Video-assisted Thoracoscopic 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.

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”

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

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.

Video-assisted thoracoscopic sympathectomy for Harlequin syndrome.

Harlequin syndrome is an exceedingly rare condition, characterized by unilateral facial flushing and hyperhidrosis. Postulated to be dysregulated sympathetic nervous system stimulation of the dermal vasculature and blood vessels of the face. There is no clear unifying pathological cause. Due to its heterogeneity and rarity, very little is known about the treatment of it. Hereafter, we describe our experience in successfully curing right-sided Harlequin syndrome through video-assisted thoracoscopic sympathectomy.

Efficacy and Outcome Prediction of Unilateral Video-Assisted Thoracoscopic Sympathectomy in Primary Palmar Hyperhidrosis: A Comparative Study with Bilateral Sympathectomy

To compare unilateral dominant-side video-assisted thoracoscopic sympathectomy (U-VATS) with bilateralprocedures (B-VATS) in terms of efficacy and complications and to identify predictors of outcome after U-VATS. A prospective multicenter cohort study in which patients presented with primary palmar hyperhidrosis were treated by either U-VATS (82 cases) or B-VATS (112 cases). The demographic, clinical, operative, and postoperative findings were collected for all patients and compared in both groups. The factors associated with outcome were identified, and predictors of outcome in U-VATS were investigated to identify best candidates for unilateral sympathectomy. Both groups were balanced regarding demographic and preoperative clinical data. U-VATS was associated with significantly less postoperative pain and shorter hospital stays. Compensatory sweating was significantly less frequent in U-VATS with significantly better improvement in planter hyperhidrosis. Both groups were comparable as regards recurrence rate, patient satisfaction, and quality of life at 1 year. Preoperative Hyperhidrosis Quality of Life Questionnaire scores predicted outcome in U-VATS, and the best cutoff point was identified. U-VATS proved to be equally effective as B-VATS with less postoperative pain, shorter hospital stay, less frequent compensatory sweating, and better improvement of planter hyperhidrosis. The results suggest that patients with preoperative Hyperhidrosis Quality of Life Questionnaire scores >80 are better operated via B-VATS, whereas lower scores are indicated for U-VATS.

Cohort study on 20 years' experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients.

Primary hyperhidrosis is a condition characterized by excessive sweating, inconsistent with the needs for thermoregulation. To assess the effectiveness and the change in the quality of life of patients undergoing bilateral VATS (video-assisted thoracoscopic sympathectomy) for treatment of hyperhidrosis, in a large case series. Cohort study conducted in a tertiary hospital specializing in hyperhidrosis located in São Paulo, Brazil. A total of 2,431 patients who underwent surgery consisting of bilateral video-assisted thoracoscopic sympathectomy between January 2000 and February 2017 were retrospectively assessed in an outpatient clinic specializing in hyperhidrosis. The patients underwent clinical and quality of life assessments on two occasions: firstly, prior to surgery, and subsequently, one month after the operation. The presence or absence of compensatory hyperhidrosis (CH) and general satisfaction after the first postoperative month were also evaluated. All the patients operated had poor or very poor quality of life before surgery. In the postoperative period, an improvement in the quality of life was observed in more than 90% of the patients. Only 10.7% of the patients did not present CH, and severe CH occurred in 22.1% of the patients in this sample. Bilateral VATS is a therapeutic method that decreases the degree of sweating more than 90% of patients with palmar and axillary hyperhidrosis. It improves the quality of life for more than 90% of the patients, at the expense of development of CH in approximately 90% of the patients, but not intensely.

Assessment of the learning curve of video-assisted thoracoscopic sympathectomy in a single neurosurgical trainee: a cumulative summation analysis

BackgroundVideo-assisted thoracoscopic sympathectomy (VATS) is a common procedure unusually practiced by neurosurgeons due to lack of training.ObjectiveTo evaluate the learning curve for VATS in a young neurosurgeon with no previous experience in open sympathectomy techniques or extracranial endoscopic procedures.MethodsThis is a retrospective review and analysis of prospectively collected data in 50 consecutive cases admitted to our facility with the diagnosis of essential palmar and axillary hyperhidrosis operated by a neurosurgical trainee under strict supervision of 2 experienced mentors. After an initial training phase, cumulative sum mation (CUSUM) analysis was used to evaluate the surgical performance of the trainee in terms of operating time, blood loss, hospital stay and failures.ResultsImprovement in operating time was noticed after the first 20 cases with significant affection by changes in OR team. The blood loss was significantly improved after the first 10 cases with less sensitivity to changes in OR team. Hospital stay and failures were steady and within expected values throughout the study.ConclusionAn average of 20 cases may be enough for a neurosurgeon with basal knowledge to attain technical competence in VATS sympathectomy. Mentored surgical training on VATS sympathectomy is a safe and effective training method with failures within expected limits. The experience of the OR team plays an important role in the rapid improvement and consistency of performance.

