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Endoscopic thoracic sympathectomy for primary palmar hyperidrosis

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Abstract

Background

Primary hyperhidrosis is a disorder that is characterized by excessive sweating in disproportion to that required for thermoregulation. In most cases, this is aggravated by emotional factors and by heat. Hyperhidrosis can be seen in the palms of the hands, armpits, soles of the feet and face. The principal characteristic of this disease is the intense discomfort of patients, which affects their social and professional life. Treatment modalities include topical application of aluminum chloride, iontophoresis, anticholinergics, botulinum toxin injection, liposuction, excision of sweat glands, and thoracic sympathectomy.

Methods

Between January 1998 and August 2007, a prospective study of endoscopic thoracic sympathectomies for palmar hyperhidrosis was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample comprised of 322 patients with a mean age of 24 years. At Apollo Hospital, New Delhi, India, bilateral video-assisted thoracoscopic T3 level sympathectomies were performed in all cases.

Results

All patients had immediate cessation of palmar hyperhidrosis. The mean postoperative stay was 1.1 days. A questionnaire was completed based on their response to a telephone conversation or e-mail. A paired t test and Wilcoxon test was performed on these data and it showed significant improvement in quality of life. Compensatory sweating was found to be the most troublesome side effect for all patients. It was seen in 63% of the patients. This is similar to other reports of compensatory sweating; however, the figure decreases to 29% if we disregard the percentage of patients who reported only mild compensatory sweating.

Conclusion

In view of the low morbidity and zero mortality rate of this surgical technique, we recommend it as a method of treatment for palmar hyperhidrosis. Thoracic sympathectomy eliminates palmar hyperhidrosis with minimal recurrence (1% in our series) and produces a high rate of patient satisfaction.

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References

  1. Stolman LP (1998) Treatment of hyperhidrosis. Dermatol Clin 16(4):863–869

    Article  CAS  PubMed  Google Scholar 

  2. Moschella SL, Hurley HJ (1992) Dermatology, vol 25, 3rd edn. Saunders, Philadelphia, pp 1514–1524

  3. Thomas MD (1996) Thoracoscopic sympathectomy. Chest Surg Clin N Am 6(1):69–83

    Google Scholar 

  4. Sacher D, Jedeikin R, Olsfanger D, Bendahan J, Sivak G, Freund U (1994) Endoscopic transthoracic sympathectomy in the treatment of primary hyperhidrosis. Arch Surg 129:241–244

    Google Scholar 

  5. Ro KM, Cantor RM, Lange KL, Ahn SS (2002) Palmar hyperhidrosis: evidence of genetic transmission. J Vasc Surg 35(2):382–386

    Article  PubMed  Google Scholar 

  6. Scout W, Thomas M (2000) Thoracic thoracoscopic sympathectomy. Gen Thorac Surg 43:579–582

    Google Scholar 

  7. Amir M, Arish A, Weinstein Y, Pfeffer M, Levy Y (2000) Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Isr J Psychiatry Relat Sci 37(1):25–31

    CAS  PubMed  Google Scholar 

  8. Drott C, Claes G, Gothberg F, Paszkowski P (1994) Cardiac effects of endoscopic electrocautery of the upper thoracic sympathetic chain. Eur J Surg Suppl 572:65–72

    PubMed  Google Scholar 

  9. White JW Jr (1986) Treatment of primary hyperhidrosis. Mayo Clin Proc 61:951–956

    PubMed  Google Scholar 

  10. Holzle E, Alberti N (1987) Long-term efficacy and side effects of tap water iontophoresis of palmoplantar hyperhidrosis—the usefulness of home therapy. Dermatologica 175(3):126–135

    Article  CAS  PubMed  Google Scholar 

  11. Hexsel AM, Hexsel CL (2003) Toxina Botulínica no Tratamento das Hiperidroses. In: Almeida ART, Hexsel DM (eds) Hiperidrose e Toxina Botulínica. Know-How, São Paulo, pp 145–227

  12. Chung IH, Oh CS, Koh KS, Kim HJ, Paik HC, Lee DY (2002) Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy. J Thorac Cardiovasc Surg 123(3):498–501

    Article  PubMed  Google Scholar 

  13. Kux E (1951) The endoscopic approach to the vegetative nervous system and its therapeutic possibilities; especially in duodenal ulcer, angina pectoris, hypertension and diabetes. Dis Chest 20(2):139–147

    CAS  PubMed  Google Scholar 

  14. Dumont P, Hamm A, Skrobala D, Robin P, Toumieux B (1997) Bilateral thoracoscopy for sympathectomy in the treatment of hyperhidrosis. Eur J Surg 11:774–775

    CAS  Google Scholar 

  15. Horgan K, O’Flanagan S, Duignan PJ, Hederman W (1984) Palmar and axillary hyperhidrosis treated with sympathectomy by transthoracic endoscopic electrocoagulation. Br J Surg 71:1002

    Google Scholar 

  16. Johnson JP, Ahn SS (1997) Thoracoscopic sympathectomy. In: Loftus CM, Batjer HH (eds) Techniques in neurosurgery, vol 3. Lippincott-Raven, Philadelphia, pp 308–314

    Google Scholar 

  17. Lardinois D, Ris HB (2002) Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach. Eur J Cardiothorac Surg 21:67–70

    Article  PubMed  Google Scholar 

  18. Reardon PR, Preciado A, Scarborough T, Matthews B, Martik JL (1999) Outpatient endoscopic thoracic sympathectomy using 2-mm instruments. Surg Endosc 13:1139–1142

