1
|
Loizzi D, Mongiello D, Bevilacqua MT, Raveglia F, Fiorelli A, Congedo MT, Ardò NP, Sollitto F. Surgical management of compensatory sweating: A systematic review. Front Surg 2023; 10:1160827. [PMID: 37035574 PMCID: PMC10073509 DOI: 10.3389/fsurg.2023.1160827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
Endoscopic thoracic sympathectomy (ETS) surgery is a highly effective treatment of primary hyperhidrosis (PH) for the palms, face, axillae. Compensatory sweating (CS) is the most common and feared side effect of thoracic sympathectomy. CS is a phenomenon characterized by increased sweating in sites distal to the level of sympathectomy. Compensatory sweating is the main problem for which many patients give up surgery, losing the chance to solve their problem and accepting a poor quality of life. There are still no treatments that offer reliable solutions for compensatory sweating. The treatments proposed in the literature are scarce, with low case histories, and with uncertain results. Factors associated with CS are extension of manipulation of the sympathetic chain, level of sympathetic denervation, and body mass index. Therapeutic options include non surgical treatment and surgical treatment. Non surgical treatments include topical agents, botulinum toxin, systemic anticholinergics, iontophoresis. Surgical treatments include clip removal, extended sympathectomy and sympathetic chain reconstruction, although the efficacy is not well-established for all the methods. In this review we provide an overview of the treatments and outcomes described in the literature for the management of compensatory CS, with focus on surgical treatment.
Collapse
Affiliation(s)
- Domenico Loizzi
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
- Correspondence: Domenico Loizzi
| | - Diletta Mongiello
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | | | | | - Alfonso Fiorelli
- Department of Translation Medicine, Thoracic Surgery Unit, Università della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Teresa Congedo
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Nicoletta Pia Ardò
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| | - Francesco Sollitto
- Department of Medical and Surgical Science, University of Foggia, Foggia, Italy
| |
Collapse
|
2
|
Liao HC, Su FT, Chen TH, Ju YT, Liao CC, Kao MC, Huang WJ, Xiao F. Effects of thoracic sympathetic stimulation on palmar perfusion: a preliminary study in pigs. Gen Thorac Cardiovasc Surg 2021; 70:153-159. [PMID: 34515948 DOI: 10.1007/s11748-021-01698-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/04/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Ablation of the upper thoracic sympathetic ganglia that innervates the hands is the most effective and permanent cure of palmar hyperhidrosis. However, this type of sympathectomy causes irreversible neural damage and may result in severe compensatory hyperhidrosis. This experiment is designed to confirm the hypothesis, in which the stimulation of T2 sympathetic chain leads to increased palmar microcirculation, and thus results in treating hyperhidrosis. METHODS In this study, we used electric stimulation to induce reversible blockade of the sympathetic ganglion in pigs and investigated its effect on palmar perfusion. An electrode was inserted to the T2 sympathetic ganglion of the pig through three different approaches: open dorsal, thoracoscopic, and fluoroscopy-guided approaches. Electric stimulation was delivered through the electrode using clinically available pulse generators. Palmar microcirculation was evaluated by laser speckle contrast imaging. RESULTS The T2 sympathetic ganglion of the pig was successfully accessed by all the three approaches, as confirmed by changes in palmar microcirculation during electric stimulation. Similar effects were not observed when the electrode was placed on the T4 sympathetic ganglion or off the sympathetic trunk. CONCLUSION We established a large animal model to verify the effect of thoracic sympathetic stimulation. Electric stimulation can be used for sympathetic blockade, as confirmed by increased blood perfusion of the palm. Our work suggests that sympathetic stimulation is a potential solution for palmar hyperhidrosis.
Collapse
Affiliation(s)
- Heng-Chun Liao
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Ting-Hsuan Chen
- Biomedical Technology and Device Research Labs, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yu-Ten Ju
- Department of Animal Science and Technology, National Taiwan University, Taipei, Taiwan
| | - Chun-Chih Liao
- Department of Neurosurgery, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Ming-Chien Kao
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Jhen Huang
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Furen Xiao
- Department of Neurosurgery, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
3
|
Chang TNJ, Daniel BW, Hsu ATW, Chen LWY, Sung CWH, Chuang DCC, Chao YK. Reversal of thoracic sympathectomy through robot-assisted microsurgical sympathetic trunk reconstruction with sural nerve graft and additional end-to-side coaptation of the intercostal nerves: A case report. Microsurgery 2021; 41:772-776. [PMID: 34292644 DOI: 10.1002/micr.30787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/14/2021] [Accepted: 06/10/2021] [Indexed: 11/05/2022]
Abstract
Thoracic sympathectomy to treat palmar hyperhidrosis (PH) has widely been performed. Many patients regret the surgery due to compensatory hyperhidrosis (CH), gustatory hyperhidrosis, arrhythmia, hypertension, gastrointestinal disturbances, and emotional distress. Robotic applications in microsurgery are very limited. We report the technique and long-term patient-reported outcomes of bilateral robot-assisted microsurgical sympathetic trunk reconstruction with a sural nerve graft in an interdisciplinary setting. A 59-year-old female suffered from severe adverse effects after endoscopic thoracic sympathectomy (ETS) for PH 25 years ago. She reported CH over the whole trunk, gustatory hyperhidrosis, excessive dry hands, and emotional distress. An interdisciplinary surgical team performed a bilateral sympathetic trunk reversal reconstruction with an interpositional sural nerve graft per side by a da Vinci® Robot. The nerve graft was microsurgically coapted using 9-0 sutures end-to-end to the sympathetic trunk stumps and side-to-end to the intercostal nerves T2-T4. At 24, 33 and 42 months, palmar dryness and emotional distress were strongly reduced. A highly specialized interdisciplinary setting may provide a precise, safe, and efficient treatment for ETS sequelae. A clinical study is initiated to validate this new therapy.
Collapse
Affiliation(s)
- Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Bassem W Daniel
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan.,Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Freiburg, Germany
| | - Angela Ting-Wei Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Cheyenne Wei-Hsuan Sung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - David Chwei-Chin Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
4
|
Oz G, Gunay E, Dumanli A, Cilekar S, Yucens B, Gokaslan S, Dogan Baki E. Effects of clipping endoscopic thoracal sympathectomy at Th 4 on cardiopulmonary functions, quality of life and psychosocial functions. Gen Thorac Cardiovasc Surg 2019; 68:516-522. [PMID: 31786724 DOI: 10.1007/s11748-019-01259-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In this study, we evaluated the cardiopulmonary and psychosocial effects of endoscopic thoracal sympathectomy (ETS) by clipping procedure at the level of Th4 and effects of ETS on quality of life of patients with hyperhidrosis. METHODS We performed a prospective study in 52 patients complaining of local sweating who applied to our clinic. Cardiac maximal treadmill stress test (CMTST), pulmonary function tests, Beck anxiety-depression inventory, Liebowitz social anxiety scale and SF-36 quality of life questionnaires were administered at preoperative period and postoperative 6th month. RESULTS In the pulmonary function test, we found a minimal decrease in FEV1, and FEV1/FVC. There were no significant change in 'resting pulse rate', 'resting systolic and diastolic blood pressures' during CMTST between before and after operation. There was a significant difference in peak heart rate before CMTST, post-exercise diastolic blood pressure, and age-predictive maximal heart rate between before and after clipping procedure. In the SF-36 questionnaire, all parameters were improved. In the Beck depression-anxiety inventory and the Liebowitz social anxiety scale significant improvement was achieved in all parameters. CONCLUSION ETS by clipping procedure at the Th4 level is advised to be a safe and effective method for management of hyperhidrosis patients.
