Palmar Hyperhidrosis Patients Research Articles

Long term outcomes and risk factors of compensatory hyperhidrosis after thoracoscopic sympathectomy in primary palmar hyperhidrosis patients: a retrospective single-center study

ObjectiveThis study aims to evaluate the long-term outcomes of compensatory hyperhidrosis (CH) after thoracoscopic sympathectomy and explore the risk factors affecting postoperative CH in primary palmar hyperhidrosis(PPH) patients.MethodA retrospective analysis was conducted on patients who underwent thoracoscopic sympathectomy in the thoracic surgery department of our hospital from January 2015 to May 2022. Long-term follow-up surveys was conducted to collect data on post-operative satisfaction, PPH recurrence, and CH occurrence. Postoperative CH outcomes were assessed using the HDSS and satisfaction scores scale. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative CH.ResultA total of 152 patients was included in the final study, with 113 cases in the CH group and 39 cases in the nCH group. The incidence of postoperative CH was 74.3% (113/152), within which 33.6% (38/113) were severe CH. The median follow-up time was 3.1 years(2.5-5.5y) and the median interval of CH onset after surgery was 30 days (14-90d). Univariate analysis showed that body mass index(BMI), surgical time, and transected nerve level are correlated with CH, with statistically significant differences. Multivariate logistic regression analysis indicated a higher BMI (OR = 0.864, 95% CI 0.755–0.989, P < 0.05) is the independent risk factor for the occurrence of CH. There was no statistically significant difference in HDSS scores among CH patients at 1 month, 1 year, and 3 years after surgery.ConclusionA higher BMI is the independent risk factor for postoperative CH after thoracoscopic sympathectomy. The incidence and severity of postoperative CH kept stable during a long term follow up.

The Rate of Compensatory Sweating and Clinical Outcomes of Selective Thoracoscopic Sympathectomy (Ramicotomy) in Patients with Primary Palmar Hyperhidrosis

Background: Primary hyperhidrosis is a sympathetic disorder characterized by prolonged and uncontrollable sweating. It is associated with emotional stress or psychological causes that preferably affects the axillae, palms, feet, and face. Video-assisted thoracoscopic sympathetic surgery is currently a globally recognized treatment for primary palmar hyperhidrosis (PH). However, compensatory sweating (CS) is the most prominent long-term adverse effect of thoracoscopic sympathectomy. Objectives: Here, we aim to perform selective sympathetic ramicotomy for primary palmar hyperhidrosis patients and evaluate the clinical outcomes of satisfaction, as well as the effect on the frequency, location, and severity of compensatory sweating. Methods: In this single-arm trial study, 24 sympathectomies were carried out on 12 patients with primary palmar hyperhidrosis who were candidates for bilateral thoracoscopic selective sympathectomy (ramicotomy) at Imam Khomeini Hospital. The patients’ demographic information was interviewed and followed up using telephone questionnaires in the health center one week after surgery. Then, the rates of compensatory sweating, satisfaction, and failure or recurrence were retrospectively analyzed. Results: No significant differences were observed between age, gender, weight, BMI, and compensatory sweating rates. Notwithstanding, there was a statistically significant difference in the severity of compensatory sweating with patients’ height (P = 0.016). Compensatory sweating occurred in 66.7% of the patients; 50% of the patients were mild, 16.7% of the patients were moderate, and there was no intolerable compensatory sweating or recurrence. The most incidence of compensatory sweating was on the lower back. The rate of satisfaction was 94.5 ± 7.8%. Conclusions: Selective thoracoscopic sympathectomy (ramicotomy) is an effective surgical procedure with a very high level of precision and satisfaction. This technique hence should be considered the method of choice for the treatment of primary palmar hyperhidrosis.

The Best Thoracic Sympathectomy Level for Palmar Hyperhidrosis: a Meta-analysis

Palmar hyperhidrosis (PH) refers to excessive sweating that affects patients’ quality of life, resulting in social and work impairment and emotional distress. Thoracic sympathectomy (TS) is the best surgery option for palmar hyperhidrosis; however, there was no agreement for the choice of optimal surgery level. The aim of this study was to systematically compare postoperative effect between thoracoscopic T3 and T4 thoracic sympathectomy for palmar hyperhidrosis and to help clinical decision. Studies comparing T3 versus T4 thoracic sympathectomy for palmar hyperhidrosis were searched overall the database and a meta-analysis was performed. After searching, 12 articles were selected and a total of 1192 patients with palmar hyperhidrosis, of whom 567 patients underwent T3 thoracic sympathectomy and 625 patients underwent T4 thoracic sympathectomy. After analysis, we found that T4 thoracic sympathectomy had fewer side effects than T3 thoracic sympathectomy, so T4 may be the optimal level for thoracic sympathectomy in palmar hyperhidrosis patients.

