Treatment Of Hyperhidrosis Research Articles

Paresis Following Type A Botulinum Toxin (Dysport) Injection: A Case Report

: Primary hyperhidrosis (PH) is a condition characterized by excessive sweating. Primary treatment options include antiperspirants or anticholinergics for symptomatic relief, while axillary and palmar hyperhidrosis can be addressed with surgery. Botulinum toxin type A (BTX-A) is a significant treatment option for these patients. This toxin inhibits the release of acetylcholine, preventing overactive eccrine sweat glands from causing excessive sweating. Despite its effectiveness in treating various neurological and cosmetic conditions, Botox may pose the risk of severe side effects resulting from local or systemic drug release. We report the case of a 21-year-old woman who developed weakness in all four limbs, dyspnea, dysphagia, and blurred vision two weeks after botulinum toxin injection for hyperhidrosis treatment.

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.

Botulinum Toxin A and B for Palmoplantar Hyperhidrosis.

Hyperhidrosis is characterized by unpredictable, uncontrollable and excessive sweating. It occurs at rest and is not related to temperature. Hyperhidrosis is a common disorder that has a negative impact on quality of life (QoL). The aim of this quality assurance study was to investigate how treatment of palmoplantar hyperhidrosis with botulinum toxin A (BTX-A) and botulinum toxin B (BTX-B) led to improvement of patient reported outcome measures related to QoL. A total of 35 patients with palmar and/or plantar hyperhidrosis who had received BTX-A (Dysport®) and BTX-B (NeuroBloc®) for palmar hyperhidrosis and BTX-B for plantar hyperhidrosis were included in this study. In total, palms were injected with a median dose (low to high) of 400 (100-550) units BTX-A and a median dose (low to high) of 200 (200-500) units. BTX-B was used in the thenar and hypothenar areas to avoid muscle weakness. In the soles a total median dose (low to high) of 600 (475-1000) units BTX-B was injected. At follow-up 2weeks post-treatment, patients' Dermatology Life Quality Index (DLQI) score improved from 13 to 2 (p < 0.001). We found that BTX-A and BTX-B treatment for palmar hyperhidrosis and BTX-B treatment for plantar hyperhidrosis led to a substantial improvement of QoL.

[Translated article] Topical Anticholinergics in the Management of Focal Hyperhidrosis in Adults and Children. A Narrative Review

Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.

Revealing the Antiperspirant Components of Floating Wheat and Their Mechanisms of Action through Metabolomics and Network Pharmacology.

Floating wheat is a classical herbal with potential efficacy in the treatment of hyperhidrosis. Aiming at revealing the main components and potential mechanisms of floating wheat, a comprehensive and unique phytopharmacology profile study was carried out. First, common wheat was used as a control to look for chemical markers of floating wheat. In the screening analysis, a total of 180 shared compounds were characterized in common wheat and floating wheat, respectively. The results showed that floating wheat and common wheat contain similar types of compounds. In addition, in non-targeted metabolomic analysis, when taking the contents of the constituents into account, it was found that there indeed existed quite a difference between floating wheat and common wheat and 17 potential biomarkers for floating wheat. Meanwhile, a total of seven components targeted for hyperhidrosis were screened out based on network pharmacology. Seven key differential components were screened, among which kaempferol, asiatic acid, sclareol, enoxolone, and secoisolariciresinol had higher degree values than the others. The analysis of interacting genes revealed three key genes, namely, MAP2K1, ESR1, and ESR2. The Kyoto Encyclopaedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment analyses showed that various signaling pathways were involved. Prolactin signaling, thyroid cancer, endocrine resistance, gonadotropin secretion, and estrogen signaling pathways were the main pathways of the intervention of floating wheat in excessive sweating, which was associated with the estrogenic response, hormone receptor binding, androgen metabolism, apoptosis, cancer, and many other biological processes. Molecular docking showed that the screened key components could form good bindings with the target proteins through intermolecular forces. This study reveals the active ingredients and potential molecular mechanism of floating wheat in the treatment of hyperhidrosis and provides a reference for subsequent basic research.

