Thoracic Sympathectomy Research Articles

Efficacy and safety of radiofrequency ablation versus surgical sympathectomy in palmar hyperhidrosis

Radiofrequency ablation (RFA) comparative efficacy of treatments using video-assisted thoracoscopic sympathectomy (VATS) in the long term remains uncertain in patients with palmar hyperhidrosis (PHH). This study aimed to compare the efficacy and safety of RFA and VATS in patients with PHH. We recruited patients aged ≥ 14 years with diagnosed PHH from 14 centres in China. The treatment options of RFA or VATS were assigned to two cohort in patients with PHH. The primary outcome was the efficacy at 1-year. A total of 807 patients were enrolled. After propensity score matching, the rate of complete remission was lower in RFA group than VATS group (95% CI 0.21–0.57; p < 0.001). However, the rates of palmar dryness (95% CI 0.38–0.92; p = 0.020), postoperative pain (95% CI 0.13–0.33; p < 0.001), and surgery-related complications (95% CI 0.19–0.85; p = 0.020) were lower in RFA group than in VATS group, but skin temperature rise was more common in RFA group (95% CI 1.84–3.58; p < 0.001). RFA had a lower success rate than VATS for the complete remission of PHH. However, the symptom burden and cost are lower in patients undergoing RFA compared to those undergoing VATS.Trial Registration: ChiCTR2000039576, URL: http://www.chictr.org.cn/index.aspx.

Long-Term Treatment Outcome of a Patient with Extensive Circular Soft Tissue Defect of the Distal Third of the Lower Extremity: A Case Report

Background. Open fractures of the lower leg bones associated with extensive soft tissue defects are among the most challenging in trauma surgery.&#x0D; Aim of the study is to demonstrate the possibilities of modern reconstructive surgery in the treatment of severe polystructural trauma of the lower limb using a unique clinical example.&#x0D; Case description. An 18-year-old patient sustained a polytrauma which included head and extremities injuries as a result of a fall under a moving train. Due to the signs of uncompensated ischemia of the left lower limb at the first stage of treatment the patient underwent emergency left tibial artery thrombectomy, repeated debridement of the left lower leg wound, remounting of the external fixator, and lumbar sympathectomy. The second stage of surgical treatment included free transplantation of a vascularized anterolateral flap of the right thigh. The third stage included staged necrectomies; replacement of the soft tissue defect of the posteromedial surface of the distal lower leg with a sural fasciocutaneous vascularized flap on the distal vascular pedicle from the contralateral tibia; the fourth stage included cutting off the fasciocutaneous cross flap. At the follow-up, 2 years after the end of the treatment the patient complained of persisting swelling of the foot, which occurred during prolonged standing in the upright position and required elastic compression of the ankle joint. The cause of the swelling was impaired lymphatic outflow due to the damage to all venous collaterals in the injury area. She walks with full load on the injured limb without additional support. There is no pain syndrome, foot sensitivity is fully preserved.&#x0D; Conclusion. Presented clinical case demonstrates the possibility of successful replacement of an extensive circular defect of the distal lower leg using sequentially free and non-free vascularized tissue complexes.

Treating Erythromelalgia with Interosseous Membrane Stimulation: An Autonomic Basis for the Condition and Its Treatment.

Erythromelalgia, which has primary and secondary presentations, causes heat, pain, and redness in the skin. The condition seems to have an autonomic basis, with vasomotor dysfunction causing dilatation of some blood vessels and constriction of others. No consistently effective treatments have been reported. Anticonvulsant, antidepressant, antihistamine, anti-inflammatory, antihypertensive, analgesic, nutritional, and topical approaches have been tried as were lidocaine infusions, nerve blocks, and thoracic and lumbar sympathectomies. Interosseous membrane stimulation appears to affect the local autonomic milieu in the extremity being treated. This approach was used on a patient with erythromelalgia. A 36-year-old woman with erythromelalgia was treated with interosseous membrane stimulation. Eight treatments were given over a 1-year timeframe at 1-3-month intervals. This patient repeatedly experienced much relief from her burning paresthesias, swelling, diaphoresis, and ruddy discoloration of her extremities for 6-8 hours following each treatment. The intensity of her discomfort subsided gradually over time. Interosseous membrane stimulation is a safe, simple, and effective treatment for erythromelalgia, which is notoriously refractory to treatment. This patient's response to treatment might have been a result of localized derangement of her autonomic nervous system. It is possible that manipulation of the autonomic milieu of an extremity is a significant factor in the mechanism of action of interosseous membrane stimulation.

