Endoscopic transthoracic dorsal sympathectomy for the treatment of upper extremity hyperhidrosis: a new minimally invasive approach

Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis

INTRODUCTION

Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life.

OBJECTIVE

To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome.

METHOD

This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels.

RESULTS

Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, I2=47.5%), the symptom control rate was 96% (95% CI = 93-99%, I2=48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare.

CONCLUSION

This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.Key messagePure axillary hyperhidrosis has great potential to compromise quality of life.Surgery should be indicated only when clinical treatment fails.Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.

A comparative study of thoracoscopic sympathectomy for the treatment of hand sweating

Background

To compare postoperative satisfaction, compensatory hyperhidrosis, and the quality of life between thoracoscopic T3 and T4 sympathectomy for the treatment of hand sweating.

Methods

From December 2010 to October 2014, 192 consecutive patients with hand sweating underwent a thoracoscopic bilateral sympathectomy with different planes (T3/T4). The patients were randomly divided into two groups, the T3 and the T4 groups, for those who underwent thoracoscopic T3 and T4 sympathectomy, respectively. All patients underwent double-lumen intubation during the thoracoscopic bilateral sympathectomy. The patients were followed up with by telephone for postoperative evaluation on the safety and effectiveness of the procedure, and the two groups (T3 versus T4) were compared to each other for any potential differences.

Results

All of the patients' sweating symptoms improved after the procedure. The incidence of compensatory hyperhidrosis and palm dryness in the T4 group was lower than that in the T3 group (P<0.05). The satisfaction rate and the rate of improvement in sweating and the incidence of palm moisture in the T4 group were higher than those in the T3 group (P<0.05).

Conclusions

Thoracoscopic T3 and T4 sympathectomy are safe and effective methods for the treatment of hand sweating. Lowering the sympathetic chain resection plane can increase patients' satisfaction and enhance improvements in sweating. It can also reduce the incidence of long-term compensatory hyperhidrosis and palm dryness, but it also increases the incidence of palm moisture.

Video-assisted Thoracic Sympathicotomy for the Treatment of Palmar and Axillary Hyperhidrosis: A 17-Year Experience

PURPOSE

Advances in video-assisted thoracoscopic surgery have allowed endoscopic surgical sympathicotomy to become a viable safe therapy for upper limb hyperhidrosis. We evaluated if and how this procedure improves the quality of life in patients after a mean follow-up of 9.5 years.

METHODS

Between 1995 and 2013, the senior author performed 1440 upper dorsal sympathicotomies in 720 patients. Questionnaires were submitted to randomized patients, both to evaluate the durability of the results and to assess their quality of life after surgery.

RESULTS

In 46 patients, anatomical distinctive features obscured the sympathetic chain, precluding partial or total completion of the procedure. The other 674 patients reported complete relief of symptoms. A mean follow-up of 9.5 years (range, 2 to 17 y) was carried out on 450 patients: 6 recurrences have been observed, severe compensatory sweating was reported in 3 patients, and 441 patients were satisfied with nothing to complain. Furthermore, when comparing presurgery and postsurgery results, a statistically significant difference between most of patients answers came out (P=0.001).

CONCLUSION

According to the data obtained, the procedure we described significantly improves the quality of life of treated patients, also proving the durability of this procedure.

DISCUSSION

Minimally invasive endoscopic transthoracic sympathicotomy has proven to be an effective and durable surgical treatment for severe primary hyperhidrosis.