Evaluation of compensatory hyperhidrosis after sympathectomy: The use of an objective method

To investigate the prevalence of compensatory hyperhidrosis following videothoracic sympathectomy to treat palmoplantar hyperhidrosis and its effect on sweating in the chest, abdomen, back and thighs. Furthermore, to evaluate the concordance between a subjective and an objective method of assessment for compensatory hyperhidrosis. Forty patients with combined palmar and plantar hyperhidrosis who underwent video-assisted thoracoscopic sympathectomy (15 women and 25 men, with a mean age of 25 years) were prospectively followed for 1 year. Subjective and objective parameters were evaluated, using respectively a questionnaire and a sudorometer (Vapometer). In the subjective analysis, in the first month, only 10% of patients did not have compensatory hyperhidrosis, and 70% continued to report it at 1 or more sites after 1 year. In the objective analysis, 35% of the patients did not present compensatory hyperhidrosis after 1 month, and this number persisted stable, with 30% of patients remaining free of compensatory hyperhidrosis after 1 year. The most frequent area affected by compensatory hyperhidrosis was the back in both assessments. There was no positive concordance between the results of the objective and subjective analysis at any time in any of the 4 regions studied. Compensatory hyperhidrosis is a very common postoperative side effect after videothoracic sympathectomy, occurring early after the procedure and persisting for prolonged periods of time. The most frequently affected body area is the back, and no concordance between objective and subjective assessments was observed.

Treatment outcomes and objectification methods of the thoracoscopic sympathectomy in patients with focal hyperhidrosis and blushing syndrome

Uniportal video-assisted thoracoscopic sympathectomy (VATS) is an effective minimally invasive surgical method of choice for the treatment of primary focal hyperhidrosis and blushing syndrome due to uncontrolled operation of the sympathetic nervous system. The aim of this study was to provide an objective assessment of the improvement in the quality of life of patients with primary focal hyperhidrosis and blushing syndrome after bilateral monoport video-assisted thoracoscopic sympathectomy. Materials and methods. The results of surgical treatment were performed for 62 patients aged 17 to 42 years, 26 men and 36 women with a diagnosis of primary focal hyperhidrosis of the extremities and blushing syndrome. All patients underwent bilateral uniport video-assisted thoracoscopic sympathectomy. Patients are divided into 3 groups depending on the level of coagulation of the sympathetic trunk: the first group of the study (n = 9) includes patients after bilateral uniport sympathectomy at the level of R3 (isolated palmar hyperhidrosis), the second (n = 31) - at the level of R3-R4 (palmar and axillary hyperhidrosis), the third group (n = 22) - at the level of R2 (blushing syndrome). Results. In this study, coagulation and separation of the sympathetic trunk through a single port using a silicone port was performed. An excellent clinical result was achieved due to the minimally invasive operation - all 62 patients (100%) were satisfied with the achievement of a rapid stable effect. According to the results of the Dermatology Life Quality Index DLQI (1 month after surgery), the best quality of life measures were observed in patients who underwent separation of the sympathetic trunk at the R3 level – improvement from 20.3 ± 5.9 points to 0.8 ± 0.8 points. After the operation at the R3-R4 level scores the quality of life decreased from 22.77 ± 5.4 points to 2.3 ± 1.3 points, and at the level of R2 - from 16.5 points (QI 14 points - QIII 20 points) to 2 points (QI 1 point - QIII 3 points) p &lt;0.001). There was a difference in quality of life measures in our three groups of patients according to the severity of the disease before surgery. The lowest quality of life was determined in patients with the 4th degree of severity (33 people) and was 26.0 points (QI 23.0 points - QIII 27.3 points) compared with patients with 2d and 3d degrees of severity, 10.0 points (QI 7.7 points - QIII 10.0 points) and 17.0 points (QI 14.0 points - QIII 19.5 points) respectively (p &lt;0.001). After a single-port VATS in three groups there was an increase in quality of life measure, regardless of the severity of the disease before surgery. Conclusions. The most highly specific tests that allow to determine an objective assessment of the severity of the disease and a real assessment of the effectiveness of surgical treatment for hyperhidrosis was TEWL-metry, for blushing syndrome – capillaroscopy. VATS is an effective method of treating patients with hyperhidrosis and blushing syndrome, which significantly improves the quality of life according to the results of the Dermatological Index of Life Quality DLQI (p &lt;0.001) questionnaire.

CT-guided Thoracic Sympathicolysis versus VATS Sympathectomy in the Therapeutic Concept for Severe Primary Palmar Hyperhidrosis.

