World Journal of Surgery

, Volume 39, Issue 9, pp 2269–2273 | Cite as

Single-Port Endoscopic Thoracic Sympathectomy with Monitored Anesthesia Care: A More Promising Procedure for Palmar Hyperhidrosis

  • Ye Ning
  • Yanan Wang
  • Xiandong Tao
  • Hua Tang
  • Jingjing Jiang
  • Yonghua Li
  • Guangyuan Sun
  • Lei XueEmail author
  • Xuewei ZhaoEmail author
Original Scientific Report with Video



Thoracic sympathectomy is considered the most effective method to treat palmar hyperhidrosis. We presented a novel procedure for thoracic sympathectomy treating palmar hyperhidrosis which could be performed under monitored anesthesia care. The aim of this study was to evaluate the continuing efficacy and safety of this innovative surgery.


From May 2011 to May 2014, we performed the single-port endoscopic thoracic sympathectomy (ETS) with a flexible thoracoscopy in 32 patients under monitored anesthesia care. All patients were followed up until today.


Under monitored anesthesia, all patients were awake during the procedure. A proper sedation and local anesthesia make it possible for patients to communicate with surgeons. The symptoms disappeared immediately when the sympathectomy was done. No surgical complications occurred during the procedure. All patients were discharged from the hospital on the first morning of postoperative day. Compared with the traditional approach, the advantages of less operative costs, fewer hospital days, and better recovery were suggested.


Single-port ETS with flexible thoracoscopy under monitored anesthesia is a promising procedure for palmar hyperhidrosis.


Dexmedetomidine Sufentanil Tropisetron Sympathetic Chain Palmar Hyperhidrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This clinical study was supported by grants from National Natural Science Foundation of China (Grant Number: 81101833) and Shanghai Outstanding Young Physician Foundation (Grant Number 20120149).

Supplementary material

268_2015_3104_MOESM1_ESM.flv (4.6 mb)
Supplementary material 1 (FLV 4667 kb)
268_2015_3104_MOESM2_ESM.flv (5.1 mb)
Supplementary material 2 (FLV 5172 kb)