Botulinum toxin A versus microwave thermolysis for primary axillary hyperhidrosis: A randomized controlled trial

Botulinum toxin A (BTX) and microwave thermolysis (MWT) represent 2 treatment modalities for axillary hyperhidrosis with different procedural and efficacy profiles. To compare long-term outcomes following BTX vs MWT treatment of axillary hyperhidrosis. A prospective, randomized, within-patient, controlled trial, treating axillary hyperhidrosis with contralateral BTX and MWT. Objective sweat measurement and patient-reported outcome measures for sweat and odor were collected at baseline, 6-month and 1-year follow-up (6M/1YFU). Hair reduction and patient treatment preference was also assessed. Sweat reduction was significant (all P <.01) for both interventions throughout the study. Objectively, sweat reduction was equal at 1-year FU (ΔP =.4282), but greater for BTX than MWT at 6-month FU (ΔP =.0053). Subjective sweat assessment presented comparable efficacy (6MFU: ΔP =.4142, 1YFU: ΔP =.1025). Odor reduction was significant (all P <.01) following both interventions, whereas only sustaining for MWT (6MFU: ΔP =.6826, 1YFU: ΔP =.0098). Long-term, hair reduction was visible after MWT, but not BTX (ΔP ≤.0001), and MWT was preferred by the majority of patients (76%). The intrinsic challenges in efficacy assessment. This study exhibited BTX and MWT with similar sweat reduction, but distinguishable odor and hair reduction at 1-year FU. These findings support individualized treatment approaches for axillary hyperhidrosis based on patient-specific symptoms and preferences.

The Efficacy of Long-Pulsed, 1064-nm Nd:YAG Laser Versus Aluminum Chloride 20% Solution in the Treatment of Axillary Hyperhidrosis.

Introduction: Hyperhidrosis (HH) refers to uncontrollable excessive sweating that has a significant negative impact on the quality of life. The aim of this study was to compare the efficacy and safety of the long-pulsed, 1064-nm Nd:YAG laser and aluminum chloride (ALCL3 ) 20% solution in axillary HH treatment. Methods: In this single-center, within-patient comparison clinical trial, 12 patients with axillary HH were treated monthly for 3 to 4 consecutive sessions with the long-pulsed, 1064-nm Nd:YAG laser system on one axilla, while the contralateral axilla was treated with ALCL3 20 % by the patient. Treatment response was evaluated by comparing the area of sweating at the end of each session and 6 months after treatment termination using the iodine starch test. Results: Both treatments led to the reduction of HH from baseline with the mean area of sweating reduced from 109.3±36.6 to 38.3±19.8 and from 92.5±31.6 to 35.6±17.1 in laser- and ALCL3-treated axilla respectively (Both P<0.001). In the 6-month follow-up, the area of sweating was 60.6±29.2 in the laser-treated armpit and 78.3±23.6 in the ALCL3-treated side, which were 45% and 14.4% lower compared to the baseline respectively. Adverse events were temporary, and none caused each of the treatments to be discontinued. Conclusion: The long-pulsed, 1064-nm Nd:YAG laser with hair reduction setting can stand as a potential therapeutic option for axillary HH since it is as effective as ALCL3. The therapeutic effect is superior in the long term for the laser; nevertheless, the beneficial effect of both treatments may lessen the following treatment cessation.

Reconstituted and frozen botulinum toxin A is as effective and safe as fresh for treating axillary hyperhidrosis: A retrospective study.