    Article  CAS  PubMed  Google Scholar 

  19. Vanaclocha V, Saiz-Sapena N, Panta F (2000) Uniportal endoscopic superior thoracic sympathectomy. Neurosurgery 46:924–928

    Article  CAS  PubMed  Google Scholar 

  20. Wahlig JB Jr, Welch WC, Weigel TL, Luketich JD (2000) Microinvasive transaxillary thoracoscopic sympathectomy: technical note. Neurosurgery 46:1254–1258

    Article  PubMed  Google Scholar 

  21. Weights CS, Raitt D, Barrie WW (2000) Thoracoscopic sympathectomy: a one-port technique. Aust N Z J Surg 70:800

    Article  Google Scholar 

  22. Drott C, Gothberg G, Claes G (1993) Endoscopic procedures of the upper-thoracic sympathetic chain: a review. Arch Surg 128(2):237–241

    CAS  PubMed  Google Scholar 

  23. Gossot D, Toledo L, Fritsch S, Célérier M (1997) Thoracoscopic sympathectomy for upper limb hyperhidrosis: looking for the right operation. Ann Thorac Surg 64(4):975–978

    Article  CAS  PubMed  Google Scholar 

  24. Hsu CP, Shia SE, Hsia JY, Chuang CY, Chen CY (2001) Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy. Arch Surg 136(10):1117–1118

    Google Scholar 

  25. Kux M (1978) Thoracic Endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 113(3):264–266

    CAS  PubMed  Google Scholar 

  26. 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(4):255–257

    Article  PubMed  Google Scholar 

  27. Riet MV, Smet AA, Kuiken H, Kazemier G, Bonjer HJ (2001) Prevention of compensatory hyperhidrosis after thoracoscopic sympathectomy for hyperhidrosis. Surg Endosc 15(10):1159–1162

    Article  CAS  PubMed  Google Scholar 

  28. Zacher J, Imhof M, Huber ER, Plas EG, Herbst F, Jaskesz R, Függer R (1999) Video assistance reduces complication rate of thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg 68(4):1177–1181

    Article  Google Scholar 

  29. Neumayer CH, Bischof G, Fugger R, Imhof M, Jakesz R, Plas EG, Herbst FR, Zacher J (2001) Efficacy and safety of thoracoscopic sympathectomy for hyperhidrosis of the upper limb: results of 734 sympathectomies. Ann Chir Gynaecol 90:195–199

    CAS  PubMed  Google Scholar 

  30. Hashmonai M, Assalia A, Kopelman D (2001) Thoracoscopic sympathectomy for palmar hyperhidrosis. Ablate or resect? Surg Endosc 15:435–441

    Article  CAS  PubMed  Google Scholar 

  31. Lin TS (2001) Endoscopic clipping in video-assisted thoracoscopic sympathetic blockade for axillary hyperhidrosis. An analysis of 26 cases. Surg Endosc 15:126–128

    Article  CAS  PubMed  Google Scholar 

  32. Lin TS (2001) Video-assisted thoracoscopic “resympathecotomy” for palmar hyperhidrosis: analysis of 42 cases. Ann Thorac Surg 72:895–898

    Article  CAS  PubMed  Google Scholar 

  33. Riet M, Smet AA, Kuiken H, Kazemier G, Bonjer HJ (2001) Prevention of compensatory hyperhidrosis after thoracoscopic sympathectomy for hyperhidrosis. Surg Endosc 15:1159–1162

    Article  CAS  PubMed  Google Scholar 

  34. Prasad A (2008) Endoscopic thoracic sympathectomy for hyperhidrosis: technique and results. J Min Access Surg 4:23

    Article  Google Scholar 

  35. Naruse H, Moriyasu K, Yokokawa H, Ohkura T, Kamio Y, Suzuki K, Suzuki S, Kitami A, Tanaka H, Suzuki T (2001) Endoscopic transthoracic sympathectomy (ETS) with a fine 2-mm thoracoscope in palmar hyperhidrosis. Kyobu Geka 54:555–559

    CAS  PubMed  Google Scholar 

  36. Li X, Tu Y-R, Lin M, Lai F-C, Chen J-F, Dai Z-J (2008) Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg 85:1747–1751

    Article  PubMed  Google Scholar 

  37. Yazbek G, Wolosker N, de Campos JR, Kauffman P, Ishy A, Puech-Leão P (2005) Palmar hyperhidrosis—which is the best level of denervation using video-assisted thoracoscopic sympathectomy: T2 or T3 ganglion? J Vasc Surg 42(2):281–285

    Article  PubMed  Google Scholar 

  38. Li X, Tu YR, Lin M, Lai FC, Chen JF, Miao HW (2009) Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow. Ann Thorac Surg 87:427–431

    Article  PubMed  Google Scholar 

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Acknowledgments

We are grateful for the support given to us by the Department of Anesthesiology, Apollo Hospital, New Delhi without which the study would not be possible. Also of note is the role played by treated patients in counseling new patients regarding the expectations, results, and side effects of the procedure.

Disclosures

Drs. Arun Prasad, Mudasir Ali, and Sunil Kaul have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Minimal Access Surgery, Apollo Hospital, Sarita Vihar, New Delhi, 110044, India

    Arun Prasad, Mudasir Ali & Sunil Kaul

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  1. Arun Prasad
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  2. Mudasir Ali
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  3. Sunil Kaul
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Correspondence to Arun Prasad.

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Prasad, A., Ali, M. & Kaul, S. Endoscopic thoracic sympathectomy for primary palmar hyperidrosis. Surg Endosc 24, 1952–1957 (2010). https://doi.org/10.1007/s00464-010-0885-5

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