  1. 1.
    Shargall Y, Spratt E, Zeldin RA (2008) Hyperhidrosis: what is it and why does it occur? Thorac Surg Clin 18:125–132PubMedCrossRefGoogle Scholar
  2. 2.
    Allen GM (2001) Thoracoscopic sympathectomy for palmar hyperhidrosis. AORN J 74:178–182PubMedGoogle Scholar
  3. 3.
    Tu YR, Li X, Lin M, Lai FC, Li YP, Chen JF et al (2007) Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People’s Republic of China. Eur J Cardiothorac Surg 31:737–739PubMedCrossRefGoogle Scholar
  4. 4.
    Kux MT (1978) Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 113:264–266PubMedCrossRefGoogle Scholar
  5. 5.
    Assalia A, Kopelman D, Markovits R, Hashmonai M (2003) Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis: a prospective, randomized trial. Surg Endosc 17:921–922PubMedCrossRefGoogle Scholar
  6. 6.
    De Campos JRM, Kauffman P, Werebe ED, Andrade LO, Kusniek S, Wolosker N et al (2003) Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg 76:886–891PubMedCrossRefGoogle Scholar
  7. 7.
    Ng CS, Yeung EC, Wong RH, Kwok MW (2012) Single-port sympathectomy for palmar hyperhidrosis with Vasoview Hemopro 2 endoscopic vein harvesting device. J Thorac Cardiovasc Surg 44:1256–1257CrossRefGoogle Scholar
  8. 8.
    Miller DL, Bryant AS, Force SD, Miller JI Jr (2009) Effect of sympathectomy level on the incidence of compensatory hyperhidrosis after sympathectomy for palmar hyperhidrosis. J Thorac Cardiovasc Surg 138:581–585PubMedCrossRefGoogle Scholar
  9. 9.
    Wait SD, Killory BD, Lekovic GP, Dickman CA (2010) Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents. J Neurosurg Pediatr 6:183–187PubMedCrossRefGoogle Scholar
  10. 10.
    Inan K, Goksel OS, Uçak A, Temizkan V, Karaca K, Ugur M et al (2008) Thoracic endoscopic surgery for hyperhidrosis: comparison of different techniques. Thorac Cardiovasc Surg 56:210–213PubMedCrossRefGoogle Scholar
  11. 11.
    Reisfeld R, Nguyen R, Pnini A (2002) Endoscopic thoracic sympathectomy for hyperhidrosis: experience with both cauterization and clamping methods. Surg Laparosc Endosc Percutan Tech 12:255–267PubMedCrossRefGoogle Scholar
  12. 12.
    Agostoni M, Fanti L, Gemma M, Pasculli N, Beretta L, Testoni PA (2011) Adverse events during monitored anesthesia care for GI endoscopy: an 8-year experience. Gastrointest Endosc 74:266–275PubMedCrossRefGoogle Scholar
  13. 13.
    Cote GA, Hovis RM, Ansstas MA et al (2010) Incidence of sedation-related complications with propofol use during advanced endoscopic procedures. Clin Gastroenterol Hepatol 8:137–142PubMedCrossRefGoogle Scholar
  14. 14.
    Berzin TM, Sanaka S, Barnett SR et al (2011) A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologist-administered sedation. Gastrointest Endosc 73:710–717PubMedCrossRefGoogle Scholar
  15. 15.
    Amornyotin S, Kachintorn U, Kongphlay S (2012) Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organization Endoscopy Training Center. World J Gastrointest Endosc 4:189–193PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Alzahrani M, Martin F, Lescanne E (2014) Combined local anesthesia and monitored anesthesia care for cochlear implantation. Eur Ann Otorhinolaryngol Head Neck Dis 131(4):261–262PubMedCrossRefGoogle Scholar
  17. 17.
    Busick T, Kussman M, Scheidt T et al (2008) Preliminary experience with dexmede to midine for monitored anesthesia care during ENT surgical procedures. Am J Ther 15(6):520–527PubMedCrossRefGoogle Scholar
  18. 18.
    Berkenstadt H, Perel A, Hadani M, Unofrievich I, Ram Z (2001) Monitored anesthesia care using remifentanil and propofol for awake craniotomy. J Neurosurg Anesthesiol 13(3):246–249PubMedCrossRefGoogle Scholar
  19. 19.
    Tschopp JM, Purek L, Frey JG, Schnyder JM, Diaper J, Cartier V et al (2011) Titrated sedation with propofol for medical thoracoscopy: a feasibility and safety study. Respiration 82:451–457PubMedCrossRefGoogle Scholar
  20. 20.
    Fritscher-Ravens A, Patel K, Ghanbari A et al (2007) Natural orifice transluminal endoscopic surgery (NOTES) in the mediastinum: long-term survival animal experiments in transesophageal access, including minor surgical procedures. Endoscopy 39:870–875PubMedCrossRefGoogle Scholar
  21. 21.
    Kobayashi T, Lemoine S, Sugawara A et al (2005) A flexible endoscopic surgical system: first report on a conceptual design of the system validated by experiments. Jpn J Clin Oncol 35:667–671PubMedCrossRefGoogle Scholar
  22. 22.
    Canes D, Lehman AC, Farritor SM et al (2009) The future of NOTES instrumentation: flexible robotics and in vivo minirobots. J Endourol 23:787–792PubMedCrossRefGoogle Scholar
  23. 23.
    Zhu LH, Du Q, Chen L, Yang S, Tu Y, Chen S, Chen W (2014) One-year follow-up period after transumbilical thoracic sympathectomy for hyperhidrosis: outcomes and consequences. J Thorac Cardiovasc Surg 147(1):25–28PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Ye Ning
    • 1
  • Yanan Wang
    • 2
  • Xiandong Tao
    • 1
  • Hua Tang
    • 1
  • Jingjing Jiang
    • 2
  • Yonghua Li
    • 2
  • Guangyuan Sun
    • 1
  • Lei Xue
    • 1
    Email author
  • Xuewei Zhao
    • 1
    Email author
  1. 1.Department of Thoracic Surgery, Changzheng HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Department of Anesthesia, Changzheng HospitalSecond Military Medical UniversityShanghaiChina

Personalised recommendations