Thoracic Endoscopic Surgery for Hyperhidrosis: Comparison of Different Techniques

Abstract

Background: Hyperhidrosis is pathological perspiration in palmar, plantar or axillary surfaces. Video-assisted thoracic surgery (VATS) is currently the most commonly used therapy for hyperhidrosis. Blockage of sympathetic ganglia is achieved by segmental resection, transection and/or cauterization, and clipping of the chain. We aimed to compare the efficacy of these methods with respect to patient satisfaction, recurrence of symptoms and complications. Methods: Eighty male patients with a mean age of 22.02 ± 2.61 years undergoing bilateral thoracoscopic sympathectomy or sympathetic blockage to treat primary hyperhidrosis were included in this randomized study. The patients were divided into four groups depending on the technique used for sympathetic blockage; techniques included resection (n = 20), transection (n = 20), ablation (n = 20), and clipping (n = 20). Results: The primary success rate for isolated palmar hyperhidrosis was 96.3 %; for palmar and axillary hydrosis it was 95.7 % and for palmar and face/scalp hyperhidrosis it was 66.7 %. No recurrence was observed. The overall success rate of the operation was 95 % and the differences between the four groups were not statistically significant. In the clipping group, the duration of the surgical procedure was significantly shorter than in the other groups. Complication rates were similar among the groups. The postoperative chest roentgenogram revealed pneumothorax in nine patients, but none of them required intervention. Conclusion: Thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted.

Key words

thoracic surgery - cardiovascular surgery - heart disease

References

• 1 Adar R, Kurchin A, Xzweig A, Moses M. Palmar hyperhidrosis and its surgical connections.  Ann Surg. 1977;  186 34-41
• 2 Dewey T M, Herbert M A, Hill S L, Prince S L, Mack M J. One-year follow-up after thoracoscopic sympathectomy for hyperhidrosis: outcomes and consequence.  Ann Thorac Surg. 2006;  81 1227-1233
• 3 Elia S, Guggino G, Mineo D, Vanni G, Gatti A, Mineo T C. Awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis: a safe outpatient procedure.  Eur J Cardiothorac Surg. 2005;  28 312-317
• 4 Leseche G, Castier Y, Thabut G. et al . Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating.  J Vasc Surg. 2003;  37 124-128
• 5 Molho M, Shemesh E, Gordon D, Adar R. Pulmonary functional abnormalities after upper dorsal sympathectomy: a comparison between the supraclavicular and the transaxillary approaches.  Chest. 1980;  77 651-655
• 6 Roos D B. Transaxillary extrapleural thoracic sympathectomy. Bergan JJ, Yao JST Operative Techniques in Vascular Surgery. New York; Grune and Stratton 1995: 115
• 7 Krasna M J, Jiao X. Thoracoscopic neurologic surgery and thoracoscopic access for spinal surgery. Demmy TL Video Assisted Thoracic Surgery (VATS). Georgetown; Landes Bioscience 2001: pp.164-174
• 8 Hashmonai M, Kopelnam D, Klein O, Schein M. Upper thoracic sympathectomy for primary palmar hyperhidrosis: long-term follow-up.  Br J Surg. 1992;  79 268-271
• 9 Dumont P, Denoyer A, Robin P. Long-term results of thoracoscopic sympathectomy for hyperhidrosis.  Ann Thorac Surg. 2004;  78 1801-1807
• 10 Doolabh N, Horswell S, Williams M. et al . Thoracoscopic sympathectomy for hyperhidrosis: indications and results.  Ann Thorac Surg. 2004;  77 410-414
• 11 Hashmonai M, Kopelman D. History of sympathetic surgery.  Clin Auton Res. 2003;  13 6-9
• 12 White J C, Smithwick R H, Allen A W. et al . A new muscle splitting incision for resection of the upper thoracic sympathetic ganglia.  Surg Gynecol Obstet. 1933;  56 651-657
• 13 Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis.  J Am Acad Dermatol. 1995;  33 78-81
• 14 Byrne J, Walsh T N, Hederman W P. Endoscopic transthoracic electrocautery of the sympathetic chain for palmar and axillary hyperhidrosis.  Br J Surg. 1990;  77 1046-1049
• 15 Lin C C, Mo L R, Lee S M, Ng S M, Hwang M H. T2-sympathectomy block by clipping: a better and reversible operation for treatment of hyperhidrosis palmaris. Experience in 326 cases.  Eur J Surg. 1998;  580 13-16
• 16 Baumgartner F J, Toh Y. Severe hyperhidrosis: clinical features and current thoracoscopic surgical management.  Ann Thorac Surg. 2003;  76 1878-1883
• 17 Alric P, Branchereau P, Berthet J P, Leger P, Mary H, Mary-Ane C. Video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: results in 102 cases.  Ann Vasc Surg. 2002;  16 708-713
• 18 Gossot D, Toledo L, Fritsch S, Celerier M. Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation.  Ann Thorac Surg. 1997;  64 975-978