Endoscopic Thoracic Sympathectomy For Treatment Research Articles

Evaluation of Efficiency of Endoscopic trans-thoracic Sympathectomy for Primary Palmar Hyperhidrosis

Backgound: Primary hyperhidrosis is a condition of unknown etiology characterized by excessive sweating, typically on the palms of the hands, on the soles of the feet, and in the arms. The sweating response is increased by emotional stimuli, temperature, or elevated anxiety level or even spontaneously with no apparent cause. Objictive: The aim of the study is to evaluate the safety, efficacy and early and late complications of bilateral simultaneous endoscopic thoracic sympathectomy in treatment of primary hyperhidrosis. Patients and methods: Thirty patients with palmar hyperhidrosis grade 3 and 4 HDSS amenable for thoracoscopic sympathectomy were primarily managed. The study compromise 12 males and 18 females; the mean age at intervention was 20 (range 12-30) years. All were evaluated preoperatively with detailed history, full physical examination and the required investigations to confirm the diagnosis and to assess the fitness for surgery. Consent was then taken after discussing everything with the parents. Results: Immediately after sympathectomy, all patients were completely free from palm sweating (100%), in relation to the side operated upon. Three patients out of the 27 patients (11%) with associated plantar hyperhidrosis showed improvement of their plantar sweating immediately after endoscopic trans-thoracic sympathectomy (ETS), but the sweating recurred during the follow up period. 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

Bilateral Simultaneous T3/T4 Endoscopic Thoracic Sympathectomy for Treatment of Primary Palmar and Axillary Hyperhidrosis

Objective: This study was conducted to evaluate the safety, and complications of bilateral simultaneous endoscopic thoracic sympathectomy by resection of T3/T4 sympathetic ganglia in treatment of primary palmar and axillary hyperhidrosis. Patients and methods: This prospective study was conducted in General Surgery Unit at Ain Shams University Hospitals in the period from May 2012 to June 2014 on twenty patients. All cases underwent thoracoscopic sympathectomy of T 3, 4 ganglia on the right &left sides at the same setting. In this prospective interventional study, we had 20 patients with severe primary hyperhidrosis with failed medical treatment who underwent bilateral simultaneous Endoscopic Thoracic Sympathectomy (ETS). Results: Of 20 patients there were 13 males (65%) and 7 females (35%). The mean age was 23.9 ±7.8. The mean operating time was 76.2 min. ± 21.4 min. all cases were completed laparoscopically and there were no serious intraoperative complications. The average length of hospital stay was 2.8 days (range: 2-5 days). The average postoperative follow-up period was 14.6 months (range: 6-20 months). Residual pneumothorax occurred in 3 patients (15%), Surgical emphysema on either side was seen in the early postoperative period in 3 patients (15%). The postoperative intercostal pain was observed in all cases (100%). most patients (19/20: 95% of patients) experienced compensatory sweating of varying degrees in other parts of the body, which was bilateral and symmetrical, most commonly at the lower back. Excessive hand dryness was reported in 8 patients (40%), one of them had to use moisturizing hand cream daily.Patients’ Satisfaction with the overall results of the operation were assessed .Only one patient (5%) stated that they were ‘dissatisfied’ and regretted having undergone the operation Conclusion: ETS with T3/T4 ganglia resection is a safe method for patients complaining of severe palmar or combined palmar and axillary hyperhidrosis . From the results of this study, we recommend using smaller ports and performing a more limited approach (T3 or T4) to patients with moderate primary hyperhidrosis symptoms to avoid dissatisfaction due to severe compensatory sweating and palmar overdryness.

Endoscopic Thoracic Sympathectomy : A Comparative Study of Resection and Electro-Diathermy Ablation in the Treatment of Primary Palmar Hyperhidrosis : Taif Experience

