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El-Hag-Aly MA, Soliman RF, Zaid NA, Eldesouky MS, Bakoush MM, Hagag MG. Uniportal video-assisted thoracoscopic drainless sympathectomy for palmar and palmo-plantar hyperhidrosis: an institutional experience. THE CARDIOTHORACIC SURGEON 2020. [DOI: 10.1186/s43057-020-00030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Primary hyperhidrosis (PH) still impacts negatively the patient’s quality of life (QoL). Progressively, it leads to poorer QoL regardless of gender. The endoscopic thoracic sympathectomy has been used safely and effectively for control of palmar hyperhidrosis, but it is still questionable in palmo-plantar type. We assessed the benefits of uniportal drainless thoracoscopic sympathectomy (UDTS) for palmo-plantar hyperhidrosis patients compared to palmar ones.
This prospective study comprised 213 consecutive patients with PH. They underwent bilateral simultaneous UDTS. We used the Hyperhidrosis Disease Severity Scale (HDSS) scoring system for assessment of QoL pre- and postoperatively. Follow-up was continued for 1-year that was aiming to detect the QoL improvement, recurrence, and compensatory hyperhidrosis (CH).
Results
All patients experienced immediate complete resolution of hyperhidrosis postoperatively. Recurrence was encountered in one patient during the first 6 months. All patients had improved QoL postoperatively, but at the end of 1-year follow-up, 2.8% of patients were still suffering moderate to severe impaired QoL. Mean hospital stay was 31.79 ± 17.5 h. We found significant longer hospital stay in palmar group than palmo-plantar group. There was no significant difference between both groups in neither operative time, recurrence, nor CH.
Conclusions
UDTS offers better QoL for patients with PH even the palmo-plantar type. The palmo-plantar type benefits similarly to the palmar type in terms of comparable postoperative QoL and CH incidence.
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Abstract
OBJECTIVE Endoscopic thoracic sympathectomy at the second rib level is considered effective as a therapeutic treatment for facial blushing. However, 10% to 15% of patients do not benefit from this intervention. No additional procedure has been developed for this disorder. Recently, ganglionectomy using application of laser speckle flow graph has been evaluated for the treatment of compensatory sweating. We report our results of ganglionectomy for facial blushing as a redo surgery. METHODS Between August 2012 and April 2017, 8 patients with facial blushing who underwent an initial sympathectomy reported symptom recurrence. Seven patients had undergone transection of the sympathetic trunk at the second rib and 1 patient had undergone transection of the sympathetic trunk at the second and third ribs. These patients were treated using ganglionectomy guided by application of laser speckle flow graph. After temporary decreases in facial skin blood perfusion were confirmed by stimulating the sympathetic ganglions, ganglionectomy was performed. RESULTS All patients' symptoms improved. There were no side effects, including deterioration of compensatory sweating, worsening of gustatory sweating, or Horner syndrome. There were no cases of mortality or conversion to open surgery. CONCLUSIONS This study shows the effectiveness of ganglionectomy for the treatment of facial blushing, representing a new treatment option for this condition. Considering the mechanism of facial blushing, it is important to recognize that ganglionectomy is effective after the interception of the sympathetic trunk on the cranial side.
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Affiliation(s)
- Hidehiro Yamamoto
- Department of Surgery, Yamamoto-Hidehiro Clinic, Shibuya-ku, Tokyo, Japan.
| | - Masayoshi Okada
- Department of Surgery, Yamamoto-Hidehiro Clinic, Shibuya-ku, Tokyo, Japan
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Yamamoto H, Okada M. A New Device of Needlescopic Thoracic Sympathectomy Through a Skin Incision. Ann Thorac Surg 2017; 103:e465-e467. [PMID: 28431730 DOI: 10.1016/j.athoracsur.2016.11.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/15/2016] [Accepted: 11/20/2016] [Indexed: 10/19/2022]
Abstract
We describe a new technique of performing sympathectomy with a new device. A single skin incision 3 mm long was made in the armpit. The device enables complete resection of the sympathetic segment through a single skin incision, whereas sympathectomy is limited by the use of the conventional needle technique. Even if sympathetic nerves and blood vessels were overlapping, separation of the two organs was performed safely. This device increases the possibility of planning surgical procedures for patients with difficult anatomies.
