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Ho AVT, Øvensen E, Lilja D, Toska K, Grenager O, Kristiansen K, Wesche J. Changes in electrodermal activity following sympathicotomy in hyperhidrosis patients. Front Surg 2024; 11:1358357. [PMID: 38529470 PMCID: PMC10961364 DOI: 10.3389/fsurg.2024.1358357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Objectives The aim of this study was to assess the potential of electrodermal activity (EDA) as a diagnostic tool for preoperative evaluation in hyperhidrosis patients. EDA levels and patterns in different skin areas were investigated before and after endoscopic thoracic sympathicotomy (ETS) and was compared to healthy subjects. Methods Thirty-seven patients underwent two days of measurements before and after the operation. Twenty-five (67.5%) of the patients also had a third measurement after six months. Non-invasive EDA measurements, involving skin conductance, were sampled from five different skin areas while patients were at rest in supine and sitting positions or when subjected to stimuli such as deep inspirations, mental challenge, and exposure to a sudden loud sound. Results Prior to the operation, hyperhidrosis patients showed higher spontaneous palm EDA variations at rest and stronger responses to stimuli compared to healthy subjects. Patients with facial blushing/hyperhidrosis or combined facial/palmar hyperhidrosis showed minimal spontaneous activity or responses, particularly during mental challenge and sound stimulus. Notably, palm EDA response was abolished shortly following sympathicotomy, although a minor response was observed after six months. Minimal EDA responses were also observed in the back and abdomen postoperatively. Conclusion Hyperhidrosis patients showed stronger EDA response to stimuli compared to healthy subjects. Sympathicotomy resulted in the complete elimination of palm EDA responses, gradually returning to a limited extent after six months. These findings suggest that EDA recordings could be utilized in preoperative assessment of hyperhidrosis patients.
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Affiliation(s)
- Ai Van Thuy Ho
- The Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Thoracic and Vascular Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Eirik Øvensen
- Department of Thoracic and Vascular Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Didrik Lilja
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Karin Toska
- The Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Odd Grenager
- Department of Thoracic and Vascular Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Knut Kristiansen
- Department of Thoracic and Vascular Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Jarlis Wesche
- The Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Thoracic and Vascular Surgery, Akershus University Hospital, Lørenskog, Norway
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2
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Kuijpers M, van Zanden JE, Harms PW, Mungroop HE, Mariani MA, Klinkenberg TJ, Bouma W. Minimally Invasive Sympathicotomy for Palmar Hyperhidrosis and Facial Blushing: Current Status and the Hyperhidrosis Expert Center Approach. J Clin Med 2022; 11:jcm11030786. [PMID: 35160238 PMCID: PMC8836383 DOI: 10.3390/jcm11030786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/18/2022] Open
Abstract
Hyperhidrosis, the medical term for excessive sweating beyond physiological need, is a condition with serious emotional and social consequences for affected patients. Symptoms usually appear in focal areas such as the feet, hands, axillae and face. Non-surgical treatment options such as topical antiperspirants or systemic medications are usually offered as a first step of treatment, although these therapies are often ineffective, especially in severe and intolerable cases of hyperhidrosis. In the treatment algorithm for patients suffering from hyperhidrosis, surgical thoracoscopic sympathicotomy offers a permanent solution, which is particularly effective in the treatment of palmar hyperhidrosis and facial blushing. In this review, we describe the current status of thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing. In addition, we share the specific treatment approach, technique and results of our Hyperhidrosis Expert Center. Last, we share recommendations to ensure an effective, reproducible and safe application of single-port thoracoscopic sympathicotomy for palmar hyperhidrosis and facial blushing, based on our extensive experience.
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Affiliation(s)
- Michiel Kuijpers
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
- Correspondence:
| | - Judith E. van Zanden
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
| | - Petra W. Harms
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
| | - Hubert E. Mungroop
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
| | - Massimo A. Mariani
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
| | - Theo J. Klinkenberg
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
| | - Wobbe Bouma
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (J.E.v.Z.); (H.E.M.); (M.A.M.); (T.J.K.); (W.B.)