Open Lumbar Sympathectomy on Buerger’s Disease: A Case Report

Thromboangiitis obliterans known as Buerger's disease is a nonatherosclerotic, progressive inflammatory disease that affects small and medium arteries in the upper and lower extremities. Strong relationship was found between the development of this disease and the patient's history of smoking. We reported a case of 50-year-old male with progressive pain in fingers of right leg with darkened ulcer. Open lumbar sympathectomy is a procedure that is rarely performed nowadays, but progressive pain in buerger’s disease patients can be managed with this procedure. The aim of sympathectomy is to reduce sympathetic response causing vasodilation effect which will reduce rest pain.

Hyperhidrosis: problems and solutions

The functional role of sweating is not limited only to thermoregulation and excretion. There are other functions of it — the ability to enhance and maintain hydration and barrier function of the skin. Excessive sweating can lead to an exacerbation or cause many skin diseases, form psychological discomfort in a person due to wet clothes or an accompanying unpleasant odor. Primary hyperhidrosis may be an autosomal dominant genetic disease. Secondary, usually generalized hyperhidrosis is often associated with drug effects on the body or a systemic disease. The following approaches are used in the treatment of hyperhidrosis: 1) blocking the release of sweat to the skin surface (aluminum salts and formaldehyde); 2) physiotherapy (iontophoresis); 3) destruction of sweat glands and cessation of sweat production (excision of a skin flap with subcutaneous fat, curettage, microwave technology, etc.); 4) termination of the signal from the central nervous system to the sweat glands (transthoracic endoscopic sympathectomy, percutaneous radiofrequency sympathectomy, botulinum toxin injections, systemic anticholinergic drugs). External remedies for excessive sweating include the Russian drug Formagel®, containing 3.7% formaldehyde. This drug is a non-invasive, easily doable, effective, safe method of treating hyperhidrosis.

Letter to the Editor Regarding “Predictors of Compensatory Sweating Following Video-Assisted Thoracoscopic Sympathectomy in Primary Palmar Hyperhidrosis”

Letter to the Editor Regarding “Predictors of Compensatory Sweating Following Video-Assisted Thoracoscopic Sympathectomy in Primary Palmar Hyperhidrosis”

The Role of Sympathetic Nerve Block in Predicting Compensatory Hyperhidrosis before Thoracoscopic Sympathectomy

The Role of Sympathetic Nerve Block in Predicting Compensatory Hyperhidrosis before Thoracoscopic Sympathectomy

Single port endoscopic thoracic sympathectomy with holmium laser for treating palmar hyperhidrosis at Thai Binh Provincial General Hospital

Introduction: thoracoscopic sympathectomy for treating palmar hyperhidrosis often uses 2 ports. Research to evaluate the results of the method using 1 port &lt; 5mm with Holmium Laser fiber.&#x0D; Object and Method: Description, prospective.&#x0D; Within 2 months from June 2023 to July 2023, 47 patients underwent single port endoscopic thoracic surgery using holmium laser to transect the sympathetic ganglia at T3 level for patients with palm sweating (26 patients) and T3-T4 level for patients with palm and axillary sweating (21 patients). The male-to-female ratio was 44.7% to 55.3%, with an average age of 18 ± 7.4 years (minimum age of 11 years, maximum age of 52 years). Surgical method: A single entry port trocar 14Fr located at the 3rd intercostal space, the posterior border of the pectoralis major muscle between the anterior and midaxillary lines, using a 12Fr endoscopic lens with integrated tunnel for Holmium Laser fiber. Patients were monitored and evaluated for early post-operative results: technical failure requiring the placement of a second port, complications during and after surgery and the degree of improvement in palmar hyperhidrosis, the rate of compensatory hyperhidrosis after 1 month and the patient's quality of life after surgery.&#x0D; Results:&#x0D; There were no technical failures. The time for transecting the sympathetic ganglion (one side) with Holmium Laser was 78 ± 40.76 seconds. All patients had dry hands after surgery, with two out of forty-seven patients having excessively dry hands. There were no complications during or after surgery, and no patients developed Horner’s syndrome. The average time to discharge after surgery was 30 ± 11.4 hours. Fourteen out of forty-seven patients had compensatory sweating after one month postoperatively at an acceptable level.&#x0D; Conclusion: The method of using a port &lt; 5mm with an endoscopic lens integrated with a Holmium Laser fiber tunnel is safe, effective, less traumatic and highly aesthetic.