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Sang HW, Li GL, Xiong P, Zhu MC, Zhu M. Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review. Surg Endosc 2017; 31:4357-4369. [PMID: 28389800 DOI: 10.1007/s00464-017-5508-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/08/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Palmar hyperhidrosis involves excessive sweating of the palms, with no known etiology. Endoscopic thoracic sympathectomy (ETS) is a safe and effective treatment for palmar hyperhidrosis, but compensatory hyperhidrosis is a common complication after ETS, leading to reduced patient satisfaction and postoperative quality of life. However, the appropriate level of the sympathetic chain to target with ETS to achieve maximum efficacy and reduce the risk of compensatory hyperhidrosis (CH) is controversial. In this systemic review, we investigated the appropriate level of sympathectomy for palmar hyperhidrosis. METHODS PRISMA guidelines were implemented to complete a systematic review. We performed a computerized systematic literature search using PubMed and EMBASE from January 1990 to July 2016. We chose the Cochrane Collaboration's tool and the methodological index for non-randomized studies tool for examining study bias. RESULTS A total of 4075 citations were identified, of which 91 were eligible for inclusion, including 68 observational studies and 23 comparative trials. In observational studies, sympathectomies showed similar efficacies for curing PH at different levels. However, T2-free groups (i.e., at levels T3, T4, or T3-T4 combined) could render a lower risk of Horner's syndrome (0 vs. 1.21 ± 0.49%, p = 0.036) and CH (28.75 ± 7.25 vs. 57.46 ± 3.86, p = 0.002) compared with T2 involved. In comparative trials, there were 12 studies describing the comparison between T2-free ETS and T2 involved, and 9 of 12 (75%) showed T2-free ETS could reduce the incidence of CH. Overall, lowering the level and limiting the extent of sympathectomy could reduce the incidence of complications. CONCLUSIONS Cumulative data from more than 13,000 patients suggest that ETS is a safe, effective, and reproducible procedure with a high degree of patient satisfaction. Currently available evidence suggests that T2-free ETS may reduce the incidence of compensatory hyperhidrosis without compromising success rates and safety.
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Affiliation(s)
- Hai-Wei Sang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.,Department of Thoracic Surgery, First Affiliated Hospital of Bengbu Medical College, 287 Chang Huai Road, Bengbu, 233004, Anhui, China
| | - Guo-Liang Li
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Peng Xiong
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Ming-Chuang Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China
| | - Min Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, Hubei, China.
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Doo KW, Yong HS, Kim HK, Kim S, Kang EY, Choi YH. Needlescopic resection of small and superficial pulmonary nodule after computed tomographic fluoroscopy-guided dual localization with radiotracer and hookwire. Ann Surg Oncol 2014; 22:331-7. [PMID: 25008029 DOI: 10.1245/s10434-014-3884-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of a needlescopic resection for small and superficial pulmonary nodules after dual localization with radiotracer and hookwire. METHODS Computed tomography (CT) fluoroscopy-guided dual marking with hookwire and (99m)Tc-phytate was performed on 36 small and superficial pulmonary nodules of 34 patients, just before the needlescopic procedure. This method was carried out through one introducer needle, after an initial single puncture. After detection of the hookwire-marked site through needlescopy, the precise lesion was confirmed using a thoracoscopic gamma probe by calculating the highest radioactivity. The pulmonary nodule was resected and diagnosed by pathologic examination. RESULTS The mean size of the nodules was 12.5 ± 5.4 mm (range 3-20), and their mean distance from the pleural surface was 5.6 ± 5.8 mm (range 0-18.7). The time of the dual localization procedure was 10.8 ± 3.6 min (range 5-18). Pneumothorax was developed in 6 of 34 patients (17.6 %) after preoperative localization, but did not require any treatment. Seven hookwires dislodged during the operation. Nevertheless, radiotracer markings detected on a gamma probe guided a successful wedge resection without difficulty in all seven cases. All nodules were successfully resected under needlescopy, except conversion to the 5-mm-sized thoracoscopy in four patients due to pleural adhesion. CONCLUSIONS Dual marking with radiotracer and hookwire under CT fluoroscopy is a safe and not time-consuming procedure, and has made needlescopy-assisted lung resection for small and superficial nodules or ground-glass opacity lesions easier, more convenient, and less hazardous.