Quality of life after thoracic sympathectomy for palmar hyperhidrosis: a meta-analysis.

Palmar hyperhidrosis affects 0.6-10% of the general population, having an important impact in patients' quality of life. The definitive treatment for palmar hyperhidrosis is thoracic sympathectomy. The purpose of this study is to evaluate the quality of life after thoracic sympathectomy for palmar hyperhidrosis. The interest studies were searched in six comprehensive databases. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane system evaluation manual. Meta-analysis was performed with RevMan version 5.3. The outcome of interest was quality of life. The subgroup analysis and sensitive analysis were performed. Nine trials, including 895 patients, with accessible data comparing preoperative quality of life score with postoperative quality-of-life score were used for data analysis. Compared with preoperative quality-of-life score, application of thoracic sympathectomy improved the postoperative quality of life of palmar hyperhidrosis patients (MD = 57.81, 95% CI 53.33-62.30). Subgroup analysis of the different thoracic sympathectomy segment showed that there was no significant difference in the results obtained when operated with single segment or multiple segments (single segment: MD = 61.16, 95% CI [56.10, 66.22], multiple segments: MD = 52.14, 95% CI [48.39, 55.88]). The meta-analysis provided evidence of the improved quality of life after thoracic sympathectomy for palmar hyperhidrosis.

The impact of endoscopic thoracic sympathectomy on sudomotor function in patients with palmar hyperhidrosis

PurposeWhen performing endoscopic thoracic sympathectomy (ETS) in palmar hyperhidrosis patients, a device can be used to measure sweat volume pre- and postoperatively in order to assess indications and treatment effects. In this study, we measured changes in the dynamics of sweating in hyperhidrosis patients pre- and postoperatively and compared the values with those in healthy subjects without hyperhidrosis.MethodsThe patient group comprised 25 persons with palmar hyperhidrosis who were scheduled for ETS. The dynamics of sweating was measured at 1 day prior to surgery and at 2 days postoperatively, in 18 patients at > 1 year postoperatively in another palmar hyperhidrosis group, and in 20 healthy subjects without hyperhidrosis. A device for measuring local sweat volume was applied at the thenar eminence of both palms. Indicators established were basal sweat rate (BSR; mg/min/cm2), peak sweat rate (PSR; mg/min/cm2) during mental stress (sympathetic sweating response), sweat volume (SV), and sweat time (ST; s).ResultsAfter surgery, all of the indicators were significantly reduced in hyperhidrosis patients and there was very little response to mental stress. The subgroup of these patients assessed at > 1 year after ETS showed a trend of increased BSR similar to that of healthy subjects. These changes did not correlate with the extent of the removal surgery. Preoperatively, hyperhidrosis patients had significantly greater BSR, PSR, and SV and longer ST than healthy subjects.ConclusionAll of the sweating parameters were increased in palmar hyperhidrosis patients prior to surgery. Immediately after ETS, all these parameters were significantly reduced. At > 1 year after ETS, the BSR had increased to a level similar to that of the healthy volunteers, although PSR did not respond to mental stress.

Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience

The discussions at the surgical levels (sympathectomy levels) about endoscopic thoracic sympathectomy (ETS) method, which is applied in hyperhidrosis treatment in the present day and acknowledged as the golden treatment method, continue. Mainly, most of the studies evaluates postoperative early period results. Our aim in this study is to compare the long-term quality of life depending on the different surgical levels (sympathectomy levels) and evaluate the postoperative complications. 165 patients operated due to palmar hyperhidrosis between January 2012 and July 2017 were evaluated. Sympathectomy was performed either by clipping or cauterization and sympathetic nerves included were T2-4, T3-4, or T3 levels. Data were retrospectively reviewed for complications, factors affecting the postoperative quality of life. Ninety of the patients were male (54.5%) and 75 (45.5%) were female. The level of ganglion block was T2-T4 in 62 patients (37.6%), T3-T4 in 46 patients (27.9%), and T3 in 57 patients (34.5%). Early complications were observed in 27 patients (16.4%). Compensatory hyperhidrosis (CH) was observed in 62 patients (37.6%). There was a significant difference in the postoperative quality of life according to ETS level (p < 0.001). Patients who underwent T2-T4 sympathectomy had a lower quality of life than patients who underwent isolated T3 or T3-T4 sympathectomy. Based on our results, we recommend performing lower level resections to increase the long-term quality of life in palmar hyperhidrosis patients. The lower risk of CH and comparable quality of life suggest that T3 sympathectomy is more effective.