Bilateral thoracic sympathectomy for refractory coronary artery spasm—A case report

Abstract A 51-year-old woman was admitted because of three-degree AV block. Serial coronary angiogram revealed right coronary artery spasm, which is refractory to drug eluting stents and Nitroglycerin infusion. She underwent bilateral cardiac sympathetic denervation with video-assisted thoracoscopic surgery and was discharged on day 26 asymptomatically. Bilateral cardiac sympathetic denervation could be used for patients with symptomatic coronary artery spasm.

Use of perioperative thermal camera for the assessment of sympathectomy effectiveness

Objectives: Primary Hyperhidrosis (HH) is the excessive sweating condition in one or more parts of the body. The definitive treatment method is surgical. The most commonly applied surgical method is endoscopic thoracic sympathectomy (ETS). We aimed to investigate the effectiveness of patients with hyperhidrosis by making temperature measurements. Methods: We analyzed the findings of 30 patients who were diagnosed with HH between January 1, 2019 and November 1, 2022 in Kahramanmaraş Sütçü İmam University Thoracic Surgery Clinic. Preoperative, intraoperative and postoperative hand temperatures of the patients who underwent bilateral endoscopic thoracic sympathectomy were examined by measuring hand temperatures with a thermal camera. Results: After the evaluation of the examination, it was revealed that there was an increase in the hand temperature measurement values before sympathectomy and after the sympathectomy operation. Conclusion: We believe that endoscopic thoracic sympathectomy performed by measuring temperature with a thermal camera will increase the comfort and safety of the surgery both on the part of the physician and the patient.

Epidemiological insights into thoracic and lumbar sympathectomies in Brazil: a comparative analysis of open versus video-assisted procedures.

To investigate the profile of hospital admissions for sympathectomies performed in the Brazilian Unified Health System (SUS), comparing open and video-assisted techniques. Data on sympathectomies were collected from the SUS Department of Informatics (DATASUS), recorded between 2014 and 2023. The data were tabulated, and descriptive statistics and correlation analyses were performed. There was reduction in the number of admissions for all sympathectomies during the analyzed period. The use of video-assisted surgeries was higher than that of open surgeries for thoracic procedures, but lower for lumbar procedures. The costs of hospital admission for the procedures were similar, although the length of stay and mortality associated with open surgeries were higher, both in thoracic and lumbar sympathectomies. The collected data were not individualized, preventing follow-up. Additionally, the study did not account for procedures performed in the private healthcare system. Despite its limitations, this study provides an overview of sympathectomies in Brazil, indicating that, although open sympathectomies are potentially more disadvantageous, they are still widely performed, especially for lumbar procedures.

The Impact of bilateral endoscopic thoracic sympathectomy on hyperhidrosis patients’ quality of life and its link to psychiatric disorders

Background and Aims: To measure the Quality of Life (QOL) of patients with hyperhidrosis after undergoing Bilateral en¬doscopic thoracic sympathectomy (BETS), and its association with psychiatric disorders, that were diagnosed using MINI psychiatric interview, and compensatory hyperhidrosis (CH). Methods: A retrospective cross-sectional study was carried out on patients with primary hyperhidrosis after undergoing BETS. 50 Patients were recruited from King Saud University Medical City database and contacted via phone calls. The interview contained a hyperhidrosis-specific QOL questionnaire, and a diagnostic psychiatric questionnaire MINI. The QOL results were classified into 5 categories and used to study QOL and its associated factors. Results: The reported QOL before the operation has 52% of the patients showing negative QOL. Alternately, the reported QOL after the operation improved with 96% patients showing positive QOL. Among this sample, 76% reported suffering from CH post procedure, 28% were diagnosed with one or more mood disorders, and 20% were diagnosed with one or more anxiety disorders. No statistical relationship was found linking the QOL of the sample to the occurrence of CH or the presence of any common psychiatric disorder. Conclusions: In conclusion, there was a significant improvement in the patients’ QOL after BETS. The improvement in QOL was unaffected by the surgeries most notable complication, compensatory hyperhidro¬sis, or the presence of any common psychiatric disorder that they were diagnosed with post-surgery. Further research is needed to explore factors that may affect the QOL of these patients.

