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Thorac Cardiovasc Surg 2019; 67(05): 415-419
DOI: 10.1055/s-0038-1642030
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Efficacy of Miniuniportal Video-Assisted Thoracoscopic Selective Sympathectomy (Ramicotomy) for the Treatment of Severe Palmar and Axillar Hyperhidrosis

Ali Akil
1   Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, Ibbenbueren, Germany
,
Michael Semik
1   Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, Ibbenbueren, Germany
,
Stefan Fischer
1   Department of Thoracic Surgery and Lung Support, Ibbenbueren General Hospital, Ibbenbueren, Germany
› Author Affiliations
Further Information

Publication History

25 November 2017

22 February 2018

Publication Date:
08 May 2018 (online)

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Abstract

Background Video-assisted thoracoscopic surgery (VATS) clipping of the sympathetic branch has become the standard approach for the treatment of essential hyperhidrosis when conservative treatment failed. However, this is associated with relevant potential complications such as postoperative compensatory sweating and recurrent sweating. We report the outcome after selective sympathectomy (ramicotomy) through a miniuniportal VATS approach in patients with therapy-refractory palmar and/or axillary hyperhidrosis.

Methods A total of 51 consecutive patients (37 females, mean age: 30 years, range: 12–64 years) who suffered from therapy-refractory palmar and/or axillary severe hyperhidrosis were included. Data were prospectively collected and retrospectively analyzed. All patients underwent bilateral miniuniportal VATS ramicotomy. Duration of surgery, hospital stay, recurrent, and compensatory sweating were documented.

Results All patients had palmar sweating, where 51% had additional axillary sweating and 57% had additional plantar sweating. In all patients, selective division of the rami communicantes of the thoracic sympathetic ganglions Th2 to Th5 was performed. The mean duration of bilateral surgery for both sides was 67 ± 2.5 minutes. The mean postoperative hospital stay was 2 ± 1 days. After surgery and at further follow-up (mean: 12 ± 2.5 months), all patients presented dry and warm hands and axillae, without any evidence of compensatory or recurrent sweating. All patients described a remarkable increase in quality of life.

Conclusion Miniuniportal VATS ramicotomy represents a feasible surgical technique with a very high success and satisfaction rate. Therefore, this approach should be considered as the method of choice for the treatment of patients with severe therapy-refractory palmar and axillary hyperhidrosis.

Keywords

hyperhidrosis - video-assisted thoracoscopic surgery - sympathetic nerve - ramicotomy
 