The relationship between preoperative psychological evaluation and compensatory sweating

BackgroundThis study analyzes the relationship between preoperative psychological states of primary palmar hyperhidrosis patients and postoperative compensatory sweating.MethodsWe evaluated the psychological states of patients with primary palmar hyperhidrosis who received sympathectomy in our hospital from 2016 to 2017. The relationship between preoperative psychological states and postoperative compensatory sweating were assessed using Spearman’s rank-order correlation.ResultsFifty-five patients who received R4 + R3 bypass transection accepted the preoperative questionnaire survey; 35 were males and 20 were females. The average age was 24.0 ± 6.3 years (range, 14–44 years). Depression symptoms were present in 21.9% (12/55) of the patients; the incidence of anxiety was almost similar, at 23.7% (13/55). Compensatory sweating occurred in 67.3% (37/55) of the patients; of these, 56.4% (31/55) was mild and 10.9% (6/55) was moderate. None of the patients had severe compensatory sweating. There was no significant relationship between the scores of SDS, SAS, and the incidence of postoperative compensatory sweating (P>0.05). However, the psychoticism scale displayed a strong impact on the degree of compensatory sweating (P<0.05). The higher the degree of psychoticism scale, the more serious the degree of compensatory sweating.ConclusionsThe results of this study showed that patients with primary palmar hyperhidrosis are more likely to have mild or moderate mental disorders, and that postoperative compensatory sweating may impact the satisfaction of surgery. In addition, the personality characteristics of patients are related to compensatory sweating.

The effect of micro-invasive endoscopic thoracic sympathectomy in palmar hyperhidrosis patients on quality of life and hyperhidrosis

The effect of micro-invasive endoscopic thoracic sympathectomy in palmar hyperhidrosis patients on quality of life and hyperhidrosis

Is compensatory hyperhidrosis after thoracic sympathicotomy in palmar hyperhidrosis patients related to the excitability of thoracic sympathetic ganglions?

The mechanism of compensatory hyperhidrosis remains unclear. The aim of this study was to explore the relationship between compensatory hyperhidrosis and thoracic sympathetic ganglion excitability to assess the effectiveness of thoracoscopic T4 sympathicotomy for treating palmar hyperhidrosis. Sixty-six cases of T4 sympathetic ganglions were prospectively collected from patients with palmar hyperhidrosis who underwent thoracoscopic T4 sympathicotomy from 2013 to 2016 in our department. The expression levels of choline acetyltransferase (ChAT), vasoactive intestinal peptide (VIP), and synaptophysin were detected using immunohistochemistry. Patients with palmar hyperhidrosis were followed-up for examination of postoperative sweating status. Thirty-eight cases (57.6%) of compensatory hyperhidrosis were identified. Mild compensatory hyperhidrosis occurred in 26 patients (39.4%), moderate in 11 (16.7%), and severe in 1 (1.5%). The rate of compensatory hyperhidrosis was higher in patients with axilla hyperhidrosis than those without (76.0% vs. 46.3%, P=0.018). However, the clinical data were similar between the compensatory hyperhidrosis group and the no compensatory hyperhidrosis group. In addition, the ChAT, VIP, and synaptophysin expression levels were not significantly different between the two groups (P values of 0.356, 0.071, and 0.141, respectively). Furthermore, the ChAT, VIP, and synaptophysin expression levels in the mild group were similar to those observed in the moderate/intense group (P values of 0.089, 0.124, and 0.149, respectively). The remission rate was 100% in palmar hyperhidrosis, 48.2% (27/56) in pedal hyperhidrosis, 56.0% (14/25) in axilla hyperhidrosis and 88.9% (16/18) in skin symptoms. No signs of chapped skin on the palms were found. There was no significant correlation between compensatory hyperhidrosis and thoracic sympathetic ganglion excitability; however, compensatory hyperhidrosis is more likely to simultaneously occur in patients with axilla hyperhidrosis. The satisfactory efficacy of thoracoscopic T4 sympathicotomy indicates that it may an ideal technique for palmar hyperhidrosis.