The objective was to compare computed tomography (CT)-guided thoracic sympathicolysis (CTSy) and video-assisted thoracoscopic sympathectomy (VATS) with regard to their feasibility, the occurrence of minor and major complications, and the clinical outcome. In this study, 88 patients treated by CTSy and 86 patients treated by VATS were retrospectively included. CTSy was performed after establishing the entry plane below the level of the intervertebral space T2/3 via a dorsolateral approach using a 22-G coaxial needle. On average of 5 mL of a sympathicolytic mixture was instilled. VATS was performed under intubation anesthesia. After insertion of the instruments via a minithoracotomy, the parietal pleura was dissected and the sympathetic trunk severed below T2. The interventions were performed unilaterally, the contralateral side being treated after approximately 6 weeks. All patients evaluated their sense of discomfort before treatment as well as 2 days, 6, and 12 months after, on the basis of a Dermatology Quality of Life Index and additionally the side effects that occurred. Both treatments led to a marked reduction of symptoms, whereby mild recurrent sweating occurred over the further course, significantly higher in the CTSy patient group. Short-term miosis and ptosis were rarely found in both groups. As the most common side effect, transient compensatory sweating was reported by 16/88 patients after CTSy and 10/86 patients after VATS. Pneumothoraces developed postoperatively in 7/86 cases. Temporary pain after thoracotomy was experienced by 12/86 patients. For patients with palmar hyperhidrosis, CTSy and VATS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit.

Plantar hyperhidrosis associated with primary palmar hyperhidrosis: Outcome following video-assisted thoracoscopic sympathectomy.

Primary palmar hyperhidrosis is an abnormal over-sweating of palms. It is usually associated with plantar hyperhidrosis. Video-assisted thoracoscopic sympathectomy is the treatment of choice for palmar hyperhidrosis; however, it may affect plantar hyperhidrosis. The aim of this study was to evaluate the effect of thoracoscopic sympathectomy on plantar hyperhidrosis. This prospective study included patients who presented to the Cardiothoracic Surgery Department with primary palmo-planter hyperhidrosis and received thoracoscopic sympathectomy between January 2014 and December 2018. Preoperatively, patients scored subjectively the degree of palmar and plantar hyperhidrosis on Visual Analogue Scale. Following surgery, scoring was performed at three intervals: 7, 30, and 180 days. Presence of compensatory sweating and its scoring was obtained at the same intervals. Complications and patient satisfaction were recorded. A total of 518 patients were included. Complication rate, excluding compensatory hyperhidrosis, was 2.7%. Preoperative Visual Analogue Scale score for palmar hyperhidrosis was 9.9 ± 3.8 that following thoracoscopic sympathectomy decreased to 0.041 ± 0.2 on the seventh postoperative day. Further decrease to 0.3 ± 0.16 was noted on the 30th day and 180th day postoperatively. Preoperative Visual Analogue Scale score for plantar hyperhidrosis was 9.54 ± 0.66 that following sympathectomy decreased to 2.27 ± 1.67 on the seventh postoperative day. However, slight insignificant increase was noted to become 2.73 ± 1.65 on the 30th day and 6th month postoperatively. Compensatory hyperhidrosis was recorded in 3.9% of patients at 6th month postoperatively. Palmar hyperhidrosis is usually associated with plantar hyperhidrosis. Thoracoscopic sympathectomy is an effective and safe treatment for palmar hyperhidrosis. It may completely or partially cure plantar hyperhidrosis.

Comparison of Radiofrequency Ablation (RFA) Versus Video-Assisted Thoracoscopic Sympathectomy (VATS) for Primary Hyperhidrosis: A Multicenter Cohort Study