Collapse
Affiliation(s)
- Gurhan Oz
- Department of Thoracic Surgery, Afyon Kocatepe University School of Medicine, 03200, Afyonkarahisar, Turkey.
| | - Ersin Gunay
- Department of Chest Diseases, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Ahmet Dumanli
- Department of Thoracic Surgery, Afyon Kocatepe University School of Medicine, 03200, Afyonkarahisar, Turkey
| | - Sule Cilekar
- Department of Chest Diseases, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Bengu Yucens
- Department of Psychiatry, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Serkan Gokaslan
- Department of Cardiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Elif Dogan Baki
- Department of Anesthesiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| |
Collapse
|
5
|
Kara M, Kose S, Ozkan B, Sertcakacilar G. Does clip removal help for compensatory hyperhidrosis complicating thoracic sympathetic clipping? Clin Auton Res 2019; 29:353-355. [PMID: 30859345 DOI: 10.1007/s10286-019-00599-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Murat Kara
- Istanbul University, Faculty of Medicine, Department of Thoracic Surgery, Istanbul, Turkey.
| | - Selcuk Kose
- Department of Thoracic Surgery, Bakirkoy Research and Training Hospital, Istanbul, Turkey
| | - Berker Ozkan
- Istanbul University, Faculty of Medicine, Department of Thoracic Surgery, Istanbul, Turkey
| | - Gokhan Sertcakacilar
- Department of Anesthesiology and Reanimation, Bakirkoy Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
6
|
Jung HS, Lee DY, Park JS. Alternative Surgical Methods in Patients with Recurrent Palmar Hyperhidrosis and Compensatory Hyperhidrosis. Yonsei Med J 2018; 59:345-348. [PMID: 29436207 PMCID: PMC5823841 DOI: 10.3349/ymj.2018.59.2.345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/26/2017] [Accepted: 08/22/2017] [Indexed: 11/27/2022] Open
Abstract
Recurrent hyperhidrosis after thoracic sympathectomy is an uncomfortable condition, and compensatory hyperhidrosis (CH) is one of the most troublesome side effects. Here, we describe two patients with recurrent palmar hyperhidrosis (PH) and CH over the whole body simultaneously. They were treated with bilateral T4 sympathetic clipping and reconstruction of the sympathetic nerve from a T5 to T8 sympathetic nerve graft, which was transferred to the resected T3 sympathetic bed site. They reported improvements in sweating and were fully satisfied with the results. Our method can be considered as an alternative approach for patients with recurrent PH and CH.
Collapse
Affiliation(s)
- Hee Suk Jung
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Doo Yun Lee
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
| | - Joon Suk Park
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| |
Collapse
|
7
|
Lin ML, Huang TR, Kao MC, Chiu HW, Lin SC, Chang FC. Pulsed radiofrequency stimulation suppresses palmar hyperhidrosis in an animal study. Brain Behav 2017; 7:e00833. [PMID: 29201541 PMCID: PMC5698858 DOI: 10.1002/brb3.833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/08/2017] [Accepted: 08/28/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Palmar hyperhidrosis (PH) exhibits excessive and unpredictable sweating. The most effective treatment for permanent cure is the ablation of thoracic sympathetic ganglia innervating hands. However, sympathectomy of T2 sympathetic ganglion by clipping or cauterization causes irreversible nerve damage, and results in a compensatory hyperhidrosis (CH). We herein used the pulsed radiofrequency (PRF) stimulation to reversibly block sympathetic ganglion to treat PH and avoid CH. MATERIAL AND METHODS A bipolar electrode was implanted into the right T2 sympathetic trunk by endoscopic surgery and PRF was delivered through the electrode. The humidity (%) of right palm was measured to indicate sweating level. RESULTS Six out of 13 rats (46.2%) that received a 5-min PRF stimulation on the T2 sympathetic trunk showed a decrease in the right palm humidity during the surgery. PRF stimulation significantly reduced humidity from 69.17% ± 0.72% obtained from baseline condition to 66.93% ± 0.69%. The humidity reduction was also observed at 10 min after the PRF stimulation. We further evaluated the effect of PRF stimulation 1 week after surgery and found that the PRF stimuli reduced right hand humidity in 5 out of 8 rats (62.5%). PRF stimulation significantly reduced humidity from 66.11% ± 0.81% obtained from sham operation control to 63.62% ± 0.82%. The percentage of right hand humidity obtained 10 min after PRF stimulation was also reduced to 63.38% ± 0.80%. Anesthetics have no effect on humidity. CONCLUSIONS These results indicate that PRF stimulation of T2 sympathetic trunk reduces palm sweating in rats.
Collapse
Affiliation(s)
- Mu-Lien Lin
- Department of Anesthesiology Medical School National Yang-Ming University Taipei Taiwan.,Pain Clinic Taipei City Hospital Taipei Taiwan
| | - Tzu-Rung Huang
- Department of Veterinary Medicine School of Veterinary Medicine National Taiwan University Taipei Taiwan
| | - Ming-Chien Kao
- Department of Surgery College of Medicine National Taiwan University Taipei Taiwan.,Department of Surgery National Cheng-Kung University Tainan Taiwan
| | - Hung-Wei Chiu
- Department of Electronic Engineering National Taipei University of Technology Taipei Taiwan
| | - Sheng-Chieh Lin
- Department of Surgery National Taiwan University Hospital Taipei Taiwan
| | - Fang-Chia Chang
- Department of Veterinary Medicine School of Veterinary Medicine National Taiwan University Taipei Taiwan.,Graduate Institute of Brain & Mind Sciences College of Medicine National Taiwan University Taipei Taiwan.,Graduate Institute of Acupuncture Science College of Chinese Medicine China Medical University Taichung Taiwan
| |
Collapse
|
8
|
Vannucci F, Araújo JA. Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results. J Thorac Dis 2017; 9:S178-S192. [PMID: 28446983 DOI: 10.21037/jtd.2017.04.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sympathectomy and its variations have been performed in thoracic surgery for more than 100 years. However, its indications have undergone profound modifications in this period. Likewise, since then the surgical technique has also evolved dramatically up to the minimally invasive techniques worldwide accessible in present days. Currently, primary hyperhidrosis is, by far, the main indication for thoracic sympathectomy and this procedure is usually carried out thoracoscopically with excellent results. However, until today, hyperhidrosis is a part of thoracic surgery still surrounded by controversy, persisting as an open field over which some confusion still resides regarding its pathophysiology, terms definitions and operative approaches. The aim of this article is to provide a wide but easily comprehensible review of the theme, discussing and clarifying the major concepts with respect to its clinical presentation, all the presently available treatment options and strategies with their potential benefits and risks, the adequate patient selection for sympathectomy, as well as the postoperative clinical results.
Collapse
Affiliation(s)
- Fernando Vannucci
- Thoracic Surgery Department, Hospital Federal do Andaraí, Rio de Janeiro, Brazil.,Thoracic Surgery Department, Hospital Central da Polícia Militar (HCPM), Rio de Janeiro, Brazil
| | - José Augusto Araújo
- Thoracic Surgery Department, Hospital Federal do Andaraí, Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Girish G, D'souza RE, D'souza P, Lewis MG, Baker DM. Role of surgical thoracic sympathetic interruption in treatment of facial blushing: a systematic review. Postgrad Med 2017; 129:267-275. [PMID: 28116967 DOI: 10.1080/00325481.2017.1283207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This paper aims to review the evidence to support the effectiveness of sympathectomy as a treatment for facial blushing in terms of relief of facial blushing, patient satisfaction, recurrence of blushing, patients regretting treatment and its associated complications. METHODS A systematic search strategy was performed in Ovid-Medline, Embase, Cochrane library and NICE. Studies reporting outcomes of sympathetic interruption in the treatment of facial blushing were retrieved. RESULTS Nine studies met the inclusion criteria with 1369 patients included in the final analysis. The age range of patients was 8 to 74 years (from 7 studies) with 56% females. Mean follow up was 21 months in 8 studies (range 6 to 30 months). The pooled proportion of patients who had good relief of facial blushing was 78.30% (95% C.I. 58.20% - 98.39%). Complete satisfaction was reported in 84.02% (95% C.I. 71.71% - 96.33%). Compensatory sweating and gustatory sweating were the commonest complications occurring in 74.18% (95% C.I. 58.10% - 90.26%) and 24.42% (95% C.I. 12.22% - 36.61%) respectively. The estimated proportion of patients regretting surgery was 6.79% (C.I 2.08% 11.50%). CONCLUSION Sympathetic interruption at T2 or T2-3 ganglia appears to be an effective treatment for facial blushing. However, lack of randomized trials comparing sympathetic interruption with non-surgical methods of treatment and heterogeneity of included studies with respect to assessment of outcome measures preclude strong evidence and definitive recommendations.