The use of reconstituted and frozen left-over botulinum toxin A, for treatment of patients with axillary hyperhidrosis seems to be common practice in healthcare. Thus, the objective of this study was to investigate the efficacy and safety of frozen and thawed versus fresh reconstituted abobotulinum toxin (Dysport®) and onabotulinum toxin (Botox®) in the treatment of axillary hyperhidrosis. A retrospective study was conducted analysing efficacy and data from pre- and 24 weeks post-treatment questionnaires together with medical records of individuals with moderate to severe axillary hyperhidrosis. The patients had received fresh prepared botulinum toxin A in their right axilla while frozen and thawed botulinum toxin A had been administered in their left axilla. Treatment was conducted at our Hyperhidrosis Clinic, Umeå University Hospital, Sweden 2019-2021. Pre- and post-treatment questionnaires from 106 patients were analysed. The patients were 18 to 55 years old, with a mean age of 30.7 ± 9.9 years. No significant differences in patient-reported variables, Hyperhidrosis Disease Severity Scale and VAS 10-point scale, were found between the different preparations (frozen compared to fresh) for abobotulinum toxin and onabotulinum toxin, before treatment and at 6 months follow-up. Multivariable regression analysis resulted in no significant difference regarding side-effects between the preparations or brands of botulinum toxin. The findings of this study support our clinical experience that both abobotulinum toxin and onabotulinum toxin, reconstituted, frozen and thawed, seem to be as effective and safe as fresh prepared botulinum toxin when treating axillary hyperhidrosis. Our findings indicate that left-over preparations of abo- and onabotulinum toxins, stored and frozen for up to 6 months, is a cost-and time-effective way of handling botulinum toxin for treatment of axillary hyperhidrosis.

Ultrasound-guided percutaneous puncturing technique: novel radiofrequency ablation technique for thoracic sympathectomy in the treatment of palmar hyperhidrosis.

Radiofrequency thoracic sympathectomy is routinely conducted under computed tomographic or fluoroscopic guidance in the treatment of palmar hyperhidrosis. However, it remains a great challenge to perform a thoracic paravertebral puncture precisely and safely, because it is associated with repeated exposure to radiation and the risk of a pneumothorax. Alternatively, an ultrasound-guided technique can provide high-resolution and real-time needle tracking during the percutaneous procedure. We have provided our experience of ultrasonic guidance in radiofrequency sympathectomy for the treatment of primary palmar hyperhidrosis.

Tailored Indications for Different Neurotoxins.

Minimally invasive procedures have become increasingly popular because they require minimal downtime and are effective for achieving a more youthful appearance. All U.S. Food and Drug Administration-approved neurotoxins are indicated for achieving similar effects, even though they are different in regard to structure, manufacturing technique, and storage requirements. It is agreed upon that each neurotoxin is unique and therefore not interchangeable. The aim of the author is to provide an approach for choosing the optimal toxin in different indications regarding the area of treatment, the age and characteristics of the patient, potential risks, and ultimate goals. As the country that the author practices carries onabotulinum (ONA), prabotulinum (PRA), and abobotulinum (ABO) toxin type-A, one of these three toxins was preferred for each category. ABO toxins were preferred in wide areas due to the broader action halo. Typical examples include hyperhidrosis treatment, wide forehead area, and calf slimming. In areas where very precise and targeted treatment is required, PRA and ONA toxins were preferred to limit potential side effects due to wider diffusion. First-time patients were typically treated with PRA toxins for a softer trial periods where as "repeat" patients were successfully treated with ABO toxins. No toxin is superior to the other in terms of producing effects. Yet, small differences in their properties can allow the plastic surgeon to cater to each patient's needs while yielding the most optimal results. This study is meant to serve as a guideline for choosing the ideal toxin in different patient settings and indications.

The success rate and associated risk factors of CT-guided percutaneous radiofrequency sympathectomy in the treatment of primary hyperhidrosis: A retrospective observational trial

