Surgical Endoscopy

, Volume 27, Issue 11, pp 4124–4129 | Cite as

Embryonic NOTES thoracic sympathectomy for palmar hyperhidrosis: results of a novel technique and comparison with the conventional VATS procedure

  • Li-Huan Zhu
  • Long Chen
  • Shengsheng Yang
  • Daoming Liu
  • Jixue Zhang
  • Xianjin Cheng
  • Weisheng Chen



To avoid the disadvantages of chronic pain and chest wall paresthesia associated with video-assisted thoracic surgery (VATS) procedures, we developed a novel surgical technique for performing sympathectomy by embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) with a flexible endoscope. In this study, we compared the outcomes of E-NOTES with conventional VATS thoracic sympathectomy on palmar hyperhidrosis.


From January 2010 to April 2011, a total of 66 patients with severe palmar hyperhidrosis were treated with thoracic sympathectomy in our department. Thirty-four transumbilical thoracic sympathectomies were performed via a 5-mm umbilicus incision with ultrathin gastroscope, then compared with 32 conventional needlescopic thoracic sympathectomies. Retrospective statistical analysis of a prospectively collected group of patients was performed.


There was no significant difference with regard to gender, mean age, body mass index, and length of hospital stay between the two groups. The operative time for E-NOTES thoracic sympathectomy was longer than that of VATS thoracic sympathectomy (56.4 ± 10.8 vs. 40.3 ± 6.5 min, p < 0.01). No mortality, diaphragmatic hernia, or Horner syndrome was observed in either group. Postoperative questionnaires were returned by all treated patients with a mean time from operation to follow-up of 1.4 ± 0.3 years. All 66 patients receiving sympathectomy reported successful treatment of their palmar hyperhidrosis. Compensatory hyperhidrosis was noticed in 7 (20.1 %) and 6 (18.8 %) patients in the E-NOTES and VATS groups, respectively (p > 0.05). Postoperative pain and paresthesia were significantly reduced in the E-NOTES group at each time interval, and the aesthetic effect of the incision was superior in the E-NOTES group.


Transumbilical-diaphragmatic thoracic sympathectomy is a safe and efficacious alternative to the conventional approach. This novel procedure can further reduce postoperative pain and chest wall paresthesia as well as afford maximum cosmetic benefits by hiding the surgical incision in the umbilicus.


Embryonic NOTES Palmar hyperhidrosis Thoracic sympathectomy Video-assisted thoracic surgery 



This work was supported by the Key Project of Science and Technology of Fujian Province (Grant 2010I0011). We thank Lily Chen for her revision.


Li-Huan Zhu, Long Chen, Shengsheng Yang, Daoming Liu, Jixue Zhang, Xianjin Cheng, and Weisheng Chen have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Li-Huan Zhu
    • 1
  • Long Chen
    • 1
  • Shengsheng Yang
    • 1
  • Daoming Liu
    • 1
  • Jixue Zhang
    • 1
  • Xianjin Cheng
    • 1
  • Weisheng Chen
    • 1
  1. 1.Department of Cardiothoracic SurgeryFuzhou General Hospital, Fujian Medical UniversityFuzhouChina

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