- Hyperhidrosis Expert Center, Dermatology, Martini Hospital, 9700 RM Groningen, The Netherlands;
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Fujiwara S, Yoshimura H, Kawamoto M. Isolated anhidrosis of an upper limb in a patient with lung cancer: 'one-sleeve shirt sign'. QJM 2021; 114:527-528. [PMID: 33752233 DOI: 10.1093/qjmed/hcab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Fujiwara
- Department of Neurology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo 650-0047, Japan
| | - H Yoshimura
- Department of Neurology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo 650-0047, Japan
| | - M Kawamoto
- Department of Neurology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo 650-0047, Japan
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Won HJ, Choi HS, Park KH. Anatomic variations of the intrathoracic nerves and the neural connections of the second and third thoracic sympathetic ganglia to the brachial plexus. Clin Anat 2020; 34:590-595. [PMID: 32372452 DOI: 10.1002/ca.23619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This study investigated morphological variations of the intrathoracic nerves and the neural connections of the second and third thoracic sympathetic ganglia to the brachial plexus based on the existence of the intrathoracic nerves and the rami communicantes. MATERIALS AND METHODS Fifty thoracic sympathetic trunks from 26 Korean adult cadavers were used. RESULTS The first intrathoracic nerve connecting the first and second thoracic nerves was observed on 36 sides (72%), and the second intrathoracic nerve connecting the second and third thoracic nerves was found on three sides (6%). There were either one (62%) or two (10%) first intrathoracic nerves, and only one second intrathoracic nerve (6%). The neural connections of the second and third thoracic sympathetic ganglia to the first thoracic nerve were classified into three types based on the existence of the intrathoracic nerves: Type I (68%) had only the first intrathoracic nerve, Type II (26%) had no intrathoracic nerve, and Type III (6%) had both the first and second intrathoracic nerves. Types I, II, and III were further subdivided into 10, 6, and 3 types, respectively, according to the types of the rami communicantes arising from the second and third thoracic sympathetic ganglia. CONCLUSIONS Improved knowledge of the variations in intrathoracic nerves and upper thoracic sympathetic ganglia will be helpful to thoracic surgeons when they are disrupting the sympathetic supply to the hand for treating palmar hyperhidrosis, and contribute to successful diagnoses and treatments.
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Affiliation(s)
- Hyung-Jin Won
- Department of Anatomy, School of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Hoon-Sung Choi
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, South Korea
| | - Kyeong Han Park
- Department of Anatomy, School of Medicine, Kangwon National University, Chuncheon, South Korea
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Cummings KW, Sridhar S, Parsons MS, Javidan-Nejad C, Bhalla S. Cross-sectional Imaging Anatomy and Pathologic Conditions Affecting Thoracic Nerves. Radiographics 2017; 37:73-92. [DOI: 10.1148/rg.2017160071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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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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Joo S, Lee GD, Haam S, Lee S. Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping. J Thorac Dis 2016; 8:934-41. [PMID: 27162669 DOI: 10.21037/jtd.2016.03.57] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thoracoscopic sympathetic surgery is regarded as a definitive treatment for palmar hyperhidrosis. However, the optimal surgical strategy remains unclear. The aim of this study was to compare outcomes based on the level and type of sympathetic disconnection in patients with palmar hyperhidrosis. METHODS From January 2009 to December 2014, 101 patients with palmar hyperhidrosis underwent thoracoscopic sympathetic surgery at Gangnam Severance Hospital. Complete follow-up information was obtained from 59 patients. We retrospectively analyzed the results of operation, degree of palmar sweating (%), grade of compensatory sweating (none, mild, moderate, severe, very severe), grade of satisfaction (very satisfied, satisfied, moderate, dissatisfied, very dissatisfied), and recurrence/failure. RESULTS R4 sympathicotomy, R4 sympathetic clipping, and R3 sympathetic clipping were performed in 16, 20, and 23 patients, respectively. The mean degree of palmar sweating after sympathetic surgery was not significantly different between these three groups (17.50% vs. 27.00% vs. 29.78%; P=0.38). The rate of life-bothering compensatory sweating was lower in the R4 sympathicotomy group compared with those of other two groups (0% vs. 25%, 47.8%; P=0.09). The rate of very satisfied to moderate grades of satisfaction were lower in the R3 sympathetic clipping group compared with those of other two groups (93.8%, 100% vs. 73.9%; P=0.07). The rate of recurrence/failure rates were lower in the R4 sympathicotomy group compared with those of other two groups (12.50% vs. 35.00%, 34.8%; P=0.25). Sympathetic surgery at the R3 level was the only significant risk factor for patient dissatisfaction (odd ratio =12.353, 95% confidence interval =1.376-110.914; P=0.025). CONCLUSIONS Our data support that R4 sympathicotomy had lower grades of compensatory sweating, higher grades of satisfaction, and lower rates of recurrence/failure. We therefore consider R4 sympathicotomy as an optimal surgical treatment for palmar hyperhidrosis.