PurposeThe aim of this study was to investigate the success rate of surgical technique and associated risk factors based on the follow-up of patients who underwent CT-guided percutaneous radiofrequency sympathectomy (RFS) to treat primary hyperhidrosis (PH). Methods370 patients who underwent RFS for PH treatment between January 2018 and April 2022 were enrolled. Patients responded to a questionnaire and telephone follow-up on the effects of treatment and their electronic medical records and imaging findings were reviewed. Logistic regression was performed to identify risk factors related to the success rate of surgical technique. ResultsA temperature difference ≥2 °C before and after procedure was defined as a successful surgical technique. Among the 370 patients (740 sides), 637 sides had successful RFS, and the technical success rate was 86.1 %. Immediately after procedure, 636 sides (85.9 %) were completely dry, 64 (8.7 %) were partially dry, and 40 (5.4 %) were still wet. During the longest follow-up period (54 months), 103 patients relapsed. The median hyperhidrosis disease severity scale score on both sides decreased from 4 to 1 after RFS. According to logistic regression analysis, only the pre-post pulse index was associated with the success rate of surgical technique (odds ratio, 1.14; 95 % confidence interval, 1.06–1.23; p = 0.0004). ConclusionsWe observed that the immediate efficiency and success rate of surgical technique after RFS for PH treatment were relatively high, although there is a possibility of recurrence in the long term. In general, RFS is a safe and effective procedure for alleviating the symptoms of patients with hyperhidrosis.

Anticolinérgicos tópicos en el manejo de la hiperhidrosis focal en adultos y niños. Una revisión narrativa

Hyperhidrosis, or excessive sweating, is characterized by overactivity of the eccrine sweat glands, usually associated with dysfunction of the autonomic nervous system. Primary focal hyperhidrosis is the most common form and can affect the axillae, palms, soles, and/or face, often leading to significantly impaired quality of life and social functioning. Treatment is complex. Topical antiperspirants are normally recommended as the first-line treatment for mild hyperhidrosis. Multiple clinical trials and prospective studies support the efficacy and tolerability of oral and topical anticholinergics in the management of hyperhidrosis. Topical glycopyrronium, which has been investigated in at least 8 clinical trials enrolling more than 2000 patients, is probably the first-line pharmacological treatment for axillary hyperhidrosis in patients with moderate to severe disease poorly controlled with topical antiperspirants. Second-line treatments include botulinum toxin injections, microwave treatment, and oral anticholinergics. We review the use of topical anticholinergics in the management of focal hyperhidrosis in adults and children.

LB1706 Development of a novel dry iontophoresis glove for the treatment of primary palmar hyperhidrosis

LB1706 Development of a novel dry iontophoresis glove for the treatment of primary palmar hyperhidrosis

How We Do It: The Role of Infrared Thermography as a Supportive Technique in the Treatment of Hyperhidrosis.

How We Do It: The Role of Infrared Thermography as a Supportive Technique in the Treatment of Hyperhidrosis.

The application of microwaves in axillary hyperhidrosis: Curative effect observation of a pathological examination over 1 year.

In Asia, axillary hyperhidrosis is a frequent problem for many people, and the consequent excessive sweating can seriously affect many aspects of daily life and even lead to mental disorders. Microwave therapy is a new, non-invasive treatment method for axillary hyperhidrosis, whose energy and long-term effectiveness still needs to be clinically validated. The aim of this study was to evaluate the clinical efficacy, safety, histological changes, and psychological status of microwave devices in the treatment of axillary hyperhidrosis and osmidrosis. We conducted a prospective self-controlled study in a top-tier Chinese hospital. After a 5/5 energy treatment session, a skin biopsy was taken to observe histological changes both before and after treatment. An iodine starch test was used to determine the sweating range. We evaluated symptoms of improved efficacy using the Hyperhidrosis Disease Severity Scale (HDSS) and assessed changes in life status with the DLQI. In the case of concurrent underarm odor, odor-5, VAS, and Young-Jin Park grading were used to assess odor relief. The effect of odor on psychology was assessed by using a psychological status symptom checklist (scl-90). The study period was 1 year. We observed 20 patients in this study. Of those, 90% met the primary treatment endpoint of a decrease in axillary hyperhidrosis symptomatology to below grade 2 on the HDSS score (p < 0.001). Furthermore, 75% of patients achieved a treatment endpoint of at least 50% reduction in VAS (p < 0.001). 70% of patients achieved a treatment endpoint of at least 50% reduction in odor-5 (p < 0.001). The iodine starch test showed that the region decreased 99% from the baseline to 12 months after follow-up had ended (p < 0.001). Eight patients volunteered to undergo histological examination; their average light density of immunohistochemistry decreased from 1.04 (0.4-2.11) to 0.07 (0.04-0.46; p < 0.05). The immunohistochemical positive number for sweat glands was initially 104 (59.75-132.5) but was 41.5 (29.75-62) after the procedure. None of the patients experienced any serious adverse reactions. The treatment demonstrated high effectiveness, safety, and short-lived adverse reactions.

