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Thorac Cardiovasc Surg 2022; 70(02): 152-158
DOI: 10.1055/s-0041-1725205
Original Thoracic

CT-guided Thoracic Sympathicolysis versus VATS Sympathectomy in the Therapeutic Concept for Severe Primary Palmar Hyperhidrosis

Julian Ramin Andresen
1   Medical School, Sigmund Freud University, Vienna, Austria
,
Fabian Scheer
2   Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
,
Eric Schlöricke
3   Department of Visceral, Thoracic and Vascular Surgery, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
,
Aria Sallakhi
1   Medical School, Sigmund Freud University, Vienna, Austria
,
Marc Olaf Liedke
3   Department of Visceral, Thoracic and Vascular Surgery, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
,
Reimer Andresen
2   Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide, Germany
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Abstract

Background The objective was to compare computed tomography (CT)-guided thoracic sympathicolysis (CTSy) and video-assisted thoracoscopic sympathectomy (VATS) with regard to their feasibility, the occurrence of minor and major complications, and the clinical outcome.

Materials and Methods In this study, 88 patients treated by CTSy and 86 patients treated by VATS were retrospectively included. CTSy was performed after establishing the entry plane below the level of the intervertebral space T2/3 via a dorsolateral approach using a 22-G coaxial needle. On average of 5 mL of a sympathicolytic mixture was instilled. VATS was performed under intubation anesthesia. After insertion of the instruments via a minithoracotomy, the parietal pleura was dissected and the sympathetic trunk severed below T2. The interventions were performed unilaterally, the contralateral side being treated after approximately 6 weeks. All patients evaluated their sense of discomfort before treatment as well as 2 days, 6, and 12 months after, on the basis of a Dermatology Quality of Life Index and additionally the side effects that occurred.

Results Both treatments led to a marked reduction of symptoms, whereby mild recurrent sweating occurred over the further course, significantly higher in the CTSy patient group. Short-term miosis and ptosis were rarely found in both groups. As the most common side effect, transient compensatory sweating was reported by 16/88 patients after CTSy and 10/86 patients after VATS. Pneumothoraces developed postoperatively in 7/86 cases. Temporary pain after thoracotomy was experienced by 12/86 patients.

Conclusion For patients with palmar hyperhidrosis, CTSy and VATS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit.

Keywords

hyperhidrosis - thoracoscopic/VATS - quality of life - computed tomography


Publication History

Received: 21 November 2020

Accepted: 13 January 2021

Article published online:
15 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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