Collapse
Affiliation(s)
- Girish Girish
- a Consultant in general and vascular surgery, Department of General & Vascular Surgery , Watford General Hospital , Watford , UK
| | - Rovan E D'souza
- b Consultant in general and vascular surgery, Department of Vascular Surgery , Royal Free Hospital, Royal Free London NHS Foundation Trust , London , UK
| | - Preethy D'souza
- c Research Associate, Social Science Research Unit and EPPI-Centre , UCL Institute of Education , London , UK
| | - Melissa G Lewis
- d Research scholar, Department of statistics , Public Health Evidence, South Asia (PHESA), Manipal University , Manipal , India
| | - Daryll M Baker
- b Consultant in general and vascular surgery, Department of Vascular Surgery , Royal Free Hospital, Royal Free London NHS Foundation Trust , London , UK
| |
Collapse
|
10
|
Menna C, Ibrahim M, Andreetti C, Ciccone AM, D'Andrilli A, Maurizi G, Poggi C, Rendina EA. Long term compensatory sweating results after sympathectomy for palmar and axillary hyperhidrosis. Ann Cardiothorac Surg 2016; 5:26-32. [PMID: 26904428 DOI: 10.3978/j.issn.2225-319x.2015.12.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathectomy is currently the best treatment for primary upper extremity hyperhidrosis, but the potential for adverse effects, particularly the development of compensatory sweating, is a concern and often precludes surgery as a definitive therapy. This study aims to evaluate long-term results of two-stage unilateral versus one-stage bilateral thoracoscopic sympathectomy. METHODS From November 1995 to February 2011, 261 patients with severe palmar and/or axillary hyperhidrosis underwent endoscopic sympathectomy with a follow-up of at least 4 years. One-hundred and twenty-six patients received one-stage bilateral, single port video-assisted thoracoscopic sympathectomy (one-stage group) and 135 patients underwent two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of four months between the procedures (two-stage group). RESULTS The mean postoperative follow-up period was 7.2 years (range, 4-9 years). Sixteen patients (12.7%) in the one-stage group and 15 patients (11.1%) in the two-stage group suffered from bradycardia (P=0.15). Recurrences occurred in three patients (2.4%) in the one-stage group and one (0.7%) in the two-stage group (P=0,09). Facial flushing or hyperthermia occurred in eight patients (6.3%) in the one-stage group and 11 (8.1%) of the two-stage group. Compensatory sweating occurred in 27 patients (21.4%) in the one-stage group and six patients (4.4%) in the two-stage group (P=0.0001). However, compensatory sweating recovered in five patients (83.3%) in the two-stage group versus nine (33.35%) in one-stage group during the follow-up period (Log-rank test P=0.016; HR, 7.196; 95% CI, 1.431-36.20). An improvement in postoperative quality of life (QoL) scores was observed in at least 90% of patients at three years after surgery in the one-stage group and at least 95% of patients in the two-stage group (P=0.001). CONCLUSIONS Compensatory sweating seems to improve during the follow-up period with a higher recovery rate after two-stage unilateral versus one-stage bilateral sympathectomy for patients with palmar and axillary hyperhidrosis.
Collapse
Affiliation(s)
- Cecilia Menna
- 1 Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, University of L'Aquila, Teramo, Italy ; 2 Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy
| | - Mohsen Ibrahim
- 1 Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, University of L'Aquila, Teramo, Italy ; 2 Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy
| | - Claudio Andreetti
- 1 Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, University of L'Aquila, Teramo, Italy ; 2 Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy
| | - Anna Maria Ciccone
- 1 Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, University of L'Aquila, Teramo, Italy ; 2 Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy
| | - Antonio D'Andrilli
- 1 Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, University of L'Aquila, Teramo, Italy ; 2 Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy
| | - Giulio Maurizi
- 1 Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, University of L'Aquila, Teramo, Italy ; 2 Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy
| | - Camilla Poggi
- 1 Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, University of L'Aquila, Teramo, Italy ; 2 Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy
| | - Erino Angelo Rendina
- 1 Division of Thoracic Surgery, "G. Mazzini" Hospital of Teramo, University of L'Aquila, Teramo, Italy ; 2 Division of Thoracic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology, University of Rome "Sapienza", Rome, Italy
| |
Collapse
|
11
|
Hirano H, Horiuchi T, Hirano H, Kurita Y, Ukawa T, Nakamura R, Saeki N, Yoshizumi M, Kawamoto M, Tsuji T. Monitoring of peripheral vascular condition using a log-linearized arterial viscoelastic index during endoscopic thoracic sympathectomy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2013:2587-90. [PMID: 24110256 DOI: 10.1109/embc.2013.6610069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper proposes a novel technique to support the monitoring of peripheral vascular conditions using biological signals such as electrocardiograms, arterial pressure values and pulse oximetry plethysmographic waveforms. In this approach, a second-order log-linearized model (referred to here as a log-linearized peripheral arterial viscoelastic model) is used to describe the non-linear viscoelastic relationship between blood pressure waveforms and photo-plethysmographic waveforms. The proposed index enables estimation of peripheral arterial wall stiffness changes induced by sympathetic nerve activity. The validity of the method is discussed here based on the results of peripheral vascular condition monitoring conducted during endoscopic thoracic sympathectomy (ETS). The results of ETS monitoring showed significant changes in stiffness variations between the periods before and during the procedures observed (p < 0.01) as well as during and after them (p < 0.01), so that it was confirmed that sympathetic nerve activity is drastically decreased in the area around the monitoring site after the thoracic sympathetic nerve trunk on the monitoring side is successfully blocked. In addition, no change was observed in the values of the proposed index during the ETS procedure on the side opposite that of the monitoring site. The experimental results obtained clearly show the proposed method can be used to assess changes in sympathetic nerve activity during ETS.
Collapse
|
12
|
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]
|
13
|
Bilateral single-port sympathectomy: long-term results and quality of life. BIOMED RESEARCH INTERNATIONAL 2013; 2013:348017. [PMID: 24383050 PMCID: PMC3870625 DOI: 10.1155/2013/348017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/16/2013] [Accepted: 10/21/2013] [Indexed: 11/17/2022]
Abstract
Object. Video-assisted thoracoscopic sympathectomy is a safe, effective, and minimally invasive procedure for primary hyperhidrosis. This study aims to evaluate long-term results and patients' quality of life and investigate potential variables responsible for compensatory sweating after one-stage bilateral single-port thoracoscopic sympathectomy. Methods. Between 2005 and 2011, 260 consecutive bilateral thoracoscopic sympathectomies were performed in 130 patients for primary palmar and axillary hyperidrosis through one-port access. Residual pain, postoperative complications, recurrence of symptoms, heart rate adjustment, and quality of life were analyzed. Multivariate analysis was performed. Results. No operative mortality and conversion to open surgery were recorded. Mean operative time was 38 ± 5 minutes. Mean hospital stay was 1.1 ± 0.6 days. Eight patients (6%) had unilateral pneumothorax. Twenty-five cases (19%) were complicated by compensatory sweating. Winter and fall were identified as protective factors for compensatory sweating occurrence. Decreased heart rate was observed 1 year after surgery and permanently over the time. No recurrence during the follow-up period (31.5 months) was observed and 90% of patients showed improved quality of life. Conclusions. One-stage bilateral miniuniportal thoracoscopic sympathectomy is a valid and safe treatment for primary hyperhidrosis, achieving definitive and esthetic results, with excellent patients' satisfaction. Compensatory sweating may potentially occur in a season-dependent manner.