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Affiliation(s)
- Kyung Won Doo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Chen W, Chen L, Zhu L, Yang S, Feng X, Zhang J, Cheng X, Liu D, Wang W. A novel approach to treat women patients with palmar hyperhidrosis: transumbilical thoracic sympathectomy with an ultrathin gastroscope. Ann Thorac Surg 2013; 96:2028-32. [PMID: 23987893 DOI: 10.1016/j.athoracsur.2013.06.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/08/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Primary palmar hyperhidrosis is very common in women. Video-assisted thoracic sympathectomy is recognized as an effective treatment for patients with severe hyperhidrosis, which has usually been performed with more than 2 skin incisions. We developed a novel approach for thoracic sympathectomy in women with palmar hyperhidrosis through the umbilicus using an ultrathin gastroscope. The approach requires only 1 tiny incision, which is hidden in the umbilicus. METHODS Under general anesthesia, patients were intubated with a dual-lumen endotracheal tube. Through the incision in the umbilicus, a newly developed long trocar was inserted into the abdominal cavity. After insertion of the ultrathin gastroscope through this trocar, a small incision was created on the both sides of diaphragm by a needle knife. The endoscope was introduced into the thoracic cavity through the incision made in the left or right diaphragm. The sympathetic chain was identified at the desired thoracic level and ablated. RESULTS From January 10, 2010, to November 30, 2011, 25 women underwent transumbilical-diaphragmatic thoracic sympathectomy. The mean operating room time for the entire bilateral procedure was 56.9 ± 6.9 minutes. There were no significant postoperative complications. The symptoms disappeared in all patients. Compensatory sweating was reported in 56%. All of the patients were satisfied with the surgical results and the cosmetic outcome of the incision. CONCLUSIONS Transumbilical thoracic sympathectomy with the ultrathin flexible endoscope was a safe and effective option for women with severe palmar hyperhidrosis that provided excellent cosmetic outcomes.
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Affiliation(s)
- Weisheng Chen
- Department of Cardiothoracic Surgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, People's Republic of China
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Kaga K, Hida Y, Nakada-Kubota R, Ohtaka K, Muto J, Ishikawa K, Kato T, Matsui Y. Reduced port video-assisted thoracoscopic surgery using a needle scope for lung and mediastinal lesions. Interact Cardiovasc Thorac Surg 2013; 17:268-72. [PMID: 23644732 DOI: 10.1093/icvts/ivt194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES There are many recent and minimally invasive surgical innovations, yet there has been little evaluation of the limitations of such techniques, particularly those related to video-assisted thoracoscopic surgery. The aims of this study were to determine the usefulness and limitations of video-assisted thoracoscopic surgery using one-port access and needle scope and to evaluate the feasibility of this procedure based on our institutional experience. METHODS This retrospective study involved 127 patients who underwent video-assisted thoracoscopic surgery using the one-window and puncture method at our institute from 1997 to 2011. One hundred patients underwent surgical treatment and 27 underwent diagnostic procedures. If there was one lesion present with only mild adhesion that did not require lymph node dissection, we decided to opt for the one-direction approach that provisionally indicates the one-window and puncture method. We compared the conversion and success groups for factors like age, sex, laterality of surgery, objective of surgery, target organ and surgery location. RESULTS Of 127 cases, 115 (91%) successfully underwent the one-window and puncture procedure. Twelve cases (9%) were converted to the two-window method or thoracotomy. Compared with those targeting the lung, patients with mediastinal lesions demonstrated a higher tendency for conversion (P<0.05). However, age (P=0.89), sex (P=0.46), laterality of surgery (P=0.34) and purpose of surgery (P=0.68) did not show any significant differences between the groups. CONCLUSIONS For lung and mediastinal diseases, video-assisted thoracoscopic surgery with the one-window and puncture method can be performed at any location (upper, middle and lower lobe of lung and anterior, middle and posterior of the mediastinum) under limited indications that include the possibility of one-way resection, mild adhesion and no requirement of lymph node dissection. Under provisional criteria, the procedure may be feasible.