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Affiliation(s)
- Seok Joo
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geun Dong Lee
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seokjin Haam
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungsoo Lee
- 1 Department of Trauma Surgery, Regional Trauma Center, Gachon University Gil Hospital, Incheon, Republic of Korea ; 2 Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Kocher GJ, Taha A, Ahler M, Schmid RA. Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature. Langenbecks Arch Surg 2014; 400:107-12. [DOI: 10.1007/s00423-014-1249-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
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9
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Wallin BG, Burton AR, Elam M, Tamaddon K, Millard R, Macefield VG. Viscerosympathetic reflexes in human spinal cord injury: relationships between detrusor pressure, blood pressure and skin blood flow during bladder distension. Exp Physiol 2013; 98:1081-91. [DOI: 10.1113/expphysiol.2012.070888] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Heidemann E, Licht PB. A comparative study of thoracoscopic sympathicotomy versus local surgical treatment for axillary hyperhidrosis. Ann Thorac Surg 2012. [PMID: 23200232 DOI: 10.1016/j.athoracsur.2012.08.103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Axillary hyperhidrosis affects approximately 1.4% of the population. Medical management is often frustrating, and the response generally transient. Surgical methods include thoracoscopic sympathectomy or sympathicotomy and local axillary surgery such as suction-curettage or en-bloc skin resection. Many case series with retrospective follow-up are available in the literature, but no comparative studies between surgical techniques have been published. METHODS During a 9-year period, two groups of consecutive patients with isolated axillary hyperhidrosis underwent thoracoscopic sympathicotomy (n = 49) or local axillary surgery (n = 47) at the same university hospital, depending on referral or preference. Patients received identical questionnaires to investigate local effect and side effects after surgery. RESULTS Questionnaires were returned by 92% after a median of 26 months, with no significant difference between the two groups. Local effect was significantly better after axillary surgery compared with sympathicotomy (p < 0.001), but mild recurrent axillary symptoms were significantly more frequent after axillary surgery (51% versus 5%, p < 0.001). Compensatory and gustatory sweating were significantly more frequent after sympathicotomy (84% versus 25%, p < 0.001; and 54% versus 26%, p = 0.01, respectively). CONCLUSIONS Outcome after surgery for isolated axillary hyperhidrosis was significantly better after local surgical treatment compared with sympathicotomy. Local effect was better and side effects fewer, but milder recurrent symptoms were more frequent. Compensatory sweating also occurs after local axillary surgery and has not been reported before. Our results suggest that local axillary surgery is preferable for isolated axillary hyperhidrosis and that R2-R3 or R2-R4 sympathicotomy should be discouraged. Sympathicotomy should only be considered for patients who have additional palmar hyperhidrosis.
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Affiliation(s)
- Erik Heidemann
- Department of Reconstructive and Plastic Surgery, Odense University Hospital, Odense, Denmark
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11
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Infraareolar access for thoracoscopic sympathectomy to treat primary hyperhidrosis. Surg Today 2012; 43:221-4. [PMID: 22669735 DOI: 10.1007/s00595-012-0214-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/15/2011] [Indexed: 10/28/2022]
Abstract
We herein present a new technique for performing thoracoscopic sympathectomy to treat primary hyperhidrosis in both genders and all ages through the mammary infraareolar access associated with the axillary access. We believe that these points of access are feasible and safe, and result in an excellent cosmetic outcome without compromising the efficacy of the thoracoscopic sympathectomy. The existence of adhesions between the parietal and visceral pleura, the presence of large breasts, and lactation made it difficult to perform the surgery, but did not make it impossible to apply the technique using the infraareolar access. However, the presence of breast implants is a contraindication for the new access.