The Correlation Between the Anxiety and the Amount of the Sweat Gland Secretion in the Patients with Palmar Hyperhidrosis

Hyperhidrosis is also known as polyhidrosis or sudorrhea, which defines as the secretion of the sweat that exceeds the amount necessary for thermoregulation of the body. Palmar hyperhidrosis is excessive sweat secretion and is limited to the area of the palm. Anxiety is associated with feelings of uncertainty and helplessness. This emotional state does not have a specific object. Conditions subjectively experienced and communicated in interpersonal relationships. The purpose of this study was to determine the relationship between anxiety with the number of sweat glands secretion in patients with palmar hyperhidrosis. This study was an observational study with cross sectional design and analytical approach, conducted at Outpatient Clinic of Dermatology and Venereology Department of Dr. Wahidin Sudirohusodo Makassar, Hasanuddin University Hospital, and Senior High School in Makassar. This study began in February to April 2016. The number of samples are 40 people who suffered from palmar hyperhidrosis with the largest age distribution that is less than 20 years as many as 26 samples (65.0%). A total of 40 samples (100.0%) do not suffer secondary disorder, experiencing excessive sweating for at least 6 months, lasting at least one week, with bilateral symmetrical distribution, the onset of age 25 or younger and no sweat at night day. Family history of suffering from palmar hyperhidrosis were found in 12 samples (30.0%). There is a daily impact on palmar hyperhidrosis patients as many as 13 samples (32.5%). Students are the most in this study as many as 26 samples (65.0%). The onset of age palmar hyperhidrosis is the most at the age of 13 to 18 years from 21 samples (52.2). The severe palmar hyperhidrosis is the most in this study, there are 16 samples (40.0%). The degrees of moderate anxiety were the most in this study as many as 25 samples (62.5%). In this study, there is a tendency relationship between the degree of anxiety by the number of sweat glands secretion. Norepinephrine associated with severity of palmar hyperhidrosis. The highest level of norepinephrine is in the mild grade of palmar hyperhidrosis. There is a tendency correlation between the score of the Hamilton Rating Scale for Anxiety with blood plasma norepinephrine levels.

TRATAMENTO DA HIPERHIDROSE PRIMÁRIA COM TOXINA BOTULÍNICA – EXPERIÊNCIA DE 5 ANOS

Introdução: A hiperhidrose primária é frequente e tem impacto psico-social e profissional significativo. Muitos dos tratamentos disponíveis são ineficazes ou têm efeitos secundários consideráveis. A toxina botulínica tipo A (TXB-A) tem-se revelado uma terapêutica segura e eficaz nos doentes refractários à terapêutica convencional, embo- ra com eficácia limitada no tempo. Material e métodos: Procedeu-se a estudo retrospectivo, com colheita de dados demográficos e clínicos, dos doentes com hiperhidrose axilar ou palmar tratados com TXB-A no nosso Serviço, no período entre Junho de 2007 e Junho de 2012. A gravidade da doença foi determinada pela “Hyperhidrosis Disea- se Severity Scale” (HDSS). Para delimitar a área a tratar utilizámos uma modificação do “minor’s iodine-starch test”. A TXB-A foi administrada numa dose de 50U/axila ou palma. Resultados: Foram tratados 16 doentes, 11 mulheres e 5 homens, com média de idades de 24 anos. Nove tinham hiperhidrose axilar e 7 palmar, com HDSS médio de 3,22 e 3,57, respectivamente. Verificou-se diminuição da sudação que se iniciou na 1.a semana pós-tratamento, manten- do-se por 16 a 26 semanas. O HDSS na 4.a semana pós-tratamento foi de 0,56 e 1,14 (doentes com hiperhidrose axilar e palmar, respectivamente). Num follow-up médio de 15 a 16 meses, não se verificaram efeitos secundários significativos. Conclusões: O tratamento com a TXB-A é relativamente fácil de executar e melhora substancialmente a qualidade de vida dos doentes. Na nossa experiência, a TXB-A mostrou-se eficaz e segura no tratamento da hiperhi- drose primária. PALAVRAS-CHAVE – Hiperhidrose; Toxina botulínica.