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Affiliation(s)
- Kichizo Kaga
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan.
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Achieving renal denervation: catheter-based and surgical management for neural ablation in the management of hypertension. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 7:314-22. [PMID: 23274863 DOI: 10.1097/imi.0b013e31827ccd90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertension refractory to conventional management with medication remains a significant cause of cardiovascular morbidity and mortality. Alternative strategies are warranted in this subgroup of patients. The target of these strategies centers around sympathetic neural activity, which is thought to play a key role in hypertension. We will review the historic and current approaches toward altering sympathetic neural activity, specifically discussing surgical sympathectomy, catheter-based renal denervation strategies, and baroreflex activation therapy.
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Achieving Renal Denervation: Catheter-Based and Surgical Management for Neural Ablation in the Management of Hypertension. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vincze K, Herke L, Ferenczy J, Seffer I, Lelovics Z. [Therapeutic modalities in the treatment of palmar and axillary hyperhidrosis]. Orv Hetil 2009; 150:1786-90. [PMID: 19740724 DOI: 10.1556/oh.2009.28618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors summarize their therapeutic methods of palmar and axillary hyperhidrosis in this article. They discuss the characteristics, frequency of upper limb and patho-anatomical features of chronic sweating. Authors summarized their almost 40 years experience in treatment methods, technological improvements as well as they review recent knowledge and relevant literature. The open thoracotomic desympathization applied in the beginnings was gradually replaced by a minimally invasive VATS-sympathectomy (Video Assisted Thoracoscopic Surgery). The possibilities of conservative treatments, local excision methods will also be discussed, as well as the application and efficiency of Botox-treatments that are used in plastic surgery. The mean frequency of 0.1-1.0% described in scientific literature is indicative of a significant number of unresolved cases, which thus requires more efficient diagnostic and patient orientation practices. Based on their experiences, the most efficient treatment of upper limb hyperhidrosis is the thoracic sympathectomy (ramicotomy and the relevant T(2) -T(3) ganglia) according to Smithwick-procedure and modified by others. If necessary, one-stage bilateral VATS-surgery may be applied. Another effective conservative possibility is the Botox-therapy, which they had applied individually at the plastic surgery clinic. Significant complications or compensatory hyperhidrosis were not detected.
