video-assisted LSB was performed using 5 mm ligamax-clip or 3 mm horizontal-clip after identifying L3-4 sympathetic ganglion through finger-touch and endoscopic vision. RESULTS Of the 82 patients, 45 were male and 37 were female. Their mean age was 26.38 years (range, 14-51 years). Mean follow-up time was 6.60 ± 3.56 months. Mean early postoperative satisfaction score was 9.6 on the 10th day postoperative evaluation. At more than 1 month later, the mean late postoperative satisfaction score was 9.2. There was no significant difference in early postoperative satisfaction score between clipping level L3 and L4/5. However, late postoperative satisfaction score was significantly better in the L3 group than that in the L4/5 group. Patient's age and body mass index did not affect the satisfaction score. However, male patients and patients who had history of hyperhidrosis operation showed higher satisfaction score than others. CONCLUSION Limited video-assisted LSB using clip provided good results with minimal complications and low compensatory hidrosis, contrary to the prejudice toward it. Therefore, surgical treatment is recommended for plantar hyperhidrosis.
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Affiliation(s)
- Seok Won Yun
- 1 Dajung Chest Surgery , Suwon, Republic of Korea
| | - Yun Seok Kim
- 2 Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan , College of Medicine, Ulsan, Republic of Korea
| | - Yongjik Lee
- 2 Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan , College of Medicine, Ulsan, Republic of Korea
| | - Han Jung Lim
- 1 Dajung Chest Surgery , Suwon, Republic of Korea
| | - Soon Ik Park
- 3 Da-jeong Clinic of Surgery , Ulsan, Republic of Korea
| | - Jong Pil Jung
- 2 Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan , College of Medicine, Ulsan, Republic of Korea
| | - Chang Ryul Park
- 2 Department of Thoracic and Cardiovascular Surgery, Ulsan University Hospital, University of Ulsan , College of Medicine, Ulsan, Republic of Korea
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Hashmonai M, Cameron AEP, Licht PB, Hensman C, Schick CH. Thoracic sympathectomy: a review of current indications. Surg Endosc 2015; 30:1255-69. [PMID: 26123342 DOI: 10.1007/s00464-015-4353-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/16/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Thoracic sympathetic ablation was introduced over a century ago. While some of the early indications have become obsolete, new ones have emerged. Sympathetic ablation is being still performed for some odd indications thus prompting the present study, which reviews the evidence base for current practice. METHODS The literature was reviewed using the PubMed/Medline Database, and pertinent articles regarding the indications for thoracic sympathectomy were retrieved and evaluated. Old, historical articles were also reviewed as required. RESULTS AND CONCLUSIONS Currently, thoracic sympathetic ablation is indicated mainly for primary hyperhidrosis, especially affecting the palm, and to a lesser degree, axilla and face, and for facial blushing. Despite modern pharmaceutical, endovascular and surgical treatments, sympathetic ablation has still a place in the treatment of very selected cases of angina, arrhythmias and cardiomyopathy. Thoracic sympathetic ablation is indicated in several painful conditions: the early stages of complex regional pain syndrome, erythromelalgia, and some pancreatic and other painful abdominal pathologies. Although ischaemia was historically the major indication for sympathetic ablation, its use has declined to a few selected cases of thromboangiitis obliterans (Buerger's disease), microemboli, primary Raynaud's phenomenon and Raynaud's phenomenon secondary to collagen diseases, paraneoplastic syndrome, frostbite and vibration syndrome. Thoracic sympathetic ablation for hypertension is obsolete, and direct endovascular renal sympathectomy still requires adequate clinical trials. There are rare publications of sympathetic ablation for primary phobias, but there is no scientific basis to support sympathetic surgery for any psychiatric indication.
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Affiliation(s)
- Moshe Hashmonai
- Faculty of Medicine, Technion-Israel Institute of Technology, PO Box 359, 30952119, Zikhron Ya'akov, Haifa, Israel.
| | | | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
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Pompili C, Novoa N, Balduyck B. Clinical evaluation of quality of life: a survey among members of European Society of Thoracic Surgeons (ESTS). Interact Cardiovasc Thorac Surg 2015; 21:415-9. [DOI: 10.1093/icvts/ivv171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/18/2015] [Indexed: 11/13/2022] Open
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