Expression and significance of NKCC1 in axillary sweat glands of palmar hyperhidrosis patients with axillary hyperhidrosis

Objective To examine the number of axillary sweat glands and the expression of Na+ K+ Cl+ cotransporter isoform1(NKCC1) in axillary sweat glands of palmar hyperhidrosis patients with axillary hyperhidrosis, palmar hyperhidrosis patients and non-hyperhidrosis patients, to investigate its relationship with the pathogenesis of palmar hyperhidrosis. Methods Axillary glands were gained in 27 cases of palmar hyperhidrosis with axillary hyperhidrosis, 11 cases of palmar hyperhidrosis and 8 cases of non-hyperhidrosis as control group. The number of axillary sweat glands was calculated by using HE staining and the expression of NKCC1 was detected respectively. Results The number of axillary sweat glands in three groups had no significant difference in statistics (HC=2.528 ,P>0.05). There was significant difference in the expression of NKCC1 between palamar hyperhidrosis patients with axillary hyperhidrosis and palmar hyperhidrosis patients (F=5.158,P 0.05). Conclusion The increase of NKCC1 expression has the relationship with axillary hyperhidrosis of palmar hyperhidrosis patients with axillary hyperhidrosis, but has no relationship with the number of axillary sweat glands. Key words: Palmar hyperhidrosis; NKCC1; Axillary sweat glands

Is Gender a Predictive Factor for Satisfaction among Patients Undergoing Sympathectomy to Treat Palmar Hyperhidrosis?

Video-assisted thoracic sympathectomy (VATS) is currently the procedure of choise for the definitive treatment of primary hyperhidrosis because it is an effective, safe, and minimally invasive method. The aim of VATS treatment is to improve the quality of life through the reduction of excessive sudoresis. The purpose of this study was to assess the quality of life after VATS for treating palmar hyperhidrosis according to gender.METHODS:A total of 1044 patients who submitted to the surgical treatment for palmar hyperhidrosis from June 2000 to February 2008 were retrospectively evaluated. The patients were divided into two groups according to gender [719 (68.8%) females and 325 (31.2%) males].RESULTS:There are no statistically significant differences between genders with regard to the quality of life in palmar hyperhidrosis patients (p = 0.726). In the interview that was performed 30 days after surgery, the quality of life in the two groups had improved, with no statistical difference between the groups.CONCLUSION:Patients with palmar hyperhidrosis present with an improvement in the quality of life after VATS regardless of gender.

Health-Related Quality of Life After Thoracoscopic Sympathectomy for Palmar Hyperhidrosis

Palmar hyperhidrosis is a benign functional disorder regarded as a psychological and social handicap. Improvement of the quality of life is a major goal of treatment. However, little attention has been given to quality of life after thoracoscopic sympathectomy, which is the first line of treatment for palmar hyperhidrosis. This study investigated the impact of thoracoscopic sympathectomy on subjective health-related quality of life (HRQoL) and psychological properties. Forty patients who underwent thoracoscopic sympathectomy were followed up for 6 months. The HRQoL measures were the Medical Outcomes Study Short Form 36 (SF-36), the Spielberger State Trait Anxiety Inventory (STAI), and the Zung Self-Rating Depression Scale (SDS). Patients were administered these questionnaires before procedure and then again at 1, 3, and 6 months after sympathectomy. A comparison between the current sample and Japanese normative data for the SF-36 showed mild impairment of HRQoL before sympathectomy. However, it also showed significant improvement of the social functioning domain after sympathectomy. While there was worsening of the bodily pain and role physical domains 1 month after sympathectomy, both domains recovered in 3 months. The results of STAI showed significant improvement of both trait and state anxiety after sympathectomy. However, the results of SDS showed patients remained neurotic. This study is the first to show the pattern of impairment in health status and therapeutic impact in palmar hyperhidrosis patients. Hyperhidrosis is associated with impaired HRQoL. It was also demonstrated that thoracoscopic sympathectomy is safe, minimally invasive, and improves HRQoL, even if compensatory hyperhidrosis occurs.

Stimulation of left stellate ganglion prolongs Q-T interval in patients with palmar hyperhidrosis.

With the advent of transthoracic video-assisted endoscopic electrocautery of the second and the third sympathetic ganglia for the treatment of palmar hyperhidrosis, it is possible to approach the stellate ganglia with ease. To see whether stimulation of stellate ganglia in humans is similar to the case in dogs, we stimulated the sympathetic ganglia in 18 palmar hyperhidrosis patients with a coagulation power of 5 W at a frequency of three times every 2 s. We found that left stellate stimulation prolongs the Q-T interval and increases the heart rate, whereas right stellate stimulation affects the Q-T interval and heart rate insignificantly, just like the case in dogs in which the left stellate ganglion predominates the right one in determining the Q-T interval. Left stellate stimulation after destruction of the left second and third ganglia also prolongs the Q-T interval, suggesting that the left stellate ganglion is more important in determining the Q-T interval.