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Affiliation(s)
- Károly Vincze
- Kaposi Mór Oktató Megyei Kórház, Altalános Sebészeti, Er- és Mellkassebészeti Osztály, Kaposvár
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Kopelman D, Hashmonai M. The correlation between the method of sympathetic ablation for palmar hyperhidrosis and the occurrence of compensatory hyperhidrosis: a review. World J Surg 2009; 32:2343-56. [PMID: 18797962 DOI: 10.1007/s00268-008-9716-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Upper dorsal sympathectomy achieves excellent long-term results in the treatment of primary palmar hyperhidrosis. Compensatory hyperhidrosis (CHH) remains an unexplained sequel of this treatment, attaining in a small percentage of cases disastrous proportions. It has been claimed that lowering the level of sympathectomy (from T2 to T3 and even T4), substituting resection by other means of ablation, and limiting its extend reduce the occurrence of this sequel. This review was designed to evaluate the validity of these claims. METHODS A MEDLINE search was performed for the years 1990--2006 and all publications about thoracoscopic upper dorsal sympathectomy for hyperhidrosis were retrieved. RESULTS The search identified 42 techniques of sympathetic ablation. However, pertinent data for the present study were reported for only 23 techniques with multiple publications found only for 10. The only statistically valid results from this review point that T2 resection and R2 transection of the chain (over the second rib) ensue in less CHH than does electrocoagulation of T2. Further comparisons were probably prevented due to the enormous disparity in the reported results, indicating lack of standardization in definitions. CONCLUSIONS The compiled results published so far in the literature do not support the claims that lowering the level of sympathetic ablation, using a method of ablation other than resection, or restricting the extend of sympathetic ablation for primary palmar hyperhidrosis result in less CHH. In the future, standardization of the methods of retrieving and reporting data are necessary to allow such a comparison of data.
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Affiliation(s)
- Doron Kopelman
- Department of Surgery B, Ha'emek Hospital, Afula, Israel
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Cabral PHO, Silva ITDCE, Melo JV, Gimenez FS, Cabral CRB, Lima APCD. Needlescopic versus laparoscopic cholecystectomy: a prospective study of 60 patients. Acta Cir Bras 2008; 23:543-50. [DOI: 10.1590/s0102-86502008000600012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 08/18/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To test the hypothesis that needlescopic cholecystectomies (NC) offer superior outcomes in comparison to common laparoscopic cholecystectomies (LC). METHODS: Sixty consecutive patients with gallbladder disease undergoing either LC or NC were evaluated with respect to differences in operative time, frequency of per-operative incidents, post-operative pain, late postoperative symptoms, length of scars and level of postoperative satisfaction. RESULTS: Mean operative time was similar in both groups. Most of the patients, irrespective of the technique, informed mild postoperative pain. NC patients had lower levels of pain on the 7th postoperative day (PO7) (p<0.01) and decreased need for additional analgesia. Less frequency of epigastric wound pain was observed in NC patients until PO4 (p<0.01). Aesthetic result was far superior after NC (total length of scars less than half after LC). No differences regarding postoperative satisfaction with the operation were observed between the studied groups. CONCLUSIONS: Both techniques were safe and effective, presenting similar operative times and low levels of postoperative pain. Downsizing the ports to 2-3 mm was associated with significantly less frequency of postoperative pain only in the epigastric wound until PO4. Aesthetic outcome of NC was significantly superior to LC, although this advantage did not influence patient level of satisfaction.
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Kim HK, Jo WM, Jung JH, Chung WJ, Shim JH, Choi YH, Lee IS. Needlescopic Lung Biopsy for Interstitial Lung Disease and Indeterminate Pulmonary Nodules: A Report on 65 Cases. Ann Thorac Surg 2008; 86:1098-103. [PMID: 18805139 DOI: 10.1016/j.athoracsur.2008.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 05/28/2008] [Accepted: 06/02/2008] [Indexed: 11/19/2022]
Affiliation(s)
- Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
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Changes in Na+, K+ concentrations in perspiration and perspiration volume with alternating current iontophoresis in palmoplantar hyperhidrosis patients. Arch Dermatol Res 2008; 300:595-600. [PMID: 18677499 DOI: 10.1007/s00403-008-0877-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
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Salati M, Brunelli A, Rocco G. Uniportal Video-Assisted Thoracic Surgery for Diagnosis and Treatment of Intrathoracic Conditions. Thorac Surg Clin 2008; 18:305-10, vii. [DOI: 10.1016/j.thorsurg.2008.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Loureiro MDP, Roman N, Weigmann SC, Fontana A, Boscardim PCB. Simpactectomia lombar retroperitoneoscópica para tratamento da hiper-hidrose plantar. Rev Col Bras Cir 2007. [DOI: 10.1590/s0100-69912007000400005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Observar o seguimento de até quatro anos de mulheres submetidas à simpatectomia lombar por retroperitonioscopia, procurando identificar seus efeitos colaterais, bem como sua efetividade no controle da hiper-hidrose plantar. MÉTODOS: Entre junho/2002 e julho2006, operamos 44 pacientes com hiperidrose plantar. Todas apresentavam hiper-hidrose plantar persistente pós simpatectomia torácica com exceção de uma única paciente com diagnóstico de hiperidrose plantar primária. RESULTADOS: O seguimento médio de 22,3 meses, mostra grande satisfação referida pela maioria das pacientes e piora do suor compensatório em 37% delas. Não houve relato de alteração sexual nesta casuística. CONCLUSÃO: A simpatectomia lombar por retroperitonioscopia é uma técnica segura, eficaz e associada a e aceitáveis efeitos colaterais, quando empregada no tratamento da hiperidrose plantar em mulheres jovens.