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12
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Martinez-Barenys C, Pérez J, López De Castro P, Melero A, Mesa M, García S, Fernández E, Astudillo J. [Initial experience of a program of clipping the sympathetic nervous system for the treatment of hyperhidrosis and facial flush]. Cir Esp 2012; 91:115-20. [PMID: 22520560 DOI: 10.1016/j.ciresp.2012.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 02/15/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE To evaluate the results of our program of clipping the thoracic sympathetic nervous system (TSNS) for the treatment of facial flush and/or hyperhidrosis (HH), and to compare the methodology-results of the program development phase (A: January 2007-April 2009) and its consolidation phase (B: May 2009-March 2010). MATERIAL AND METHODS The program included a total of 44 patients (88 procedures) subjected to videothoracoscopy and clipping of the TSNS in a one day surgery unit. Data were collected and analysed retrospectively, and a descriptive and comparative statistical analysis was performed between the two periods (A and B). RESULTS The overall morbidity was 5 cases (11.3%). The post-surgical occurrence rate of HH was 4.54% (2 cases), and the incidence of compensatory sweating was 65.9% (minimal in 26 of the 29 cases). On comparing period B with period A, there was a significant decrease in surgical time, disappearance of recurrence of HH, a decrease of 30% in morbidity, reduction by half in the incidence of moderate to severe compensatory sweating, and an increase in the level of satisfaction. The clamps were removed in one of the poorly tolerated compensatory sweating cases, resulting in its disappearance. CONCLUSIONS Clipping the TSNS is a safe technique in the one day surgery unit, with a short learning curve (20 cases) after which comparable, or even better, results are obtained than those of sympatholysis. These results, together with their potential reversibility, makes it, in our opinion, the technique of choice in the surgery of the TSNS.
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Affiliation(s)
- Carlos Martinez-Barenys
- Servicio de Cirugía Torácica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
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13
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Sympathetic chain clipping for hyperhidrosis is not a reversible procedure. Surg Endosc 2011; 26:1258-63. [DOI: 10.1007/s00464-011-2023-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 10/17/2011] [Indexed: 11/26/2022]
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Hoorens I, Ongenae K. Primary focal hyperhidrosis: current treatment options and a step-by-step approach. J Eur Acad Dermatol Venereol 2011; 26:1-8. [PMID: 21749468 DOI: 10.1111/j.1468-3083.2011.04173.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS).
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Affiliation(s)
- I Hoorens
- Department of Dermatology, University Hospital, Ghent, Belgium.
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Guidelines on surgery of the thoracic sympathetic nervous system. Arch Bronconeumol 2011; 47:94-102. [PMID: 21342743 DOI: 10.1016/j.arbres.2010.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 05/29/2010] [Indexed: 11/23/2022]
Abstract
Thoracic sympathetic nervous system (TSNS) surgery has increased in importance in the last few years, generating great expectations among the general population and the scientific community. This has been due to the excellent results obtained by videothoracoscopy-assisted thoracic sympathectomy in the treatment of essential hyperhidrosis and other TSNS disorders. This minimally invasive surgical technique has been shown to be effective, and with a low morbidity it is accepted as one of the best therapeutic options for the treatment of palmar and bilateral axillary hyperhidrosis and the number of patients consulting with the intention of having the operation has increased considerably. Although compensatory sweating, which is occasionally intense, often occurs after the surgery, this and other secondary effects of the technique are well tolerated by patients. The current evidence on TSNS and the treatment of essential hyperhidrosis is based on observational studies, making it difficult to compare series and draw conclusions. There has been much discussion on standardising the technique, defining the most favourable levels for clipping, and choosing the type of denervation with least secondary effects. This has led to the need to draw up these guidelines which should clarify and standardise the criteria for managing patients with disorders of TSNS.
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Santana-Rodríguez N, Clavo-Varas B, Ponce-GonzÁlez MÁ, Jarabo-Sarceda JR, Pérez-Alonso D, Ruiz-Caballero JA, Olmo-Quintana V, Atallah yordi N, Fiuza-Pérez MD. Primary frontal hyperhidrosis successfully treated with low doses of botulinum toxin A as a useful alternative to surgical treatment. J DERMATOL TREAT 2010; 23:49-51. [DOI: 10.3109/09546634.2010.495379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wait SD, Killory BD, Lekovic GP, Ponce FA, Kenny KJ, Dickman CA. Thoracoscopic Sympathectomy for Hyperhidrosis. Neurosurgery 2010; 67:652-6; discussion 656-7. [DOI: 10.1227/01.neu.0000374719.32137.bb] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Hyperhidrosis (HH) profoundly affects a patient's well-being.
OBJECTIVE
We report indications and outcomes of 322 patients treated for HH via thoracoscopic sympathectomy or sympathotomy at the Barrow Neurological Institute.
METHODS
A prospectively maintained database of all patients who underwent sympathectomy or sympathotomy between 1996 and 2008 was examined. Additional follow-up was obtained in clinic, by phone, or by written questionnaire.