Collapse
|
14
|
Long-term results of endoscopic sympathetic block using the Lin-Telaranta classification. Surg Endosc 2013; 27:3860-4. [PMID: 23708713 DOI: 10.1007/s00464-013-2995-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathectomy has been used successfully in the treatment of blushing, excessive sweating, and social phobia. However, the adverse effects of endoscopic thoracic sympathectomy are more severe and frequent than the adverse effects of endoscopic sympathetic block (ESB). The use of different blocking levels for different indications in ESB according to the Lin-Telaranta classification further decreases the postoperative adverse effects. However, there are few data on the long-term results of ESB performed using the Lin-Telaranta classification. METHODS Ninety-five patients (55 men, 40 women) were interviewed by before the surgery using our routine questionnaire, and the same questionnaire was answered postoperatively by the patients. In addition, a long-term follow-up questionnaire was sent to all patients whose address was known. Forty-seven patients (24 men, 23 women) answered to this questionnaire. The Davidson brief social phobia scale and the Liebowitz quality of life scale were used. Patients were divided to 3 categories: category 1, patients with sweating problems; category 2, patients with blushing; and category 3, and patients with symptoms other than sweating or blushing. RESULTS Among patients in category 1, social phobia decreased from 12.43 to 6.71 (p = 0.004), in category 2 from 13.97 to 7.69 (p < 0.001), and in category 3 from 13.18 to 9.64 (p = 0.007) during long-term follow-up. Among patients with severe sweating problems preoperatively, sweating decreased from 2.50 to 1.29 (p = 0.003) among patients in category 1 and from 1.86 to 1.16 (p < 0.001) among patients in category 2. Among patients with unbearable blushing, blushing decreased from 4 to 1.80 (p < 0.001). CONCLUSIONS Patients got a clear help from ESB performed using the Lin-Telaranta classification to treat blushing, excessive sweating, and social phobia with and without physical symptoms. In addition, compensatory sweating increased only slightly.
Collapse
|
15
|
Ibrahim M, Menna C, Andreetti C, Ciccone AM, D'Andrilli A, Maurizi G, Poggi C, Vanni C, Venuta F, Rendina EA. Two-stage unilateral versus one-stage bilateral single-port sympathectomy for palmar and axillary hyperhidrosis. Interact Cardiovasc Thorac Surg 2013; 16:834-8. [PMID: 23442937 DOI: 10.1093/icvts/ivt039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. METHODS From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). RESULTS The mean postoperative follow-up period was 12.5 (range: 1-24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/moderate pain (P = 0.8482). The mean operative time was 38 ± 5 min in the one-stage group and 39 ± 8 min in the two-stage group (P = 0.199). Pneumothorax occurred in 8 (6%) patients of the one-stage group and in 11 (8%) of the two-stage group. Compensatory sweating occurred in 25 (19%) patients of the one-stage group and in 6 (4%) of the two-stage group (P = 0.0001). No patients developed Horner's syndrome. CONCLUSIONS Both two-stage unilateral and one-stage bilateral single-port video-assisted thoracoscopic sympathectomies are effective, safe and minimally invasive procedures. Two-stage unilateral sympathectomy can be performed with a lower occurrence of compensatory sweating, improving permanently the quality of life in patients with palmar and axillary hyperhidrosis.
Collapse
Affiliation(s)
- Mohsen Ibrahim
- Division of Thoracic Surgery, Faculty of Medicine and Psychology, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Kopelman D, Costa MG, Bejar J, Zaretsky A, Hashmonai M. Attempted reversible sympathetic ganglion block by an implantable neurostimulator. Interact Cardiovasc Thorac Surg 2012; 14:605-9. [PMID: 22316522 DOI: 10.1093/icvts/ivr137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Primary palmar hyperhidrosis is a pathological condition of excessive perspiration of the hands of unknown aetiology. The only effective treatment for permanent cure is the ablation of the sympathetic ganglia supplying the hands. One of the sequelae is compensatory sweating, namely increased perspiration in other parts of the body. Its mechanism is unknown. In a small proportion of patients, it may attend devastating proportions. It has practically no remedy, and the degree of compensatory hyperhidrosis is unpredictable prior to sympathectomy. The purpose of the present study was to obtain a reversible sympathetic block which may disclose subjects prone to develop severe compensatory hyperhidrosis and unfit for permanent ganglionic ablation. METHODS In three dogs, an experimental electrode was implanted via a left thoracotomy on the stellate ganglion, connected to a stimulator. The stimulation was activated after recovery. The contralateral ganglion served as control. Effect of the stimulation was assessed by observing the development of Horner's syndrome, which includes the appearance of miosis, ptosis and enophthalmus. Reversal of the sympathetic block was expected when the neurostimulation was discontinued and assessed by the disappearance of these signs. RESULTS Stimulation produced only a partial effect - an incomplete Horner's syndrome (miosis and sometime ptosis), which was not completely reversible after ceasing the stimulation. CONCLUSIONS Although neurostimulation achieved a partial sympathetic block, the present method failed to obtain a completely reversible effect. However, these results may indicate that different nervous pathways moderate the various components of the Horner's triad. Concerning the creation of a reversible sympathectomy; other approaches must be sought after.
Collapse
Affiliation(s)
- Doron Kopelman
- Department of Surgery B, Haemek Medical Center, Afula, Israel
| | | | | | | | | |
Collapse
|
17
|
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).
Collapse
Affiliation(s)
- I Hoorens
- Department of Dermatology, University Hospital, Ghent, Belgium.
| | | |
Collapse
|
18
|
Scognamillo F, Serventi F, Attene F, Torre C, Paliogiannis P, Pala C, Trignano E, Trignano M. T2-T4 sympathectomy versus T3-T4 sympathicotomy for palmar and axillary hyperhidrosis. Clin Auton Res 2011; 21:97-102. [PMID: 21243401 DOI: 10.1007/s10286-010-0110-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 12/03/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate and compare the immediate and long-term outcomes of videothoracoscopic T2-T4 sympathectomy and T3-T4 sympathicotomy for the treatment of palmar and axillary hyperhidrosis. METHODS Between October 1993 and September 2007, we treated a total of 88 patients affected by palmar and axillary hyperhidrosis. Twenty-four patients underwent T2-T4 sympathectomy with 5-10 mm trocars (Group A), 43 T2-T4 sympathectomy with 2-5 mm trocars (Group B), 15 T3-T4 sympathicotomy with 5-10 mm trocars and 6 T3-T4 ganglion block with 2-5 mm trocars (Group C). The mean operative time, for each side, was 15 min for sympathicotomy and 28 min for sympathectomy. In September 2008, we recontacted 98% of patients (total 86), by telephone, to establish long-term results (follow-up range 1-15 years). RESULTS In this series, we did not find any significant difference between T2-T4 sympathectomy and T3-T4 sympathicotomy in terms of postsurgical palmar anhidrosis or onset of compensatory hyperhidrosis, while both methods show high efficacy for remission of palmar hyperhidrosis. The slightly higher recurrence rate in our early experience (Group A) can be attributed to the learning curve. Using smaller trocars (2-5 mm), we reduced postsurgical intercostal pain and obtained better aesthetic results and a higher grade of patient's satisfaction. INTERPRETATION Thoracoscopic approach to hyperhidrosis has evolved in the last few decades with a consequent decrease in side effects. In this series, all patients experienced an improvement in quality of life even in case of recurrence or onset of compensatory hyperhidrosis. Due to these results, the shorter operative time and easier performance of sympathicotomy, we prefer this method.
Collapse
Affiliation(s)
- Fabrizio Scognamillo
- Department of Surgical Pathology, University of Sassari, Viale San Pietro 43b, 07100, Sassari, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Analysis of clamping versus cutting of T3 sympathetic nerve for severe palmar hyperhidrosis. J Thorac Cardiovasc Surg 2010; 140:984-9. [PMID: 20951250 DOI: 10.1016/j.jtcvs.2010.08.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/25/2010] [Accepted: 08/09/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Endoscopic thoracic sympathectomy can predictably eliminate the disabling symptoms of palmar hyperhidrosis. Debate has ensued over competing techniques, in particular, cutting versus clamping of the sympathetic chain. We subjectively assessed the sweat severity in different areas of the body and evaluated changes in the quality of life in patients undergoing either the cutting or clamping technique. METHODS Patients examined between June 2003 and March 2007 were asked to quantify the severity of their symptoms before and after endoscopic thoracic sympathectomy. The interviews were conducted approximately 1 year after the procedure. Only the patients undergoing sympathectomy at the T3 level for a chief complaint of palmar hyperhidrosis were included in the analysis (n = 152). In 45% of these patients, clamping of the sympathetic chain was performed, and the remaining 55% had the chain cut. RESULTS After surgery, no patients had continued excessive sweating of the hands. Of all the patients, 95% were satisfied with the results after the cutting procedure and 97% were satisfied after clamping. No difference was seen in any outcome between the patients undergoing clamping versus cutting of the sympathetic chain, including sweating on the hands, face, armpits, feet, trunk, and thighs or in the quality of life. CONCLUSIONS We found high rates of success and patient satisfaction when T3 sympathectomy was performed for palmar hyperhidrosis, with no differences found between the cutting and clamping techniques.
