Abstract
Background Primary palmar hyperhidrosis (PPH) is featured by aberrantly perspiration of the
hands, which may bring a lot of inconvenience to patient's daily life and work. The
purpose of this study is to summarize the clinical effect of needlescopic video-assisted
thoracic bilateral T4 sympathicotomy for the treatment of PPH.
Patients and Methods Between January 2009 and March 2014, 200 patients received needlescopic video-assisted
thoracic bilateral T4 sympathicotomy. We, respectively, took two 5-mm incisions in
the third intercostal space on the anterior axillary line and in the fifth intercostal
space on the middle axillary line. After collapsing left lung, needlescopic exploration
was the first step to determine the targeted sympathetic chain through the third intercostal
space. Electric coagulation hook was inserted from another port to cut T4 sympathetic
chain and the bypassing nerve fibers for 2 to 3 cm along the surface of the fourth
rib. Right thoracic cavity was also administered the same procedure. The palmar temperature
was recorded before and after sympathicotomy. The symptom improvement, operative complications,
patients' recovery, and satisfaction were evaluated.
Finding One hundred and ninety-seven patients uneventfully received two 5-mm port bilateral
sympathicotomy, and another 3 patients with extensive pleural adhesions completed
the surgery through enlarging the third intercostal incision to 2 cm without conversion
to open surgery. All operative procedures were completed in 15 to 35 minutes. The
hospital stay was 2 to 4 days. The palmar temperature increased by 2.0 ± 0.5°C, and
hyperhidrosis immediately disappeared in both hands after surgery. The efficacy rate
was 100%. The postoperative complications such as hemorrhage, hemopneumothorax, bradycardia,
or Horner's syndrome had no occurrence. During 6 to 60 months follow-up, mild compensatory
sweating of buttock, back, and thigh occurred in 30 patients (15%) at 2 to 5 days
after surgery and gradually disappeared at postoperative 15 to 30 days or longer time.
All patients were greatly satisfied with the effect with better confidence and quality
of life. Until now, no recurrent palmar hyperhidrosis happened.
Conclusion Needlescopic video-assisted thoracic bilateral T4 sympathicotomy could reach an excellent
and immediate result of treating PPH. It is a safe, convenient, and minimally invasive
method appropriate for wide clinical use.
Keywords
needlescope - primary palmar hyperhidrosis - thoracic sympathicotomy - compensatory
sweating