  • References

  • 1 Baumgartner FJ, Toh Y. Severe hyperhidrosis: clinical features and current thoracoscopic surgical management. Ann Thorac Surg 2003; 76 (06) 1878-1883
    CrossrefPubMedGoogle Scholar
  • 2 Kamudoni P, Mueller B, Halford J, Schouveller A, Stacey B, Salek MS. The impact of hyperhidrosis on patients' daily life and quality of life: a qualitative investigation. Health Qual Life Outcomes 2017; 15 (01) 121
    CrossrefPubMedGoogle Scholar
  • 3 Alexander W. The Treatment of Epilepsy. Edinburgh: Young J. Pentland; 1889: 27-106
    Google Scholar
  • 4 Seguin A, Martinod E, Azorin JF. Sympathectomic thoracique par videothoracoscopic del'hyperhidrose. Sang Thrombox Vaisseaux 2003; 15 (04) 187-192
    PubMedGoogle Scholar
  • 5 Hughes J. Endothoracic sympathectomy. Proc R Soc Med 1942; 35 (09) 585-586
    PubMedGoogle Scholar
  • 6 Lin CC, Mo LR, Lee LS, Ng SM, Hwang MH. Thoracoscopic T2-sympathetic block by clipping--a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases. Eur J Surg Suppl 1998; 580 (580) 13-16
    PubMedGoogle Scholar
  • 7 Coelho MdeS, Silva RF, Mezzalira G. , et al. T3T4 endoscopic sympathetic blockade versus T3T4 video thoracoscopic sympathectomy in the treatment of axillary hyperhidrosis. Ann Thorac Surg 2009; 88 (06) 1780-1785
    CrossrefPubMedGoogle Scholar
  • 8 Cho HM, Chung KY, Kim DJ, Lee KJ, Kim KD. The comparison of VATS ramicotomy and VATS sympathicotomy for treating essential hyperhidrosis. Yonsei Med J 2003; 44 (06) 1008-1013
    CrossrefPubMedGoogle Scholar
  • 9 Bryant AS, Cerfolio RJ. Satisfaction and compensatory hyperhidrosis rates 5 years and longer after video-assisted thoracoscopic sympathotomy for hyperhidrosis. J Thorac Cardiovasc Surg 2014; 147 (04) 1160-1163.e1
    CrossrefPubMedGoogle Scholar
  • 10 Ro KM, Cantor RM, Lange KL, Ahn SS. Palmar hyperhidrosis: evidence of genetic transmission. J Vasc Surg 2002; 35 (02) 382-386
    CrossrefPubMedGoogle Scholar
  • 11 Kurta AO, Glaser DA. Emerging nonsurgical treatments for hyperhidrosis. Thorac Surg Clin 2016; 26 (04) 395-402
    CrossrefPubMedGoogle Scholar
  • 12 de Campos JR, 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 (06) 919-922
    CrossrefPubMedGoogle Scholar
  • 13 Fiorelli A, D'Aponte A, Canonico R. , et al. T2-T3 sympathectomy versus sympathicotomy for essential palmar hyperhidrosis: comparison of effects on cardio-respiratory function. Eur J Cardiothorac Surg 2012; 42 (03) 454-461
    CrossrefPubMedGoogle Scholar
  • 14 Byrne J, Walsh TN, Hederman WP. Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 1990; 77 (09) 1046-1049
    CrossrefPubMedGoogle Scholar
  • 15 Gossot D, Toledo L, Fritsch S, Célérier M. Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation. Ann Thorac Surg 1997; 64 (04) 975-978
    CrossrefPubMedGoogle Scholar
  • 16 Gray H. The sympathetic nerves. Anatomy of the Human Body. Philadelphia: Lea & Febiger; 2000: 1292-1299
    Google Scholar
  • 17 Yazbek G, Wolosker N, de Campos JR, Kauffman P, Ishy A, Puech-Leão P. Palmar hyperhidrosis--which is the best level of denervation using video-assisted thoracoscopic sympathectomy: T2 or T3 ganglion?. J Vasc Surg 2005; 42 (02) 281-285
    CrossrefPubMedGoogle Scholar
  • 18 Lee DY, Kim DH, Paik HC. Selective division of T3 rami communicantes (T3 ramicotomy) in the treatment of palmar hyperhidrosis. Ann Thorac Surg 2004; 78 (03) 1052-1055
    CrossrefPubMedGoogle Scholar
  • 19 Ishy A, de Campos JR, Wolosker N. , et al. Objective evaluation of patients with palmar hyperhidrosis submitted to two levels of sympathectomy: T3 and T4. Interact Cardiovasc Thorac Surg 2011; 12 (04) 545-548
    CrossrefPubMedGoogle Scholar
  • 20 Liu Y, Yang J, Liu J. , et al. Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg 2009; 35 (03) 398-402
    CrossrefPubMedGoogle Scholar
  • 21 Cerfolio RJ, De Campos JR, Bryant AS. , et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 2011; 91 (05) 1642-1648
    CrossrefPubMedGoogle Scholar
  • 22 Gorur R, Yiyit N, Yildizhan A. , et al. Is T3 and T6 sympathetic clipping more effective in primary palmoplantar hyperhydrosis?. Thorac Cardiovasc Surg 2011; 59 (06) 357-359
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Xiao P, Liu A, Liu W. Effect of T4 thoracoscopic sympathectomy on plantar hyperhidrosis in patients with primary palmoplantar hyperhidrosis [in Chinese]. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2016; 41 (03) 300-304
    PubMedGoogle Scholar