Collapse
|
20
|
Vorkamp T, Foo FJ, Khan S, Schmitto JD, Wilson P. Hyperhidrosis: Evolving concepts and a comprehensive review. Surgeon 2010; 8:287-92. [PMID: 20709287 DOI: 10.1016/j.surge.2010.06.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 05/28/2010] [Accepted: 06/01/2010] [Indexed: 11/20/2022]
Affiliation(s)
- Tobias Vorkamp
- Department of Thoracic, Cardiac and Vascular Surgery, University of Goettingen, Germany
| | | | | | | | | |
Collapse
|
21
|
Bachmann K, Standl N, Kaifi J, Busch P, Winkler E, Mann O, Izbicki JR, Strate T. Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis: four-year outcome and quality of life after bilateral 5-mm dual port approach. Surg Endosc 2009; 23:1587-93. [PMID: 19259731 DOI: 10.1007/s00464-009-0392-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 01/24/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND During recent years, thoracoscopic sympathectomy has been the standard treatment for hyperhidrosis. Different surgical techniques have been described without proving their advantages compared with other procedures. This study was designed to evaluate our modification of thoracoscopic sympathectomy and to compare the effectiveness between axillary and palmar hyperhidrosis. METHODS Ninety patients with axillary or palmar hyperhidrosis who underwent bilateral thoracoscopic sympathectomy with single-lumen ventilation with a dual 5-mm port approach were followed up for a median of 3.9 (range, 1-6) years. The clinical course and data during the hospitalization and consultation in our outpatient clinic were reviewed. The following parameters were evaluated: clinical improvement, satisfaction, changes in quality of life, and compensatory sweating and gustatory sweating. RESULTS The perioperative mortality was 0, and the morbidity was 6.5%. In 81% clinical improvement of sweating was noticed; 55% did not sweat at all. A total of 88% of patients were satisfied with the result of the operation. The rates of compensatory sweating and gustatory sweating were 93.5% and 49.4%, respectively. The result of sympathectomy in patients with palmar hyperhidrosis were significantly better concerning rate of satisfaction (p = 0.006) and improvement of symptoms (p = 0.027) compared with patients with axillary symptoms. Additionally it was found that the compensatory sweating had significantly impacted the satisfaction rating of the operation. CONCLUSION Currently different effective surgical approaches for the treatment of hyperhidrosis with improvement rates of more than 80% are available. The quality of the intervention has to be evaluated by changes in quality of life and intensity of compensatory sweating. Thoracoscopic sympathectomy as performed in our institution offers results and complications comparable to previously published trials; however, because of single-lumen ventilation the management is much easier. Therefore, this technique offers an interesting option for the treatment of patients with palmar and axillary hyperhidrosis.
Collapse
Affiliation(s)
- Kai Bachmann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
History of thoracoscopic surgery in Japan and the world. Gen Thorac Cardiovasc Surg 2009; 57:64-70. [PMID: 19214446 DOI: 10.1007/s11748-008-0326-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to review articles to learn how current thoracoscopic surgery was developed to the present status. MATERIALS AND METHODS The Internet literature search engines PubMed and Index Medicus were used to search for the published articles. Interpretation of the articles was reflected in the reviewer's personal experience, who was closely associated with the developmental history. RESULTS Altogether, 49 articles were selected and reviewed. CONCLUSIONS A variety of applications of thoracoscopy have been developed. It remains the major surgical technique in thoracic surgery.
Collapse
|
23
|
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.
Collapse
Affiliation(s)
- Doron Kopelman
- Department of Surgery B, Ha'emek Hospital, Afula, Israel
| | | |
Collapse
|
24
|
Solish N, Bertucci V, Dansereau A, Hong HCH, Lynde C, Lupin M, Smith KC, Storwick G. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33:908-23. [PMID: 17661933 DOI: 10.1111/j.1524-4725.2007.33192.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hyperhidrosis can have profound effects on a patient's quality of life. Current treatment guidelines ignore disease severity. OBJECTIVE The objective was to establish clinical guidelines for the recognition, diagnosis, and treatment of primary focal hyperhidrosis. METHODS AND MATERIALS A working group of eight nationally recognized experts was convened to develop the consensus statement using an evidence-based approach. RECOMMENDATIONS An algorithm was designed to consider both disease severity and location. The Hyperhidrosis Disease Severity Scale (HDSS) provides a qualitative measure that allows tailoring of treatment. Mild axillary, palmar, and plantar hyperhidrosis (HDSS score of 2) should initially be treated with topical aluminum chloride (AC). If the patient fails to respond to AC therapy, botulinum toxin A (BTX-A; axillae, palms, soles) and iontophoresis (palms, soles) should be the second-line therapy. In severe cases of axillary, palmar, and plantar hyperhidrosis (HDSS score of 3 or 4), both BTX-A and topical AC are first-line therapy. Iontophoresis is also first-line therapy for palmar and plantar hyperhidrosis. Craniofacial hyperhidrosis should be treated with oral medications, BTX-A, or topical AC as first-line therapy. Local surgery (axillary) and endoscopic thoracic sympathectomy (palms and soles) should only be considered after failure of all other treatment options. CONCLUSIONS These guidelines offer a rapid method to assess disease severity and to treat primary focal hyperhidrosis according to severity.
Collapse
Affiliation(s)
- Nowell Solish
- Division of Dermatology, New Women's College Hospital, Toronto, Ontario, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Assalia A, Bahouth H, Ilivitzki A, Assi Z, Hashmonai M, Krausz MM. Thoracoscopic Sympathectomy for Primary Palmar Hyperhidrosis: Resection Versus Transection—A Prospective Trial. World J Surg 2007; 31:1976-9; discussion 1980-1. [PMID: 17687600 DOI: 10.1007/s00268-007-9160-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Upper dorsal sympathectomy is the only successful therapeutic method for idiopathic palmar hyperhidrosis (IPHH). However, the techniques for sympathetic ablation are still debated. The aim of this study was to compare prospectively two accepted methods for endoscopic sympathetic ablation: resection of T2-T3 ganglia versus transection of the chain over the second to fourth ribs. During the period September 2000 to June 2002, a total of 32 patients with IPHH were operated on. Operations were performed under general anesthesia through two 5-mm trocars using electrocautery. Resection was done on one side and transection on the other, with both sides being addressed during the same operation. The sides of resection/transection were alternated at each operation. There were 14 men and 18 women aged 18.8 +/- 4.7 years. The mean operating times for sympathectomy were 12.0 +/- 3.1 minutes for resection and 6.6 +/- 1.9 minutes for transection (p = 1.38). All patients were examined at 2 weeks postoperatively and again at 1 month. During November-December 2005, patients were approached by telephone questionnaire, the mean follow-up period being 4.3 +/- 0.9 years. Altogether, 26 of the 32 patients could be located (15 women, 11 men). There was no significant difference with regards to perioperative complications, immediate or long-term pain. All but two hands were warm and dry 1 month after operation and remained so at follow-up. The exceptions included one hand with recurrent hyperhidrosis after 1.5 years and one that became less dry and cold at 3 years. Both were on the transected sides. Our results suggest that sympathetic resection may achieve slightly better long-term results than transection in patients with IPHH. Large-scale prospective studies are needed to confirm these results.
