Single-Port Thoracoscopic Sympathicotomy Using a Double-Lumen Electrocautery Tube and Cautery Hook for Primary Palmar Hyperhidrosis: A Randomized Controlled Trial

Abstract

Objective The objective of this study is to assess the use of a novel, double-lumen electrocautery tube (DLET) device for ablating the sympathetic nerve chain in patients with primary palmar hyperhidrosis (PPH).

Methods Forty-six patients with severe PPH were recruited into the study between November 2010 and February 2012. All patients underwent single port, bilateral video-assisted thoracoscopic sympathicotomy. Twenty-four patients were randomized to receive sympathicotomy using a conventional 5-mm electrocautery hook (hook group) and 22 patients were randomized to the DLET group.

Results The mean postoperative follow-up period was 8.1 months (range: 1 to 15 months). After surgery the hands of all patients became dry and warm. Mean incision size was 10.6 ± 1.0 in the hook group and 6.5 ± 0.5 mm in the DLET group (p = 0.001). The mean pain score was 1.4 ± 0.6 with hook surgery and 0.9 ± 0.6 with the DLET device (p = 0.016). The mean operative time was longer in the hook group (36.8 ± 3.4 min) than in the DLET group (30.5 ± 3.9 min; p = 0.001). There were no significant differences between the two procedures in terms of hospital stay and compensatory sweating, or patient satisfaction. Pneumothorax occurred in two (8.3%) patients in the hook group and in one (4.5%) patient in the DLET group. None of the patients required chest drainage and none developed Horner syndrome.

Conclusions Single-port video-assisted thoracoscopic sympathicotomy using hook or DLET procedures is effective, safe, and minimally invasive method for palmar hyperhidrosis. The DLET device allows a shorter operation time, smaller incision, better cosmetic results, less pain, and better clarity of video, making it suitable for single-port thoracoscopic sympathicotomy.

Keywords

hyperhidrosis - video-assisted thoracoscopic sympathectomy - sympathicotomy

• References

• 1 Moreno Balsalobre R, Moreno Mata N, Ramos Izquierdo R , et al; SEPAR. Guidelines on surgery of the thoracic sympathetic nervous system. Arch Bronconeumol 2011; 47 (2) 94-102
• 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 García-Franco CE, España A. Utilidad de la simpatectomía videotoracoscópica bilateral en el tratamiento de la hiperhidrosis esencial. Actas Dermosifiliogr 2008; 99 (7) 523-527
• 4 Vanderhelst E, De Keukeleire T, Verbanck S, Vincken W, Noppen M. Quality of life and patient satisfaction after video-assisted thoracic sympathicolysis for essential hyperhidrosis: a follow-up of 138 patients. J Laparoendosc Adv Surg Tech A 2011; 21 (10) 905-909
• 5 Baumgartner FJ, Reyes M, Sarkisyan GG, Iglesias A, Reyes E. Thoracoscopic sympathicotomy for disabling palmar hyperhidrosis: a prospective randomized comparison between two levels. Ann Thorac Surg 2011; 92 (6) 2015-2019
• 6 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 (3) 398-402
• 7 Lai YT, Yang LH, Chio CC, Chen HH. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery 1997; 41 (1) 110-113 , discussion 113–115
• 8 Nüesch B, Ammann J, Hess P, Lüdin A. Die thorakale Sympathektomie bei der Hyperhidrosis palmarum: Vergleich/thorakoskopisches Vorgehen. Swiss Surg 1996; (3) 112-115
• 9 Hashmonai M, Kopelman D, Assalia A. The treatment of primary palmar hyperhidrosis: a review. Surg Today 2000; 30 (3) 211-218
• 10 Baumgartner FJ. Surgical approaches and techniques in the management of severe hyperhidrosis. Thorac Surg Clin 2008; 18 (2) 167-181
• 11 Chen YB, Ye W, Yang WT , et al. Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Chin Med J (Engl) 2009; 122 (13) 1525-1528
• 12 Atkinson JL, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ. Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period. Mayo Clin Proc 2011; 86 (8) 721-729
• 13 Murphy MO, Ghosh J, Khwaja N , et al. Upper dorsal endoscopic thoracic sympathectomy: a comparison of one- and two-port ablation techniques. Eur J Cardiothorac Surg 2006; 30 (2) 223-227
• 14 Lardinois D, Ris HB. Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach. Eur J Cardiothorac Surg 2002; 21 (1) 67-70
• 15 Bouma W, Klinkenberg TJ, Mariani MA. Bilateral single-port thoracoscopic sympathectomy with the VasoView device in the treatment of palmar and axillary hyperhidrosis. Interact Cardiovasc Thorac Surg 2011; 12 (2) 106-109