Outcome of Bilateral Video-Assisted Thoracoscopic Sympathectomy (BVATS) Thoracic Sympathectomy in Treatment of Hyperhydrosis

Outcome of Bilateral Video-Assisted Thoracoscopic Sympathectomy (BVATS) Thoracic Sympathectomy in Treatment of Hyperhydrosis

Evaluation of the quality of life 10 years after bilateral thoracoscopic sympathicotomy in subjects with primary focal hyperhidrosis

Introduction/Objective. Primary focal hyperhidrosis (PFH) is an idiopathic condition where excessive sweating affects one or more body regions, including axillae, palms, soles, and/or face. Most studies on quality-of-life focus on the period up to one year after bilateral thoracoscopic sympathectomy (BTS). This study aims to determine the 10-year trend in quality of life among patients from the Republic of Serbia with palmar-plantar-axillary primary focal hyperhidrosis, treated with BTS at the R3-R4 level. A secondary goal is to ascertain the existence of compensatory sweating. Methods. All patients underwent a standardized BTS in a single act, through the cutting of ganglia with ultrasonic scissors at the R3-R4 level. For data collection, patients completed the "Hyperhidrosis Quality of Life Questionnaire (HQLQ)," and the Hyperhidrosis Disease Severity Scale (HDSS), preoperatively, postoperatively within 30 days, and 10 years after BTS. Results. The total sample consisted of 103 subjects who completed all three questionnaires. Considering the improvement in Quality of Life (QoL) from the group excellent, good, and average, the postoperative improvement was immediately postoperative in 88.4% of patients, while in the ten-year period, it was 87.4%. No statistically significant differences were found between the assessment of life satisfaction after 30 days and 10 years after BTS. Out of the total number of operated patients, two patients (1.94%) characterized their compensatory sweating as very pronounced. Conclusion. After 10 years from BTS, the QoL remains at an exceptionally high level, with an annual trend of decline of about 0.1%.

Comparison Between Modified Wittmoser Method and Conventional Thoracoscopic Sympathectomy in Treating Patients with Primary Hyperhidrosis

Comparison Between Modified Wittmoser Method and Conventional Thoracoscopic Sympathectomy in Treating Patients with Primary Hyperhidrosis

Prevalence of Azygos Lobe of the Lung in Southern Indian Cadaveric Population: A Retrospective Observational Study

Introduction: The azygos lobe is a developmental anomaly found in the upper lobe of the right lung. It has a prevalence of 0.4% in clinical scenarios and 1% during routine anatomical dissections. Clinically, the azygos lobe mimics various conditions. It is a rare incidental finding during chest radiography or Computed Tomography (CT). Aim: To determine the prevalence of the azygos lobe during anatomical dissection. Materials and Methods: A retrospective observational study was conducted over a 13-year period from June 2010 to August 2023 in various medical colleges in Mangaluru, Karnataka, India. A total of 102 adult cadavers were studied. The dissected right and left lungs of each cadaver were examined for the presence or absence of an azygos lobe and recorded. The morphology of the azygos lobe was studied, including its size, the presence of the azygos fissure, the depth of the azygos fissure, and the course of the azygos vein. The presence of mesoazygos was also checked, and its attachments were noted. Descriptive statistics were used in terms of frequency and percentage. Results: Out of the 102 cadavers, only one right lung had an azygos lobe. None of the cadavers had bilateral azygos lobes. The maximum height of the lobe was 5.8 cm, and the width was 4.5 cm. An azygos fissure was found, through which the mesoazygos was present. The mesoazygos was located from the lung to the thoracic wall. Conclusion: Despite being an incidental finding, the azygos lobe is clinically important. Physicians should be aware of this anomaly, and thoracic surgeons should exercise caution during surgeries involving the thoracic region, such as Video-Assisted Thoracic Sympathectomy (VATS).

Sexual effects and long-term outcomes of endoscopic lumbar sympathectomy for plantar hyperhidrosis in men: a cross-sectional study.

Plantar hyperhidrosis (PHH) is a disease with high psychosocial impact, and endoscopic lumbar sympathectomy (ELS) has been shown to be the best choice for treatment, but with some concerns such as compensatory sweating (CS) and sexual effects (SE), particularly in men. The aim of this study is to evaluate the long-term effectiveness of ELS for controlling PHH in men, its side effects, and perceived sexual modifications. A cross-sectional study including only male patients operated for PHH with ELS between 2014-2022 at a private practice. During remote interviews, patients were asked about symptoms before and after ELS and about the postoperative effects on PHH. They were also objectively asked about any SE during the postoperative period. Validated quality of life for hyperhidrosis and erectile function questionnaires were also administered. 10 male patients averaging 4.26±2.86 years post-ELS were interviewed. Eight of them (80%) achieved complete response (≥80% of sweat reduction) in the first month after surgery and this response was maintained up to the interview date. Two patients had partial response. In six patients, CS occurred, with 5 reporting it as non-troublesome. Six patients reported some type of SE, but none reported erectile dysfunction. Regarding the functional results, all patients rated ELS from good (10%) to very good (30%) or excellent (60%). Endoscopic lumbar sympathectomy was effective for treatment of plantar hyperhidrosis in these patients, improving their quality of life and providing lasting PHH control, with some transient sexual dysfunctions that did not impair their sexual life.