Collapse
Affiliation(s)
- Ahmad Assalia
- Department of Surgery B, Rambam Health Care Campus and the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | | | | | | | | | | |
Collapse
|
26
|
Katara AN, Domino JP, Cheah WK, So JB, Ning C, Lomanto D. Comparing T2 and T2–T3 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis: a randomized control trial. Surg Endosc 2007; 21:1768-71. [PMID: 17404794 DOI: 10.1007/s00464-007-9241-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 10/13/2006] [Accepted: 11/02/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Thoracoscopic sympathectomy is a useful therapeutic option for palmar hyperhidrosis. Surgeons differ in the level of the sympathetic chain ablated. This study aimed to compare the blockade of the T2 with levels T2 and T3 to verify the effectiveness of different ablation levels in relieving hyperhidrosis symptoms. METHODS For patients undergoing bilateral thoracoscopic sympathectomy for palmar hyperhidrosis, T2-T3 ablation is performed bilaterally. In our series, 25 consecutive patients were blindly randomized to undergo unilateral T2 and T3 ablation followed by contralateral ablation of level T2 only. The patients were followed up and analyzed for comparison of symptoms bilaterally, compensatory hyperhidrosis, and levels of satisfaction postoperatively. RESULTS The study group consisted of 25 patients with a male:female ratio of 3:2 and a mean age of 32 years (range, 19-50 years). The mean operative time was 35 min. The patients were followed up for a mean period of 23 months (range, 2-65 months). All 25 patients confirmed that their palmar sweating resolved postoperatively, with both palms equally dry. Of the 25 patients, 20 (80%) complained of compensatory hyperhidrosis, which also was bilaterally symmetric. The areas involved were trunk (80%), lower limbs (32%), and armpits (12%). Overall, 80% of the patients were very satisfied with the procedure. The remaining 20% experienced mild to moderate compensatory hyperhidrosis, which did not seem to affect their lifestyle. CONCLUSION The findings show that T2 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis is as effective as T2-T3 ablation in terms of symptomatic relief, recurrence, compensatory hyperhidrosis, and patient satisfaction.
Collapse
Affiliation(s)
- A N Katara
- Minimally Invasive Surgical Centre, Department of General Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore, 119074.
| | | | | | | | | | | |
Collapse
|
27
|
Malmivaara A, Kuukasjärvi P, Autti-Ramo I, Kovanen N, Mäkelä M. Effectiveness and safety of endoscopic thoracic sympathectomy for excessive sweating and facial blushing: A systematic review. Int J Technol Assess Health Care 2007; 23:54-62. [PMID: 17234017 DOI: 10.1017/s0266462307051574] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives:Despite controversies, endoscopic thoracic sympathectomy (ETS) has been used as a treatment for excessive sweating of hands and face and for facial blushing. This study aims to evaluate the effectiveness of ETS for the current indications in a systematic review.Methods:Controlled clinical trials and cohort studies with more than 100 patients were included. Abstracts were searched from MEDLINE and CCTR from 1966 to June 2004. Two reviewers extracted the data and assessed study quality. Data on effectiveness and safety were synthesized qualitatively.Results:We did not find any controlled clinical trials. Fifteen prospective studies were included. The internal and external quality of these studies were poor overall. Follow-up was commonly less than 2 years, during which time excessive sweating and facial blushing seemed to decrease among most patients. Immediate complications related to thoracoscopy occurred in up to 10 percent of patients. Compensatory sweating below breast level was reported in up to 90 percent of the patients. Other common side effects included dryness of face and hands, gustatory sweating, and neuralgic pain. Several other less common side effects were reported.Conclusions:The evidence of the effectiveness of ETS is weak due to a lack of randomized trials. The intervention leads to severe immediate complications in some of the patients, and to persistent side-effects for many of the patients.
Collapse
Affiliation(s)
- Antti Malmivaara
- Finnish Office for Health Technology Assessment, and Department of Physiatrics, University of Oulu, Box 8000, 90014 University of Oulu, Finland.
| | | | | | | | | |
Collapse
|
28
|
Chou SH, Kao EL, Lin CC, Huang MF. The outcome of ganglion clipping in hyperhidrosis and blushing. Clin Auton Res 2006; 16:240-2. [PMID: 16763754 DOI: 10.1007/s10286-006-0347-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 03/23/2006] [Indexed: 11/27/2022]
Abstract
A total of 114 patients with various sympathetic disorders underwent endoscopic sympathetic block over different thoracic ganglions by the clipping method. The advantages of this method include the recognition of the clipped level, changeability, and reversibility. However, 4.4% of patients were unilaterally clipped at the wrong level.
Collapse
Affiliation(s)
- Shah-Hwa Chou
- Department of Surgery, Kaohsiung Medical University, 100 Shih Chuan 1st Road, Kaohsiung 80708, Taiwan.
| | | | | | | |
Collapse
|
29
|
Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I, Ferrer G. Thoracic sympathicolysis for primary hyperhidrosis: a review of 918 procedures. Surg Endosc 2006; 20:598-602. [PMID: 16437263 DOI: 10.1007/s00464-005-0557-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 11/21/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Bilateral upper thoracic sympathectomy or sympathicolysis, currently the standard treatment for palmar or axillary hyperhidrosis, is regarded as a safe procedure. This study evaluates the quantitative and qualitative incidence of intraoperative and postoperative complications resulting from bilateral thoracic sympathicolysis. METHODS From 1996 to 2004, 458 consecutive patients with primary hyperhidrosis underwent surgery. These patients comprised 143 men (31.2%) and 315 women (68.7%) with a mean age of 26 years (range, 14-52 years). In all but seven cases, the procedure was bilaterally synchronous. RESULTS No mortality was recorded. The anhydrosis rate was 97.4%, with a hypohidrosis rate of 2.4% and a failure rate of 0.2%. The latter was resolved with reintervention. The mean hospital stay was 17 h. The rate of major perioperative complications with conversion to thoracotomy was 0.4%. The overall rate of postoperative complications was 3.6%. The complications and rates observed were as follows: pneumothorax (2.06%), subcutaneous emphysema (1.08%), pleural bleeding (0.2%), hemothorax (0.1%), and atelectasis (0.1%). Compensatory hyperhidrosis was observed in 48.4% of the patients, but the sensation of compensatory hyperhidrosis was reported in 85.6% of the cases. Excessive dryness of the hands was reported in 0.38%, Horner's syndrome in 0.32%, and gustatory hyperhidrosis in 1.1% of the cases. The overall satisfaction rate was 88.5%. CONCLUSIONS The results suggest that endoscopic bilateral thoracic sympathicolysis is an effective method for managing primary hyperhidrosis, especially severe palmar hyperhidrosis, but it is necessary to inform patients fully concerning the undesirable effects.
Collapse
Affiliation(s)
- J Moya
- Department of Thoracic Surgery, Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907, Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
30
|
Fujita T, Mano M, Nishi H, Shimizu N. Intraoperative prediction of compensatory sweating for thoracic sympathectomy. ACTA ACUST UNITED AC 2005; 53:481-5. [PMID: 16200888 DOI: 10.1007/s11748-005-0091-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Postoperative compensatory sweating (PCS) is an important problem impacting on quality of life for patients after endoscopic thoracic sympathectomy (ETS). The present study investigated whether intraoperative palmar temperature and blood flow are useful for assessing PCS after ETS. METHODS Retrospectively, results were evaluated for ETS in 27 consecutive patients with primary palmar hyperhidrosis between 1996 and 2002. For all patients, bilateral nerve conduction to the palms was interrupted. The relationship between the range of PCS and intraoperative changes in palmar temperature and blood flow was investigated. RESULTS PCS developed in all cases. After completion of ETS, mean blood flow and temperature increased respectively. Significant correlations were found between the range of PCS and increases in palmar temperature (p<0.05) and blood flow (p<0.05). CONCLUSION Intraoperative monitoring of increases in palmar temperature and blood flow may be useful in patients with primary hyperhidrosis, to predict the range of PCS after ETS.