Craniofacial hyperhidrosis treated with video endoscopic sympathectomy.

Craniofacial hyperhidrosis as well as palmar hyperhidrosis is an abnormal state of local excessive sweating of unclear etiology. The hyperhidrosis may be isolated in the craniofacial region or associated with palmar hyperhidrosis. The patient's face is so wet with sweat that their daily activities are often seriously disturbed. To the best of our knowledge, there has been no satisfactory medical therapy, nor any effective surgical treatment reported in the literature. In 1991, we started to treat a patient with such distress using endoscopic ablation of the sympathetic T2 segment, because we mastered the technique after treating a large series of palmar hyperhidrosis patients. Furthermore, we were impressed by concomitant reduction of craniofacial sweating after T2-3 sympathectomy resulting from the relatively different domination of sympathetic supply between the eye and face. It appears possible to relieve excessive sweating of the head and face, without producing ptosis or miosis by ablation of the T2 segment. During the past 2 years, 7 patients with severe craniofacial hyperhidrosis have been successfully treated with the method and all obtained a satisfactory result. No complete Horner's syndrome has been produced except in one patient, who showed a mild and transient left eye ptosis, in whom coagulation of the sympathetic trunk higher than the T2 segment was performed. Intraoperative monitoring of forehead skin perfusion and observation of the change of pupillary size is emphasized during the lesion making. The longest postoperative follow-up was 2 years, with a mean follow-up of 12.4 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic Activities in Hyperhidrosis Patients before, during, and after Endoscopic Laser Sympathectomy

Three hundred palmar hyperhidrosis (PH) patients have been treated with video endoscopic laser sympathectomy during the last 2 years. Monitoring the palmar skin perfusion (PSP) and palmar skin temperature (PST) has been used intraoperatively to aid the confirmation of the correct sympathetic segment for laser ablation. The preoperative and postoperative PSP and PST and sympathetic skin response (SSR) also have been measured to evaluate the therapeutic effect of this method. An apparent increase of PSP would occur intraoperatively after the interruption of the T2 sympathetic segment, and then a gradual elevation of PST would follow after the extirpation of the segment. A rise of PST of about 3 degrees C after laser ablation of the appropriate segment indicated sufficient denervation of the hand and predicted long-lasting relief of PH. Furthermore, both PSP and PST also significantly increased after the operation. The postoperative elevation of the PST (usually about 3 degrees C) is similar to that recorded during intraoperative monitoring. The amplitude and the latency of SSR in the palm and sole were recorded both before and after sympathectomy. A remarkable decrease of palmar SSR amplitude and its ratio was found postoperatively by comparing it with that of plantar SSR in the same patient. These autonomic activity changes have correlated well with the postoperative satisfaction of the patients. Based on our study, the anatomic identification confirmed by the sympathetic monitorings has proved essential to achieve a definite and adequate sympathectomy leading to a satisfactory resolution of PH without the need of a tissue diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Video Endoscopic Sympathectomy Using a Fiberoptic CO2 Laser to Treat Palmar Hyperhidrosis

Palmar hyperhidrosis is a common disorder among orientals. A new therapeutic technique for this disorder has been designed by combining a computer compact disc video endoscopic system with a fiberoptic CO2 surgical laser unit. The operation is performed under general anesthesia with alternating one-lung ventilation. There are three important aids in localizing the correct sympathetic segment: 1) direct visualization of its magnified image on the television monitor; 2) identification with an electrode probe palpation at its presumed location; and 3) monitoring the microvasomotor changes on the skin of the finger resulting from electrical stimulation of the sympathetic trunk. Subsequently, the confirmed sympathetic target is vaporized using a low power CO2 laser under direct vision on the television monitor. The laser is delivered to the target by a small optical fiber passing through a throacoscope, which is introduced into the thoracic cavity via the intercostal space between the second and third ribs at the midclavicular line. Fourteen palmar hyperhidrosis patients were successfully treated by this method. No complications, such as Horner's syndrome, bleeding, or intercostal neuralgia, were encountered. Although the number of cases treated was small, and the follow-up period was short, the evidence indicates that a definite sympathectomy on a confirmed segment under magnified vision is possible with this procedure, and could warrant a definite and long-lasting therapeutic effect. Based on our experience, the method is considered a relatively minor and safe procedure, causing minimal discomfort and almost invisible scars. The operation time and hospital stay were remarkably shortened in comparison with other conventional sympathectomy procedures.