Transnasal humidified rapid-insufflation ventilator exchange compared with laryngeal mask airway for endoscopic thoracic sympathectomy: a randomized controlled trial.

Transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has the characteristics of operating easily and maintaining oxygenation and eliminating CO2, which makes it possible to be used in endoscopic thoracic sympathectomy (ETS). The application of THRIVE in ETS remains undefined. The purpose of this randomized controlled study is to assess the efficacy between THRIVE and laryngeal mask airway (LMA) for ETS. In total, 34 patients from May 2022 to May 2023 in Huazhong University of Science and Technology Union Shenzhen Hospital undergoing ETS were randomly divided into a THRIVE group (n = 17) and an LMA group (n = 17). A serial arterial blood gas analysis was conducted during the perioperative period. The primary outcome was the arterial partial pressure of carbon dioxide (PaCO2) during the perioperative period. The secondary outcome was arterial partial pressure of oxygen (PaO2) during the perioperative period. The mean (SD) highest PaCO2 in the THRIVE group and LMA group were 99.0 (9.0) mmHg and 51.7 (5.2) mmHg, respectively (p < 0.001). The median (inter-quartile range) time to PaCO2 ≥ 60 mmHg in the THRIVE group was 26.0 min (23.2-28.8). The mean (SD) PaO2 was 268.8 (89.0) mmHg in the THRIVE group and 209.8 (55.8) mmHg in the LMA group during surgery (p = 0.027). CO2 accumulation in the THRIVE group was higher than that of the LMA group during ETS, but THRIVE exhibited greater oxygenation capability compared to LMA. We preliminarily testified that THRIVE would be a feasible non-intubated ventilation technique during ETS under monitoring PaCO2.

Enhancing Quality of Life: Pre- and Postoperative Assessment in Idiopathic Hyperhidrosis Patients.

This study aimed to characterize patients, describe surgical complications, and evaluate the pre- and postoperative quality of life (QOL) of individuals who underwent surgery for primary hyperhidrosis (PHH). A prospective, non-randomized, uncontrolled study was conducted, documenting cases of patients undergoing surgery for PHH at a reference center in La Habana, Cuba, from January 2016 to December 2022. A total of 49 cases were described, with a median age of 16 years; 59.1% were female. The most common presentation was palmar-plantar-axillary, observed in 53% of cases. The palmar presentation was more frequent in female patients (p<0.05). Within 24 hours post-procedure, 85.7% of patients showed dryness in the palmar and axillary areas, with surgical complications occurring in 14.3% of cases (intercostal neuritis, pneumothorax, and hemothorax). CHof some form was recorded in 89.8% of cases. At least 30 days after the surgery, 95.9% of the patients reported a significant improvement in their QOL. Thoracic sympathectomy is an efficient and safe method for treating hyperhidrosis in adolescents, leading to an enhanced QOL. However, this study reported a higher incidence of complications, particularly CH, compared to previous national and international studies.

The Role of Lumbar Sympathectomy in the Management of Buerger's Disease: A Systematic Review

Introduction Lumbar sympathectomy has been explored to manage Buerger's disease (BD) with varying success rates, but the results are often controversial. Despite the substantial morbidity associated with BD, there is a scarcity of comprehensive reviews on the topic. The current study is a systematic review of the efficacy of lumbar sympathectomy in the management of BD. Methods A meticulous systematic exploration was conducted across reputable databases and search platforms. The search strategy employed the following keywords:(lumbar sympathetic OR sympathectomy OR lumbar sympathetic block) AND (Buerger's disease OR Buerger OR thromboangiitis obliterans OR lower limb disease). Out of 42 identified studies, 16 were excluded during the initial screening phase. Following initial and full-text screenings, 10 studies remained eligible. The assessment of studies regarding the inclusion criteria was conducted independently by two authors, with a third author intervening to arbitrate any discrepancies. Results The demographic characteristics revealed that all participants were male, with a mean age of 38.9 years. Smoking prevalence among the cases was notably high (99%). Chemical sympathectomy was the predominant intervention, employed in 87.8% of cases, while surgical sympathectomy was utilized in only 12.2% of cases. Among the cases, 8.7% achieved complete resolution from the disease, while 91.3% reported partial relief. Conclusion Lumbar sympathectomy can be a viable treatment option for BD with fair outcomes. Nevertheless, smoking cessation remains the primary factor impeding disease progression and aggressiveness.