Collapse
Affiliation(s)
- Takeo Fujita
- Department of Cancer and Thoracic Surgery, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | | | | | | |
Collapse
|
31
|
Chou SH, Kao EL, Lin CC, Chuang HY, Huang MF. Sympathetic Hypertensive Syndrome: A Possible Surgically Curable Type of Hypertension. Hypertens Res 2005; 28:409-14. [PMID: 16156504 DOI: 10.1291/hypres.28.409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Poorly controlled hypertension was incidentally cured after performing an endoscopic sympathetic block (ESB) in a patient with hyperhidrosis craniofacialis (HHC). A survey of the literature indicated that 30% to 40% of essential hypertension is of sympathetic origin. Patients with facial sweating associated with hypertension were then studied to determine whether blood pressure is lowered after performing ESB. Between November 2002 and July 2003, 17 hypertensive patients (13 males and 4 females) ranging in age from 22 to 62 years underwent ESB solely for HHC at the Department of Surgery of Kaohsiung Medical University, Taiwan. Their preoperative systolic blood pressure (SBP) values ranged from 170 +/- 6 to 200.7 +/- 7.6 mmHg, and their diastolic blood pressure (DBP) values ranged from 94.7 +/- 6.1 to 120.3 +/- 5.7 mmHg. Their heart rates were between 92.67 +/- 2.28 and 119.67 +/- 5.13 beats per minute (bpm). They were refractory to aggressive medical treatment, including lifestyle modifications and antihypertensive medications. Their postoperative blood pressure, heart rate and surgical outcomes were recorded. After performing ESB, HHC was cured in all 17 patients. Based on the reductions in blood pressure and heart rate, the patients could be divided into two groups, one showing high-level reductions (Group T) and one showing low-level reductions (Group S). The blood pressure of Group T (ten patients) was reduced to the range of 120.2 +/- 6.9 to 131.6 +/- 3.5 mmHg SBP and 74.8 +/- 3.1 to 85.4 +/- 4.5 DBP, and the heart rate of this group was reduced to the range of 65.36 +/- 4.63 to 85 +/- 3.60 bpm, while the blood pressure and heart rate of Group S (seven other patients) were reduced to the ranges of 145.9 +/- 5.7 to 160.5 +/- 5.5 mmHg SBP, 90 +/- 4 to 100.7 +/- 3.2 mmHg DBP, and 80 +/- 4 to 90.83 +/- 3.53 bpm, respectively. The patients in Group S were well controlled at 119.8 +/- 5.5 to 130.6 +/- 8.0 mmHg SBP and 70.1 +/- 3.8 to 84.5 +/- 5.7 mmHg DBP with a daily low-dose of calcium channel blocker. The average follow-up periods of the two groups were 17.00 +/- 2.906 and 17.43 +/- 2.37 months, respectively. We named this surgically curable form of hypertension "Sympathetic Hypertensive Syndrome" (SHS), which we define by the presence of all three of the following: 1) stage II hypertension; 2) HHC or other sympathetic disorders; and 3) heart rate > or = 100 bpm. If the patient is male the reductions of blood pressure after the surgery will be better, which might be due to the link with Y chromosome. Finally, we recommend that ESB should be performed in patients with SHS, although the female would respond less satisfactorily in terms of the blood pressure.
Collapse
Affiliation(s)
- Shah-Hwa Chou
- Department of Surgery, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | | | | | | | | |
Collapse
|
32
|
Hund M, Sinkgraven R, Rzany B. Randomisierte, plazebokontrollierte klinische Doppelblindstudie zur Wirksamkeit und Vertraglichkeit der oralen Therapie mit Methantheliniumbromid (VagantinR) bei fokaler Hyperhidrose. Randomized, placebo-controlled, double blind clinical trial for the evaluation of the efficacy and safety of oral methantheliniumbromide (VagantinR) in the treatment of focal hyperhidrosis. J Dtsch Dermatol Ges 2004; 2:343-9. [PMID: 16281522 DOI: 10.1046/j.1439-0353.2004.04765.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Methanthelinium bromide is a quaternary ammonium derivate with anticholinergic activity. Since 1951 it has been used to treat patients with hyperhidrosis. However, all efficacy data has so far been limited to case reports and case series. We here report on the results of the first randomised clinical controlled trial on the efficacy and safety of methanthelinium bromide. PATIENTS AND METHODS A total of 41 patients with a mean age (+/- standard deviation) of 28 +/- 9.8 years (Range 18.7-54.8) were included, 31 (76%) of them were females. Main inclusion criteria were are focal hyperhidrosis of a one year or longer duration and a gravimetrically assessed sweat production of > or =50 mg/min. Patients were treated with 2 x 50 mg methanthelinium bromide or placebo orally daily for 4 weeks. The therapeutic effect was determined by repeated gravimetric measurement of sweat production and by recording the patients' degree of satisfaction. RESULTS The efficacy was most pronounced for patients with an axillary hyperhidrosis of > or =50 mg/min (p = 0.02, chi2-test, two-sided). For the total group the main axillary sweat production decreased in the verum-treated arm from a mean value of 89.2 +/- 73.4 mg/min prior to therapy to 53.3 +/- 48.7 mg/min during therapy (p = 0.02, Wilcoxon test, two-sided). In contrast, no difference was detected in the placebo arm with 60.7 +/- 42.8 mg/min prior to and 59.1 +/- 40.6 mg/min during therapy (p = 0.92, Wilcoxon test, two-sided). For the palmar sweat production no difference between the verum- and the placebo-treated group was found. No serious adverse events were reported. As expected, dryness of the mouth, a known adverse reaction of anticholinergics, was reported significantly more frequently in the verum-treated arm. CONCLUSIONS Methanthelinium bromide has been considered for many years as a therapeutic option for the treatment of focal hyperhidrosis. However, its efficacy and safety have not previously been investigated in controlled randomised studies. We demonstrated both a decline in axillary sweat production and good tolerance. Therefore, the treatment of axillary hyperhidrosis with methanthelinium bromide in a regimen of 50 mg twice daily can be recommended, especially in those cases which are refractory to topical treatment with for example aluminium chloride hexahydrate solution. In contrast, we found no evidence for a clinically relevant diminution of palmar sweating.
Collapse
Affiliation(s)
- Martina Hund
- Division of Evidence Based Medicine, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin, Berlin.
| | | | | |
Collapse
|
33
|
Neumayer C, Zacherl J, Holak G, Függer R, Jakesz R, Herbst F, Bischof G. Limited endoscopic thoracic sympathetic block for hyperhidrosis of the upper limb: reduction of compensatory sweating by clipping T4. Surg Endosc 2003; 18:152-6. [PMID: 14625754 DOI: 10.1007/s00464-002-8940-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Accepted: 07/01/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathicotomy of T2 to T4 (ETS 2-4) has evolved into an effective treatment for severe hyperhidrosis of the upper limb. Complications such as bleeding or Horner's syndrome are rare, but side effects such as compensatory and gustatory sweating occur in 30-50% of patients. Following the Lin-Telaranta classification, we aimed to reduce these side-effects by clipping T4 solely [endoscopic thoracic sympathetic block (ESB 4)]. We present our experience and clinical results using this method, with emphasis on patients' quality of life. METHODS A total of 176 procedures (91 patients) were carried out in the ETS 2-4 group and 103 procedures (53 patients) in the ESB 4 group: 60.4 and 43.4% had palmar hyperhidrosis, 8.8 and 5.7% had isolated axillary, and 30.8 and 50.9% had combined manifestations, respectively. Follow-up was 22.1 months (obtained from 79.1% of patients) for the ETS 2-4 group and 7.5 months for the ESB 4 group (obtained from 88.7%). RESULTS The success rate was similar for both groups: 87.9 and 64.5% had completely dry limbs, 9.9 and 35.5% ( p < 0.0002) were nearly dry, and 2.1 and 0% remained wet. (ETS 2-4 vs ESB 4). Although the armpits remained slightly humid in more patients in the ESB 4 group, 100% stated full satisfaction. Complications did not differ significantly. However, compensatory sweating (55.6 vs 8.5%, p = 0.0002) and gustatory sweating (33.3 vs 2.1%, p = 0.0019) were markedly reduced (ETS 2-4 vs ESB 4). Quality of life was assessed by a hyperhidrosis index, which significantly improved in most patients. CONCLUSIONS ETS 2-4 and ESB 4 have similar success rates in the treatment of upper limb hyperhidrosis. The major side effects of compensatory and gustatory sweating were effectively reduced by the limited method of clipping T4, and patients' satisfaction and improvement in quality of life were remarkable.