Background and aim of the work: Palmar Hyperhidrosis is an excessive and unpleasant sweating and it is under control of the thoracic sympathetic chain. At present, endoscopic upper thoracic Sympathectomy (ETS) offers a safe and durable solution of the condition. The operation includes excision, electro diathermy ablation or application of surgical clips on the thoracic sympathetic ganglia T2 and T3. The present study was done to compare the results achieved by excision and electro-diathermy ablation. Patients and methods: This prospective randomized study was conducted in King Abdul Aziz Specialist Hospital and Al-Hada Armed Forces Hospital, Taif- Saudi Arabia, from January 2007 to August 2010 and included sixteen patients with primary palmar hyperhidrosis. They were randomized into 2 groups; each of 8 patients. In one group; the sympathetic chains with T2 and T3 ganglia were excised on both sides and in the other group, the sympathetic chains and ganglia were ablated bilaterally using electro-coagulation diathermy hook. Results: There were 10 women and six men. The mean age of the ablation group was 23.6±7.6 years and in the resection group it was 22.5±8.4years. The mean operating time for bilateral Sympathectomy in the resection group was 74±18.6minutes; whilst in the thermal ablation group it was 32±7.8 minutes. The mean postoperative hospital stay in the excision group was 48±12 hours and in the ablation group, it was24±6 hours. No deaths occurred and all patients are discharged with dry hands. The mean follow up was 24±18 months. Intraoperative intercostal venous bleeding occurred in 18.75% of sympathectomies in the excision group but not in the ablation group. Neuralgic pain of the chest wall developed in 31.25% of sympathectomies of the excision group and 6.25% of the sympathectomies of the ablation group. Horner's syndrome developed in 6.25% per cent of the sympathectomies in both groups. Compensatory hyperhidrosis of trunk and thighs occurred in 37.5% of both groups. Recurrence developed in 6.25% of ablation group but no recurrence in the excision group. Conclusion: The rate of recurrence after endoscopic thoracic sympathectomy for treatment of primary palmar hyperhydrosis, if ablation is used, may be higher than resection, however; it is practically accepted as the procedure is easier, has shorter operating time with less liability to develop neuralgic pain and intercostal venous bleeding.

Uniportal Endoscopic Thoracic Sympathectomy for Treatment of Palmar and Axillary Hyperhidrosis: Analysis of 2000 Cases

Primary hyperhidrosis of the upper limbs is a common and troublesome condition in Taiwan. Therefore, we present our experience in treating hyperhidrosis via uniportal endoscopic thoracic sympathectomy. Between April 1993 and March 2000, a total of 2000 patients underwent endoscopic thoracic sympathectomy for treatment of palmar or axillary hyperhidrosis. There were 1520 patients with palmar hyperhidrosis and 480 patients with axillary hyperhidrosis. There were 788 male and 1212 female patients, with a mean age of 22.9 years (range, 9-60 yr). All patients were placed in a semi-sitting position, with single-lumen-intubation anesthesia. We performed T2 sympathectomy at the second and third rib beds for patients with palmar hyperhidrosis, using an 8-mm, 0-degree, offset thoracoscope (Karl Storz GmbH & Co., Tuttlingen, Germany), via a 0.8-cm incision below each axilla. Similar procedures were used for T3 and T4 sympathectomies at the third, fourth, and fifth rib beds for patients with axillary hyperhidrosis. Questionnaires were sent to all patients after surgery. Among these 2000 patients, successful bilateral sympathectomies were performed for 1992 patients. The operations were usually completed within 20 minutes (range, 10-30 min). Most patients were discharged within 4 hours after surgery. The surgical complications were minimal, including pneumothorax (10 cases, 0.5%), segmental atelectasis (7 cases, 0.35%), hemothorax (2 cases, 0.1%), and mild wound infections (2 cases, 0.1%). There were no surgery-related deaths. The mean postoperative follow-up period was 51.7 months (range, 6-89 mo). A total of 1720 patients (86%) developed compensatory sweating of the trunk and lower limbs. The recurrence rates for palmar and axillary hyperhidrosis after surgery were 0 and 4.1% in the first year, 0.1 and 8.2% in the second year, 0.5 and 10.4% in the third year, 0.6 and 14.1% in the fourth year, and 1.3 and 16.7% in the fifth year, respectively. Uniportal endoscopic thoracic sympathectomy is a safe, effective method for the treatment of patients with palmar or axillary hyperhidrosis. For surgery, both a semi-sitting position and single-lumen-intubation anesthesia are recommended.

Endoscopic Thoracic Sympathectomy for Treatment of Essential Hyperhidrosis Syndrome: Experience With 650 Patients

Patients with essential hyperhidrosis (EH) syndrome may experience subjective suffering and social/occupational challenges. We examined the safety and efficacy of minimally invasive endoscopic surgery for treating EH. Single bilateral incisions, followed by endoscopic thoracic sympathectomy (ETS)-mediated bilateral ablation of the T2 sympathetic ganglia, were used to treat 650 patients with a primary diagnosis of palmar (90%) or facial hyperhidrosis (10%). Palmar and facial hyperhidrosis were resolved in 584 of 585 (>99%) and 62 of 65 (95%) patients, respectively. Surgery required less than 1 hour, and no patient experienced a life-threatening adverse event. Compensatory sweating was observed in 83% of patients and was considered mild or moderate in approximately 67% of those patients. Innovations in ETS have resulted in minimally invasive, highly efficient, safe treatment of EH. Surgery is minimally intrusive to patients, who were usually discharged within 2 hours after surgery and able to resume normal activities within 1 week.