RESULTS
A total of 322 patients (218 female patients) had thoracoscopic treatment (mean age 27.6 years; range, 10–60 years). Mean follow-up was 8 months. Presentations included HH of the palms (43 patients, 13.4%), axillae (13 patients, 4.0%), craniofacial region (4 patients, 1.2%), or some combination (262 patients, 81.4%). Sympathectomy and sympathotomy were equally effective in relieving HH. Palmar HH resolved in 99.7% of patients. Axillary or craniofacial HH resolved or improved in 89.1% and 100% of cases, respectively. Hospital stay averaged 0.5 days. Ablating the sympathetic chain at T5 increased the incidence of severe compensatory sweating (P = .0078). Sympathectomy was associated with a significantly higher incidence of Horner's syndrome compared with sympathotomy (5% vs 0.9%, P = .0319). Patients reported satisfaction and willingness to undergo the procedure again in 98.1% of cases.
CONCLUSION
Thoracoscopic sympathectomy is effective and safe treatment for severe palmar, axillary, and craniofacial HH. Ablating the T5 ganglion tends to increase the severity of compensatory sweating. Sympathectomy led to a higher incidence of ipsilateral Horner's syndrome compared with sympathotomy.
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Affiliation(s)
- Scott D. Wait
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Brendan D. Killory
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | | | - Francisco A. Ponce
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kathy J. Kenny
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Curtis A. Dickman
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Wait SD, Killory BD, Lekovic GP, Dickman CA. Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents. J Neurosurg Pediatr 2010; 6:183-7. [PMID: 20672941 DOI: 10.3171/2010.5.peds09225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Palmar, axillary, and plantar hyperhidrosis is often socially, emotionally, and physically disabling for adolescents. The authors report surgical outcomes in all adolescents treated for palmar hyperhidrosis via bilateral thoracoscopic sympathectomy at the Barrow Neurological Institute by the senior author. METHODS A prospectively maintained database of all adolescent patients undergoing bilateral thoracoscopic sympathectomy between 1998 and 2006 (inclusive) was reviewed. Additional follow-up was obtained as needed in clinic or by phone or written questionnaire. RESULTS Fifty-four patients (40 females) undergoing bilateral procedures were identified. Their mean age was 15.4 years (range 10-17 years). Average follow-up was 42 weeks (range 0.2-143 weeks). Hyperhidrosis involved the palms alone in 10 patients; the palms and axilla in 6 patients; the palms and plantar surfaces in 17 patients; and the palms, axilla, and plantar surfaces in 21 patients. Palmar hyperhidrosis resolved completely in 98.1% of the patients. Resolution or improvement of symptoms was seen in 96.3% of patients with axillary and 71.1% of those with plantar hyperhidrosis. Hospital stay averaged 0.37 days with 68.5% of patients discharged the day of surgery. One patient experienced brief intraoperative asystole that resolved with medications and had no long-term sequelae. Otherwise, no serious intraoperative complications occurred. No patient required chest tube drainage. The percentage of patients who reported satisfaction and willingness to undergo the procedure again was 98.1%. CONCLUSIONS Biportal, bilateral thoracoscopic sympathectomy is an effective and low-morbidity treatment for severe palmar, axillary, and plantar hyperhidrosis.
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Affiliation(s)
- Scott D Wait
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Licht PB, Clausen A, Ladegaard L. Resympathicotomy. Ann Thorac Surg 2010; 89:1087-90. [DOI: 10.1016/j.athoracsur.2010.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 01/04/2010] [Accepted: 01/04/2010] [Indexed: 11/15/2022]
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Awad MS, Elzeftawy A, Mansour S, Elshelfa W. One stage bilateral endoscopic sympathectomy under local anesthesia: Is a valid, and safe procedure for treatment of palmer hyperhidrosis? J Minim Access Surg 2010; 6:11-5. [PMID: 20585488 PMCID: PMC2883825 DOI: 10.4103/0972-9941.62529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 01/28/2010] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Thoracoscopic sympathetic surgery is currently the best treatment for hyperhidrosis, and the success rate is quite high, but poor emphasis has been given to the type of anaesthesia and its application through either one or two stages of surgery. This study has evaluated the operative and postoperative results of one-stage bilateral thoracoscopic sympathectomy under local anaesthesia. MATERIALS AND METHODS From 2003 to 2007, n=14 patients with hyperhidrosis of the upper limbs [4 females and 10 males] with a mean age of 28+/-2.11 year [range 26-44] were included. They were operated on by means of bilateral ETS under local anaesthesia. The mean follow-up was 1.5 years (range 13-24 months). RESULTS No operative mortality was recorded. The mean operating room time for the whole bilateral procedure under was 73. 5+/-14.5 range [60 -120] min most of the patients were discharged the same day after a chest roentgenogram except, only two patients with gustatory sweating one recurrent sweating in the patient who had previously axillary hyperhidrosis. Also among them two patients (20%) experienced a minimal pneumothorax that required no treatment. Postoperative quality of life and satisfaction were excellent and cost was significantly reduced. CONCLUSIONS Bilateral thoracoscopic sympathectomy for palmar hyperhidrosis could be safely and effectively performed in patients refusing GA regarding cost and satisfaction.