Topical Oxybutynin 3% Gel Versus Aluminum Chloride 15% Lotion in Treatment of Primary Focal Hyperhidrosis.

Hyperhidrosis is excessive sweating beyond thermoregulatory needs. It is a potentially disabling condition with challenging management. Aluminum chloride is the established topical treatment; however, response remains unsatisfactory. Oxybutynin is an anticholinergic drug that stands as a therapeutic chance for hyperhidrosis. comparing the efficacy of topical oxybutynin 3% gel versus aluminum chloride 15% lotion in treatment of primary focal hyperhidrosis. Forty patients with hyperhidrosis were randomly distributed into 2 equal groups treated by either topical oxybutynin 3% gel or topical aluminum chloride 15% lotion once daily night application for 4 weeks (both groups). Evaluation was done at 2 and 4 weeks of treatment and after 1 month of the end of treatment for follow up by Minor iodine starch test, hyperhidrosis disease severity scale (HDSS) and dermatology life quality index (DLQI). Both treatment modalities were effective with insignificant differences between patients of both groups regarding improvement in Minor iodine starch test and HDSS after 2 weeks of treatment (P = 0.561, 0.33 respectively). Oxybutynin 3% gel yielded significantly better improvement of Minor's test, HDSS and patient's quality of life at the end of 4 weeks of treatment with lower recurrence rate than aluminum chloride 15% lotion at 1 month follow up. Minimal adverse effects were noted in both studied groups. Oxybutynin 3% gel could be considered as a promising treatment modality for hyperhidrosis with higher efficacy than aluminum chloride 15% lotion and lower recurrence rate.

Compensatory Hyperhidrosis After Non-Surgical Treatment of Primary Focal Hyperhidrosis: Two-Year Single-Centered Prospective Study From Jordan.

Primary focal hyperhidrosis (PH) can be managed by a wide range of medical and surgical modalities. Compensatory hyperhidrosis (CH) is a well-documented complication of surgical treatment. We aimed to investigate the occurrence of compensatory hyperhidrosis (CH) in PH patients after nonsurgical treatment with botulinum toxin A (BTX- A) or iontophoresis. We carried out a unicentric prospective study on PH patients from King Abdullah University Hospital (KAUH) in Jordan. PH patients were evaluated after 1-month of nonsurgical treatment. Patients who developed CH were re-assessed after 3-6 months through a telephone-based interview. A total of 86 patients with PH who underwent nonsurgical treatment with iontophoresis or botulinum toxin were recruited. Twenty-four (27.9%) patients developed subjective CH. It was mild in (75%), moderate in (21%), and severe in (4%) of patients affected, it was self-limiting within a few months in all patients. Patients with CH did not differ significantly in demographic or clinical variables from patients who did not develop CH except at the site of PH (p value = .05). The findings of this study indicate that more than quarter (27.9%) of patients with PH may develop minor compensatory sweating, however this didn't affect satisfaction with treatment.

Anatomical proposal of local anesthesia injection for median nerve block in treating hyperhidrosis with botulinum neurotoxin.

