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DOI: 10.1055/s-0035-1550339
Electrocautery versus Ultracision versus LigaSure in Surgical Management of Hyperhidrosis
Publikationsverlauf
26. Januar 2015
09. März 2015
Publikationsdatum:
18. Mai 2015 (online)
![](https://www.thieme-connect.de/media/thoracic/201508/lookinside/thumbnails/10-1055-s-0035-1550339_154007ot-1.jpg)
Abstract
Objective The aim of the study was to evaluate the sympathectomy procedures for primary hyperhidrosis in terms of complications and effectiveness.
Methods From January 2010 to September 2012 we performed 130 sympathectomies in 65 patients, 27 males (42%) and 38 females (58%). Electrocoagulation was used in 20 procedures (15%), ultrasonic scalpel in 54 (42%), and radiofrequency dissector in 56 (43%). Seven patients (11%) underwent bilateral sympathectomy in the same surgical session, while in 58 (89%) the right surgical approach was delayed 30 days from the first procedure.
Results We noticed 12 complications (9%): (a) chest pain in 6 patients (4 with electrocoagulation, 1 with ultrasonic scalpel, and 1 with radiofrequency dissector), which disappeared in 20 ± 1 day; (b) paresthesias in 3 electrocoagulation patients, was solved in 23 ± 5 days; (c) bradycardia in 1 ultrasonic patient, normalized in 4th postoperative hour; (d) unilateral relapse in 2 electrocoagulation patients after the second side approach, positively treated in 1 patient by resurgery in video-assisted thoracoscopy (VAT). The quality-adjusted life year and the quality of life evaluation revealed a statistically significant improvement (p = 0.02) in excessive sweating and general satisfaction after surgery, with Ultracision and LigaSure showing better findings than electrocoagulation.
Conclusion The latest generation devices offered greater efficacy in the treatment of hyperhidrosis, minimizing complications and facilitating the resumption of normal work and social activity of patients.
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References
- 1 Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004; 51 (2) 241-248
- 2 Tu YR, Li X, Lin M , et al. Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China. Eur J Cardiothorac Surg 2007; 31 (4) 737-739
- 3 Reisfeld R, Berliner KI. Evidence-based review of the nonsurgical management of hyperhidrosis. Thorac Surg Clin 2008; 18 (2) 157-166
- 4 Cerfolio RJ, De Campos JRM, Bryant AS , et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 2011; 91 (5) 1642-1648
- 5 Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg 2009; 137 (6) 1370-1376 , discussion 1376–1377
- 6 Walles T, Somuncuoglu G, Steger V, Veit S, Friedel G. Long-term efficiency of endoscopic thoracic sympathicotomy: survey 10 years after surgery. Interact Cardiovasc Thorac Surg 2009; 8 (1) 54-57
- 7 Rathinam S, Nanjaiah P, Sivalingam S, Rajesh PB. Excision of sympathetic ganglia and the rami communicantes with histological confirmation offers better early and late outcomes in Video assisted thoracoscopic sympathectomy. J Cardiothorac Surg 2008; 3: 50 . doi: 10.1186/1749-8090-3-50
- 8 Black SA, Taylor FG, Russell MH, Ariga R, Thomas MH. Thorascopic sympathectomy performed using laser. Ann R Coll Surg Engl 2008; 90 (2) 142-145
- 9 Chang YT, Li HP, Lee JY , et al. Treatment of palmar hyperhidrosis: T(4) level compared with T(3) and T(2). Ann Surg 2007; 246 (2) 330-336
- 10 Lin TS, Kuo SJ, Chou MC. Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: analysis of 2000 cases. Neurosurgery 2002; 51 (5, Suppl): S84-S87
- 11 EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990; 16 (3) 199-208
- 12 Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care 2005; 43 (3) 203-220
- 13 Amir M, Arish A, Weinstein Y, Pfeffer M, Levy Y. Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Isr J Psychiatry Relat Sci 2000; 37 (1) 25-31
- 14 de Campos JRM, Kauffman P, Werebe EdeC , et al. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg 2003; 76 (3) 886-891
- 15 Miller DL, Force SD. Temporary thoracoscopic sympathetic block for hyperhidrosis. Ann Thorac Surg 2008; 85 (4) 1211-1214 , discussion 1215–1216
- 16 Reisfeld R, Pasternack GA, Daniels PD, Basseri E, Nishi GK, Berliner KI. Severe plantar hyperhidrosis: an effective surgical solution. Am Surg 2013; 79 (8) 845-853
- 17 Lin CC, Telaranta T. Lin-Telaranta classification: the importance of different procedures for different indications in sympathetic surgery. Ann Chir Gynaecol 2001; 90 (3) 161-166
- 18 Chou SH, Kao EL, Lin CC, Chang YT, Huang MF. The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases. Surg Endosc 2006; 20 (11) 1749-1753
- 19 Zee RFY. Case report: hazards associated with cervico-thoracic sympathectomy. Anaesth Intensive Care 1977; 5 (1) 76-77
- 20 Lai CL, Chen WJ, Liu YB, Lee YT. Bradycardia and permanent pacing after bilateral thoracoscopic T2-sympathectomy for primary hyperhidrosis. Pacing Clin Electrophysiol 2001; 24 (4 Pt 1) 524-525
- 21 O'Connor K, Molin F, Poirier P, Vaillancourt R. Cardiac arrest as a major complication of bilateral cervico-dorsal sympathectomy. Interact Cardiovasc Thorac Surg 2009; 8 (2) 238-239
- 22 Lin CC, Mo LR, Hwang MH. Intraoperative cardiac arrest: a rare complication of T2,3-sympathicotomy for treatment of hyperhidrosis palmaris. Two case reports. Eur J Surg Suppl 1994; 572 (572) 43-45
- 23 de Campos JRM, Wolosker N, Yazbek G , et al. Comparison of pain severity following video-assisted thoracoscopic sympathectomy: electric versus harmonic scalpels. Interact Cardiovasc Thorac Surg 2010; 10 (6) 919-922
- 24 Licht PB, Pilegaard HK. Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg 2004; 78 (2) 427-431
- 25 Dumont P, Denoyer A, Robin P. Long-term results of thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg 2004; 78 (5) 1801-1807
- 26 Lin TS, Wang NP, Huang LC. Pitfalls and complication avoidance associated with transthoracic endoscopic sympathectomy for primary hyperhidrosis (analysis of 2200 cases). Int J Surg Investig 2001; 2 (5) 377-385
- 27 Lester BR, Miller K, Boers A, Harris DC, Gamble WG. Comparison of in vivo clinical performance and shaft temperature and in vitro tissue temperature and transection times between new and reprocessed harmonic scalpels. Surg Laparosc Endosc Percutan Tech 2010; 20 (5) e150-e159
- 28 Kopelman D, Bahous H, Assalia A, Hashmonai M. Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis. The use of harmonic scalpel versus diathermy. Ann Chir Gynaecol 2001; 90 (3) 203-205
- 29 Wilkinson HA. Radiofrequency percutaneous upper-thoracic sympathectomy. Technique and review of indications. N Engl J Med 1984; 311 (1) 34-36
- 30 Divisi D, Ferrari V, De Vico A , et al. Electrocautery versus Ultracision versus LigaSure in surgical management of hyperhidrosis. 21st European Conference on General Thoracic Surgery 2013; P-173: 229.