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Affiliation(s)
- Mohamed Salah Awad
- Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt
| | - Awny Elzeftawy
- Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt
| | - Salah Mansour
- Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt
| | - Wael Elshelfa
- Department of Surgery, Zagazig University Hospital, General Surgery Department, Egypt
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Weksler B, Pollice M, Souza ZBB, Gavina R. Comparison of ultrasonic scalpel to electrocautery in patients undergoing endoscopic thoracic sympathectomy. Ann Thorac Surg 2009; 88:1138-41. [PMID: 19766797 DOI: 10.1016/j.athoracsur.2009.06.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/16/2009] [Accepted: 06/19/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sympathectomy is an effective treatment for hyperhidrosis. The ultrasonic scalpel and electrocautery have been used for the procedure, but the use of the ultrasonic scalpel has been promoted as superior to that of electrocautery. This study explored whether a reusable electrocautery probe was equally as effective and safe as the ultrasonic scalpel for sympathectomy. METHODS We retrospectively analyzed 140 consecutive patients. The ultrasonic scalpel (HDH 05, Ethicon Endo-Surgery, Cincinnati, OH) was used in 70 patients (group 1) and a reusable 5-mm cautery hook (Edlo, Canoas, Brazil) was used in 70 patients (group 2). End points were improvement in symptoms (% improvement score), length of stay, return to work, and complications. Data were analyzed using two-tailed t test and the chi(2) (p = 0.05 was significant). Data are mean +/- standard deviation. RESULTS Follow-up was 27.2 +/- 8.4 months. Groups were similar in demographics, disease site, and level of sympathectomy. There was no significant difference in improvement score by site. The feet had the least improvement score (36.5% +/- 32.3%), and the hands the highest improvement score (97.0% +/- 11.3%). Length of stay was similar, 11.4 +/- 5.9 (group 1) vs 10.1 +/- 5.4 hours (group 2). Return to work in group 1 was 4.8 +/- 2.7 vs 5.7 +/- 3.6 days (p = 0.09). Group 1 had 14 complications and group 2 had 7 (p = 0.16). CONCLUSIONS We could not demonstrate a clear advantage in the use of the ultrasonic scalpel.
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Affiliation(s)
- Benny Weksler
- Division of Cardiothoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
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Zhang B, Li Z, Yang X, Li G, Wang Y, Cheng J, Tang X, Wang F. Anatomical variations of the upper thoracic sympathetic chain. Clin Anat 2009; 22:595-600. [PMID: 19418453 DOI: 10.1002/ca.20803] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim is to clearly delineate the upper thoracic sympathetic chains and neural connections between the chains and ventral rami of the thoracic nerves, and to provide an anatomical foundation for successful upper thoracic sympathicotomy for treating upper essential hyperhidrosis. The upper thoracic sympathetic chains, upper five intercostal nerves, and neural connections between them in 50 halves of 25 adult cadavers have been dissected, measured, and mapped. The stellate ganglion had an incidence of 80%. The second to the fourth thoracic sympathetic ganglia were commonly located in the corresponding intercostal spaces with the presence of 92%, 68%, and 50%, respectively. The incidence of the first and second intercostal rami was 40% and 6%, and that of the ascending or descending rami from the second, third and fourth ganglia was 54%, 24%, and 14%, respectively. Additional rami communicantes joined the ventral ramus of the 1st thoracic nerve proximal to the point where the latter gave a branch to the brachial plexus. The farthest horizontal distance from the sympathetic chain to the junction between the additional rami communicantes and the second to the fourth intercostal nerves was 29.1 mm. Only 16% of cadavers had similar anatomy bilaterally. Anatomical variations of the upper thoracic sympathetic trunk in relation to intercostal nerves, which may be one of the causes resulting in surgical failures and recurrences, were striking. Attention should be given to such anatomical variations when planning thoracic sympathicotomy.