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Licht PB, Pilegaard HK. Gustatory Side Effects After Thoracoscopic Sympathectomy. Ann Thorac Surg 2006; 81:1043-7. [PMID: 16488719 DOI: 10.1016/j.athoracsur.2005.09.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Revised: 09/14/2005] [Accepted: 09/21/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND Compensatory sweating is a frequent side effect after thoracoscopic sympathectomy for primary hyperhidrosis. Gustatory sweating is less commonly reported. It is defined as facial sweating when eating certain foods (particularly spicy food or acidic fruits) and has no generally accepted pathophysiologic explanation. We decided to investigate this phenomenon in patients who underwent thoracoscopic sympathectomy for primary hyperhidrosis and analyze whether the occurrence was influenced by the extent of sympathectomy. METHODS During an 8-year period (1997 to 2005) a total of 238 patients were treated by thoracoscopic sympathectomy for primary hyperhidrosis or blushing. Sympathectomy was performed bilaterally at T2 for facial hyperhidrosis or blushing (n = 97), T2-T3 for palmar hyperhidrosis (n = 76), and T2-T4 for axillary hyperhidrosis (n = 65). All patients received the same questionnaire at follow-up. RESULTS The questionnaire was returned by 96% of patients after a median of 17 months. Overall, gustatory sweating occurred in 32% of patients, and the incidence was significantly associated with extent of sympathectomy (p = 0.04). However, because the extent of sympathectomy was always decided by the location of primary hyperhidrosis, the latter may also explain the risk of gustatory sweating. CONCLUSIONS Gustatory sweating is a frequent side effect after thoracoscopic sympathectomy. This is the first study to report that its incidence is significantly related to the extent of sympathectomy or the location of primary hyperhidrosis. Although there is no pathophysiologic explanation of gustatory sweating, these findings should be considered before planning thoracoscopic sympathectomy and patients should be thoroughly informed.
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Affiliation(s)
- Peter B Licht
- Department of Cardiothoracic Surgery, Skejby Sygehus, Aarhus University Hospital, Aarhus, Denmark.
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Abstract
Laparoscopic surgeons have made significant efforts to minimize the trauma induced by their procedures. One of the newest methods is the use of mini and micro instruments. This work is reviewed here.
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Rocco G. Endoscopic VATS sympathectomy: the uniportal technique. Multimed Man Cardiothorac Surg 2005; 2005:MMCTS.2004.000323. [PMID: 24413770 DOI: 10.1510/mmcts.2004.000323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Presentation of the uniportal VATS sympathectomy technique: through a single port incision, a videothoracoscope, a diathermy hook and, if needed, a lung grasper are introduced into the pleural cavity. Upon identification of the sympathetic chain, the relevant ganglia are divided. By extending laterally the dissection, the aberrant accessory sympathetic nerve fibers are also severed. Anatomic variations are illustrated and an overview of the literature is presented.