Collapse
Affiliation(s)
- C Neumayer
- Department of General Surgery, University Clinic of Surgery, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | | | | | | | | | | | | |
Collapse
|
34
|
Reisfeld R, Nguyen R, Pnini A. Endoscopic thoracic sympathectomy for hyperhidrosis: experience with both cauterization and clamping methods. Surg Laparosc Endosc Percutan Tech 2002; 12:255-67. [PMID: 12193821 DOI: 10.1097/00129689-200208000-00011] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The goal was to review results of sympathectomy, performed with use of either cauterization or clamping, in patients with hyperhidrosis (n = 1,312): 653 early patients undergoing electrocautery sympathectomy, 305 later patients undergoing cauterization, and 354 patients treated with a clamping procedure. Patients were interviewed by telephone about the status of symptoms, adverse outcomes, and satisfaction. Palmar hyperhidrosis was cured in all but one patient, with a 98% satisfaction rate in the clamping group and 94.3% and 95.1% in the two cauterization groups ( < or = 0.025, clamping > cauterization). Facial sweating or blushing was cured in the majority (88%) of the 301 patients reporting this symptom. Severe compensatory hidrosis occurred in less than 6% (3% of the clamping group; < or = 0.001, clamping < cauterization). Recurrence rate was 3.0%. A number of factors were related to outcome. Endoscopic thoracic sympathectomy with clamping appears to be at least as safe and effective as earlier cauterization techniques, with the potential advantage of reversibility in those patients unhappy with the outcome.
Collapse
Affiliation(s)
- Rafael Reisfeld
- Center for Hyperhidrosis, Beverly Hills Center for Special Surgery, 1125 South Beverly Drive, Suite 500, Los Angeles, CA 90035, USA.
| | | | | |
Collapse
|
35
|
Gossot D, Kabiri H, Caliandro R, Debrosse D, Girard P, Grunenwald D. Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures. Ann Thorac Surg 2001; 71:1116-9. [PMID: 11308146 DOI: 10.1016/s0003-4975(01)02422-5] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thoracic endoscopic sympathectomy (TES) has become the surgical technique of choice for treating intractable palmar hyperhidrosis and is usually considered as a simple and safe procedure. To evaluate the complication rate of TES, we conducted a prospective study of peri- and postoperative complications. METHODS From 1995 to 1999, 467 consecutive patients were operated on for upper limb hyperhidrosis. There were 164 men and 303 women, ranging in age from 15 to 59 years (mean 31 years). In all but 5 cases, the procedure was bilateral. Eleven patients underwent a reoperation for failure; thus the total number of sympathectomies was 940. The procedure was performed in two stages in 182 patients and in one stage in 267 patients. All patients were seen 1 month after the operation. RESULTS There was no mortality. The mean postoperative hospital stay was 2.3 days in the group of patients who were operated on in two stages and 1.1 day in patients who were operated on in one stage. There were three major complications: one tear of the right subclavian artery and two chylothoraces. There were 25 cases (5.3%) of bleeding (300 to 600 mL) during dissection of the sympathetic trunk due to injury to an intercostal vein; in all cases it was controlled thoracoscopically. There were 12 pneumothoraces (1.3%) after removal of chest tubes. All of these were unilateral. Four required chest drainage for a period of less than 24 hours. One patient had a mild pleural effusion. Four patients had a unilateral partial Horner Syndrome (0.4%) that disappeared within 3 months in 2 patients. The other 2 patients were lost to follow-up. One patient complained of rhinitis. CONCLUSIONS Although morbidity was low, significant complications of TES occurred. Patients should be clearly warned that TES is not as minor a procedure as usually asserted. Complications as well as adverse effects should be considered when discussing this surgical indication.
Collapse
Affiliation(s)
- D Gossot
- Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
| | | | | | | | | | | |
Collapse
|
36
|
Lin TS, Huang LC, Wang NP, Lai CY. Video-assisted thoracoscopic T2 sympathetic block by clipping for palmar hyperhidrosis: analysis of 52 cases. J Laparoendosc Adv Surg Tech A 2001; 11:59-62. [PMID: 11327127 DOI: 10.1089/109264201750162211] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endoscopic thoracic sympathectomy or sympathicotomy is a standard method in treating palmar hyperhidrosis, but postoperative compensatory sweating may be troublesome in some patients. Therefore, we designed a new technique for only T2 sympathetic blocking by clipping instead of interruption of the sympathetic trunk. PATIENTS AND METHODS Between September 2000 and July 2001, we saw a total of 100 patients with palmar hyperhidrosis who underwent video-assisted thoracoscopic sympathetic blocking of the T2 ganglion. All patients were placed in a semisitting position under single-lumen intubated anesthesia. We performed sympathetic blocking by clipping of the T2 ganglion at the level of the second and third rib beds using an 8-mm, 0 degree thoracoscope (Storz). RESULTS We supposed that the postoperative improvement in palmar hyperhidrosis would be perfect. The operation could be accomplished within 30 minutes. All patients were discharged within 4 hours after the operation. Surgical complications were minimal, without surgical mortality. A few patients were willing to receive the reverse operation and should get improvement of compensatory sweating after removal of the endo clips. CONCLUSION We believe that video-assisted thoracoscopic T2 sympathetic block by clipping will be a safe and effective method of treating patients with palmar hyperhidrosis. Compensatory sweating may be improved by the reverse operation: removal of the endo clip.
Collapse
Affiliation(s)
- T S Lin
- Department of Surgery, Changhua Christian Hospital, Changhua City, Taiwan, ROC. Lin8065cms14.hinet.net
| | | | | | | |
Collapse
|
37
|
Lin TS. Endoscopic clipping in video-assisted thoracoscopic sympathetic blockade for axillary hyperhidrosis. An analysis of 26 cases. Surg Endosc 2001; 15:126-8. [PMID: 11285952 DOI: 10.1007/s004640080107] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Endoscopic thoracic sympathectomy or sympathicotomy is the standard method for the treatment of axillary hyperhidrosis. But postoperative compensatory sweating may be troublesome in some patients. Therefore, we use endoclips to perform the T3 and T4 sympathetic blockade instead of permanently interrupting the transmission of nerve impulses from the sympathetic trunk. METHODS Between May 1997 and June 1998, a total of 26 patients with axillary hyperhidrosis underwent video-assisted thoracoscopic sympathetic blocking of the T3 and T4 ganglia at our hospital. There were 10 men and 16 women with a mean age of 31.7 years (range, 16-47). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed the sympathetic blockade by clipping the T3 and T4 ganglia at the level of the third, fourth, and fifth rib beds using an 8-mm 0 degree thoracoscope. RESULTS Bilateral T3 and T4 sympathetic blockade was achieved in all 26 patients. The operation was usually completed within 30 min (range, 20-42). Most patients were discharged within 4 h after the operation. Surgical complications were minimal, with only one case of segmental atelectasis (3.8%). There were no deaths. The mean postoperative follow-up period was 31.3 months (range, 24-37). Twenty-three patients (88.5%) developed compensatory sweating of the trunk and lower limbs. Twenty-four patients (92.3%) were satisfied with the results of the operation. Improvement of axillary hyperhidrosis was obtained in all patients. One patient underwent a reverse operation to remove the endoclips due to intolerable compensatory sweating; improvement was seen 25 days after removal of the clips. CONCLUSION Video-assisted thoracoscopic T3 and T4 sympathetic blockade by clipping is a safe and effective method for the treatment of patients with axillary hyperhidrosis. Patients who experience excessive compensatory sweating may require a reverse operation for endoclip removal.
Collapse
Affiliation(s)
- T S Lin
- Department of Surgery, Changhua Christian Hospital, Chung Shan Medical and Dental College, 135 Nan-Siao Street, Changhua City, Taiwan, Republic of China
| |
Collapse
|
38
|
Fredman B, Zohar E, Shachor D, Bendahan J, Jedeikin R. Surg Laparosc Endosc Percutan Tech 2000; 10:226-229. [DOI: 10.1097/00019509-200008000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
39
|
Video-assisted Transthoracic Sympathectomy in the Treatment of Primary Hyperhidrosis: Friend or Foe? Surg Laparosc Endosc Percutan Tech 2000. [DOI: 10.1097/00129689-200008000-00009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|