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Affiliation(s)
- Bensi Zhang
- Department of Anatomy, Faculty of Basic Medicine, Dali University, Dali, Yunnan Province, China.
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Transection of more than one sympathetic chain ganglion for hyperhidrosis increases the severity of compensatory hyperhidrosis and decreases patient satisfaction. J Surg Res 2009; 156:110-5. [PMID: 19631343 DOI: 10.1016/j.jss.2009.04.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 04/04/2009] [Accepted: 04/09/2009] [Indexed: 11/23/2022]
Abstract
Sympathectomy (ETS) is an effective treatment for hyperhidrosis (HH), but compensatory hyperhidrosis (CH) is a common side effect. We reviewed our experience with 200 patients. Two hundred patients were retrospectively analyzed. Patients completed a questionnaire regarding their postoperative symptoms [% improvement score (IS), CH score], and their level of dissatisfaction, which was assessed as a function of regretting the choice to undergo ETS. Significance set at P< or =0.05. There were 123 (61.5%) females. Mean age was 28.2+/-7.4. Follow-up (mo) was 20.9+/-12.1. One ganglion was transected in 112 (56%) patients (G1), and more than one in 88 (G2). Overall, 157 (78.5%) patients had CH, 88 (74.1%) patients in G1 and 74 (84.1%) in G2, P=0.06. Patients in G2 had a higher CH score (4.1+/-2.7 versus 3.0+/-2.5, P<0.01), and a higher number of patients regretting surgery (11.4% versus 3.6%, P=0.05). Multivariate analysis showed age, high CH score, and surgery on T2 as independent predictors of patient's dissatisfaction (P<0.05). Patients with more than one ganglion transected demonstrate a trend toward a higher incidence of CH, a significantly higher CH score, and are more dissatisfied with ETS. Age, surgery on T2, and high CH score are independent predictors of patient's dissatisfaction.
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Minimizing Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis: Guided by Palmar Skin Temperature and Laser Doppler Blood Flow. Ann Thorac Surg 2009; 87:427-31. [DOI: 10.1016/j.athoracsur.2008.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 10/01/2008] [Accepted: 10/08/2008] [Indexed: 11/19/2022]
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Macefield VG, Sverrisdottir YB, Elam M, Harris J. Firing properties of sudomotor neurones in hyperhidrosis and thermal sweating. Clin Auton Res 2008; 18:325-30. [PMID: 18989617 DOI: 10.1007/s10286-008-0507-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 10/08/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Idiopathic palmar-plantar hyperhidrosis is characterized by excessive sweating of the palms and feet, and is commonly treated by transthoracic regional sympathicotomy. As the condition is believed to be due to a high sudomotor drive, we wanted to assess the firing properties of individual sudomotor neurones in this state of sympathoexcitation, extending our recent work on other pathologies associated with high sympathetic nerve activity. METHODS Single-unit recordings were made from eight sudomotor neurones supplying the fingers via tungsten microelectrodes inserted percutaneously into the median nerve at the wrist or upper arm. RESULTS Typical of sudomotor, muscle vasoconstrictor and cutaneous vasoconstrictor neurones recorded in healthy individuals in states of high sympathetic drive, all units had low firing probabilities (active in only 30.0 +/- 6.7 (SE) % of cardiac intervals) and primarily fired only once per heart beat. The percentage of cardiac intervals in which the neurones generated 1, 2, 3 or 4 spikes was 60.4 +/- 6.3, 22.9 +/- 3.9, 9.7 +/- 2.1 and 3.4 +/- 1.3%, respectively. For comparison, these values were 77.6 +/- 7.7, 15.0 +/- 4.1, 4.6 +/- 2.3 and 1.8 +/- 1.3% for eight sudomotor neurones innervating the hairy skin of the foot during thermally-induced sweating in normal subjects. INTERPRETATION We conclude that the firing properties of spontaneously active sudomotor neurones in subjects with hyperhidrosis are similar to those of sudomotor neurones active during thermal sweating, reflecting an increase in central sympathetic drive to the sweat glands in hyperhidrosis.
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