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Affiliation(s)
- Gaetano Rocco
- The Price-Thomas Thoracic Unit, Directorate of Cardiothoracic Surgery, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield S5 7AU, UK
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Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, Ahn S, Stolman LP. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51:274-86. [PMID: 15280848 DOI: 10.1016/j.jaad.2003.12.029] [Citation(s) in RCA: 258] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Connolly M, de Berker D. Management of primary hyperhidrosis: a summary of the different treatment modalities. Am J Clin Dermatol 2004; 4:681-97. [PMID: 14507230 DOI: 10.2165/00128071-200304100-00003] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Hyperhidrosis is a common and distressing condition involving increased production of sweat. A variety of treatment modalities are used to try to control or reduce sweating. Sweat is secreted by eccrine glands innervated by cholinergic fibers from the sympathetic nervous system. Primary hyperhidrosis most commonly affects palms, axillae and soles. Secondary hyperhidrosis is caused by an underlying condition, and treatment involves the removal or control of this condition. The treatment options for primary hyperhidrosis involve a range of topical or systemic medications, psychotherapy and surgical or non-surgical invasive techniques. Topical antiperspirants are quick and easy to apply but they can cause skin irritation and have a short half life. Systemic medications, in particular anticholinergics, reduce sweating but the dose required to control sweating can cause significant adverse effects, thus, limiting the medications' effectiveness. Iontophoresis is a simple and well tolerated method for the treatment of hyperhidrosis without long-term adverse effects; however, long-term maintenance treatments are required to keep patients symptom free. Botulinum toxin A has emerged as a treatment for hyperhidrosis over the past 5-6 years with studies showing good results. Unfortunately, botulinum toxin A is not a permanent solution, and patients require repeat injections every 6-8 months to maintain benefits. Psychotherapy has been beneficial in a small number of cases. Percutaneous computed tomography-guided phenol sympathicolysis achieved good results but has a high long-term failure rate. Surgery has also been shown to successfully reduce hyperhidrosis but, like other therapies, has several complications and patients need to be informed of these prior to undergoing surgery. The excision of axillary sweat glands can cause unsightly scarring and transthoracic sympathectomy (either open or endoscopic) can be associated with complications of compensatory and gustatory hyperhidrosis, Horner syndrome and neuralgia, some of which patients may find worse than the condition itself.
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Affiliation(s)
- Maureen Connolly
- Bristol Dermatology Centre, Bristol Royal Infirmary, Bristol, UK
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Abstract
Needlescopic operation using instruments with a diameter of 2 mm has not been applied to partial lung resection because of the difficulty in grasping the lung firmly or the possibility of injuring the lung easily with 2-mm forceps. We have developed a technique using a mini-loop retractor and successfully performed partial lung resection in 35 patients with pneumothorax, small lung tumor, or interstitial pneumonia.
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Affiliation(s)
- Yasunori Ikeda
- Department of Cardiothoracic Surgery, Dokkyo University School of Medicine, Shimotugagun, Tochigi, Japan.
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Guijarro Jorge R, Arnau Obrer A, Fernández Centeno A, Regueiro Mira F, Pérez Alonso A, Cañizares Carretero M, Granell Gil M, Cantó Armengod A. [Our experience in the treatment of hyperhidrosis of the upper limbs by video-assisted thoracoscopy: an analysis of our first 100 procedures]. Arch Bronconeumol 2002; 38:421-6. [PMID: 12237013 DOI: 10.1016/s0300-2896(02)75255-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sympathectomy of the thoracic chain is an effective surgical procedure for treating axillary and palmar hyperhidrosis. The procedure has been performed with minimal invasion and good results in recent years through the use of videothoracoscopic surgery. This paper describes the technique and our experience with a series of 50 patients between 16 and 48 years old. The earliest approach was unilateral in successive operations. The procedure was later performed bilaterally, at first with the patients in sequential lateral decubitus positions and later in semi-seated position. Complications were 1 case of incomplete Claude-Bernard-Horner syndrome that resolved spontaneously two months after surgery; 1 failure when sympathectomy was performed without location of the chain, obliging rapid re-operation; laminar pneumothorax in 12% of the series; compensatory hyperhidrosis in 26%; 10% with chest pain due to intercostal involvement, resolving with time; and slight bleeding in 8%. Outcome was excellent, with complete disappearance of axillary and palmar perspiration. Patient satisfaction was 9.2/10 one year after surgery. Mean hospital stay was less than 36 h.