Hyperhidrosis, causing excessive sweat, can be treated with Botulinum neurotoxin injection. Botulinum toxin, an effective and safe treatment for hyperhidrosis, unfortunately involves significant pain due to multiple injections. This study aims to propose a more efficient and less painful approach to nerve blocks for relief, by identifying optimal injection points to block the median nerve, thereby enhancing palmar hyperhidrosis treatment. This study, involving 52 Korean cadaver arms (mean age 73.5years), measured the location of the median nerve relative to the transverse line at the pisiform level to establish better nerve block injection sites. In between the extensor carpi radialis and palmaris longus, the median nerve was located at an average distance of 47.39 ± 6.43mm and 29.39 ± 6.43mm from the transverse line at the pisiform level. To minimize discomfort preceding the botulinum neurotoxin injection, we recommend the optimal injection site for local anesthesia to be located 4cm distal to the transverse line of the pisiform, within the tendons of the palmaris longus and flexor carpi radialis muscles.

Development of a novel nomogram to predict the risk of severe compensatory sweating following endoscopic thoracic sympathectomy.

Endoscopic thoracic sympathectomy (ETS) is a permanent and effective treatment for primary hyperhidrosis and facial blushing; however, severe compensatory sweating (SCS) remains a devastating complication. We aimed to (i) construct a nomogram to predict the risk of SCS, and (ii) investigate factors associated with the level of satisfaction. From Jan 2014 to Mar 2020, 347 patients underwent ETS by a single surgeon. These patients were asked to complete an online questionnaire regarding primary symptom resolution, level of satisfaction, and development of compensatory sweating. Multivariable analysis was conducted via logistic regression and ordinal regression to predict SCS and satisfaction level respectively. Nomogram was developed based on significant predictors. In total, 298 (85.9%) patients responded to the questionnaire with a mean follow up of 4.9 ± 1.8 years. Significant factors associated with SCS in the nomogram included older age (OR 1.05, 95% CI 1.02-1.09, P = 0.001), primary indication other than palmar hyperhidrosis (OR 2.30, 95% CI 1.03-5.12, P = 0.04), and current smoking (OR 5.91, 95% CI 2.46-14.20, P < 0.001). The area under receiver operating characteristic curve was 0.713. Multivariable analysis revealed that longer follow up (β = -0.201 ± 0.078, P = 0.01), gustatory hyperhidrosis (β = -0.781 ± 0.267, P = 0.003), primary indication other than palmar hyperhidrosis (β = -1.524 ± 0.292, P < 0.001), and SCS (β = -3.061 ± 0.404, P < 0.001) were independently associated with a lower degree of patient satisfaction. The novel nomogram can provide a personalized numerical risk estimate to assist both the clinician and patient weigh the pros and cons as part of the decision-making process, mitigating the chance of patient dissatisfaction.

Predictors of Compensatory Sweating Following Video-Assisted Thoracoscopic Sympathectomy in Primary Palmar Hyperhidrosis

Compensatory sweating (CS) is a frequent health concern following treatment of palmar hyperhidrosis using video-assisted thoracoscopic sympathectomy (VATS) and can reduce level of patient satisfaction. A retrospective cohort study including consecutive patients who underwent VATS for primary palmar hyperhidrosis (HH) over a 5-year period was conducted. Various demographic, clinical, and surgical variables were tested for their correlation to postoperative CS through univariate analyses. Variables with significant correlation to outcome were included in a multivariable logistic regression for determining significant predictors. The study included 194, predominantly male (53.6%), patients. About 46% of patients developed CS, mostly during the first month after VATS. Variables with significant correlation (P < 0.05) to CS included age (20 ± 3.6 years), body mass index (BMI) (mean 27 ± 4.9), smoking (34%), associated plantar HH (50%), and laterality of VATS (40.2% in dominant side). Only level of activity showed a statistical trend (P= 0.055). In multivariable logistic regression, BMI, plantar HH, and unilateral VATS were significant predictors for CS. Using receiver operating characteristic curve, the best cutoff point of BMI for prediction was 28.5, with sensitivity 77% and specificity 82%. CS is a frequent health concern early after VATS. Patients with BMI >28.5 and no plantar HH are at higher risk of postoperative CS, and a unilateral dominant side VATS as an initial management step may lessen the risk of CS. Bilateral VATS can be provided for patients with low risk of CS and patients with low satisfaction after unilateral VATS.