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Affiliation(s)
- R Guijarro Jorge
- Servicios de Cirugía Torácica, Hospital General Universitario de Valencia, Spain.
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Gómez Sebastián G, Fibla J. Simpatectomía videotoracoscópica: experiencia de un grupo cooperativo español. Arch Bronconeumol 2002. [DOI: 10.1016/s0300-2896(02)75153-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Matthews B, Mostafa G, Harold K, Kercher K, Reardon P, Heniford B. Surg Laparosc Endosc Percutan Tech 2001; 11:351-355. [DOI: 10.1097/00019509-200112000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Matthews BD, Mostafa G, Harold KL, Kercher KW, Reardon PR, Heniford BT. Minilaparoscopic appendectomy. Surg Laparosc Endosc Percutan Tech 2001; 11:351-5. [PMID: 11822857 DOI: 10.1097/00129689-200112000-00002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the feasibility of using 2-mm laparoscopic instruments in the treatment of appendicitis and to identify risk factors that may limit their use. Minilaparoscopic appendectomy was performed through a 2-mm port in the umbilicus for a videoendoscope, a 2-mm working port in the right upper quadrant, and a 5/12-mm suprapubic port for an endoscopic stapler. Minilaparoscopic appendectomy was attempted in 26 consecutive patients with appendicitis. Thirty-two consecutive patients undergoing conventional laparoscopic appendectomy with 5- and 10-mm instruments and videoendoscopes before the availability of 2-mm instrumentation were analyzed for comparison. Statistical comparisons were made by the Student t test and Fisher exact test. Differences were considered statistically significant at a P value less than 0.05. There were no conversions to an open appendectomy in the minilaparoscopic appendectomy or conventional laparoscopic appendectomy group. The mean operative time was 69.5 minutes for the minilaparoscopic appendectomy group and 85.5 minutes for the conventional laparoscopic appendectomy group (P = 0.02). The mean postoperative length of stay was 1.7 days for the minilaparoscopic appendectomy group and 2.5 days for the conventional laparoscopic appendectomy group (P = 0.08). There was no significant difference in the complication rates (P = 0.31). Minilaparoscopic appendectomy was completed in 13 (50.0%) patients. Independent risk factors (P = 0.05) for conversion to 5- or 10-mm ports were a retrocecal appendix and increasing patient age. There were no differences in the mean postoperative length of stay (P = 0.12) or complication rate (P = 0.39) between the two groups, but mean operative time was longer (P = 0.05) in the converted group. Perioperative outcomes for minilaparoscopic appendectomy are comparable to those of conventional laparoscopic appendectomy. The use of 2-mm instrumentation in the management of appendicitis is limited in patients with retrocecal appendicitis. Increasing patient age and a history of abdominal surgery may influence the need to convert 2-mm ports to 5- or 10-mm ports.
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Affiliation(s)
- B D Matthews
- Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA.
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Glogau RG. Treatment of palmar hyperhidrosis with botulinum toxin. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2001; 20:101-8. [PMID: 11474742 DOI: 10.1053/sder.2001.25140] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Excessive sweating of the palms, axillae, and soles can be managed with intradermal injections of botulinum toxin as an alternative to more aggressive surgical therapies such as sympathectomy and less effective techniques including topical antiperspirants. The dosage and injection techniques can be optimized to provide several months of freedom from this troubling disorder.
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Affiliation(s)
- R G Glogau
- Department of Dermatology, University of California, San Francisco, USA
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