Background: Hyperhidrosis may affect approximately a hundred million global people; lead to they may be socially stigmatized. We hypothesized that radiofrequency ablation (RFA) and video-assisted thoracoscopic sympathectomy (VATS) would be equivalent in the treatment for primary hyperhidrosis (PH). Methods: In this multicenter cohort study, we recruited patients aged ≥14 years with diagnosed PH from 14 centers in China. The treatment options of RFA or VATS were recruited in patient with informed consent. Clinical effectiveness of treatment was assessed in patients the day of hospital discharge and on the time of study endpoint. Hyperhidrosis Disease Severity Scale (HDSS) and quality of life (QOL) were assessed in patients the day before operative and on the time of study endpoint. The primary endpoint was the rate of complete remission for hyperhidrosis. Propensity scoring and multivariable models respectively were used to assess the clinical effectiveness and the symptom recurrence risk of treatment options. Findings: Between March 4, 2015, and Sept 31, 2020, 807 patients were enrolled in our study. 351 of these patients underwent RFA, and 456 were VATS. After propensity score matching, the rate of complete remission was lower in RFA than in VATS (287/351[80.3%] versus 319/351 [90.1%], standardized mean differences, -30.4%). We did find the rate of symptom recurrence risk was higher in RFA than in VATS (HR 2.315, 95%CI 1.511-3.546, P <0.0001). HDSS and QOL were significantly improved in postoperative than in preoperative for two groups, however, it was more significant improvement in VATS than in RFA (p<0.0001). Interpretation: This study suggested that performing RFA or VATS was significant success procedure for patients with PH. However, the RFA had a lower success rate than VATS for complete remission of hyperhidrosis in postoperative 1-year, but it is more possibly accepted due to lower symptomatic burden and costs in patients. Funding Statement: This work was supported by the National Natural Science Foundation of China (No. 81671957, 81873951 and 82072208), Key projects of Guangdong Natural Science Foundation (No. 2018B030311038). Declaration of Interests: The writing committee declares that they have no conflicts of interest. Ethics Approval Statement: The study was approved by institution ethics committees at principal investigator centers. All patient’s follow-up provided written informed consent before inclusion. The study was done in accordance with the Declaration of Helsinki and Good Clinical Practice principles.

Video-assisted thoracoscopic sympathectomy for thoracic three versus thoracic four for the treatment of primary hyperhidrosis (single-center study)

Background Hyperhidrosis is a pathologic disease of excessive sweating in amounts greater than the physiologically necessary thermoregulation. Although hand sweating does not have a significant effect on the health of patients, it can be uncomfortable to shake hands, complicate the writing, and cause humiliation and psychological distress. The primary treatment for patients with the disease is video-assisted thoracic sympathectomy (VATS) to be done with accuracy, with improved health care and good outcomes. Aim The aim was to assess the effect VATS on patient’s quality of life according to the level of sympathectomy performed, as well as the presence of postoperative complications. Patients and methods This is a comparative randomized study that was conducted at Al-Zahraa University Hospital. A total of 126 patients with palmar hydrosis were involved in this study. The authors included patients from 16 to 40 years, in whom the sweating had a negative effect on their work. The authors have classified patients into two groups, those who underwent VATS on T3 and those who on T4 level, randomly. The authors followed patients at 1, 6, 12, and 24 months. Results The study was conducted on 126 patients, comprising 27.7% males and 72.3% females, with mean age of 25.8+5.8 and 25.2+4.4 in T3 and T4 groups, respectively. The incidence of compensatory hyperhidrosis was significantly lower in T4 group at 6 and 12 months, and also it was lower at long-term follow-up of 24 months, but with no significance statistically. We have noticed high rates of satisfaction of different degrees in both groups. T4 group showed better efficacy in limiting compensatory hyperhidrosis compared with T3 group. Conclusion Thoracoscopic T4, T3 sympathectomy provides very good results, with very low incidence of compensatory hyperhidrosis. T4 appears to be the best segment for treatment of primary hyperhidrosis.

Is intravenous morphine alone effective for postoperative analgesia in bilateral, single-port video-assisted thoracoscopic sympathectomy performed in the supine position?

Introduction The method of operation carried out by clip application that utilizes the supine position and single port for thoracoscopic sympathectomy has been defined in recent years. This method leads to less pain as less tissue damage occurs. There is no any recommendation about postoperative analgesia management. The aim of this study is to investigate whether intravenous morphine alone effective for postoperative analgesia in bilateral, single-port video-assisted thoracoscopic sympathectomy performed in the supine position. Methods After obtaining ethical committee approval, postoperative analgesia management of 28 patients who underwent bilateral, single-port video-assisted thoracoscopic sympathectomy was retrospectively investigated. The patients were divided into two groups; After induction of anaesthesia, intrathecal morphine was administered to a group at a dose of 0.6 mg/3 mL, and postoperative patient-controlled analgesia(PCA) was administered intravenously (IV) with a locked time of 1 mg bolus for 30 minutes(Group ITM,n=14). In the other group, IV morphine was applied in the same doses only by the PCA method(Group PCA,n=14). Visual analogue scale (VAS) values and IV total morphine consumption were recorded at the time of extubation and at the 6th, 24th and 48th hours postoperatively. For statistical significance p value was determined as 0.05. Results In terms of demographic and surgical data (mean age, gender, ASA scores, duration of operation), there was no statistically difference between the groups. At the time of extubation and at the postoperative 6th hour, VAS scores were statistically significantly lower in Group ITM than in the Group PCA (Comparison of the recorded VAS score after extubation: 0.71±1.20 in Group ITM, 2.43±1.74 in Group PCA, p=0.012. Postoperative 6th hour VAS score comparison: 0.21±0.57 in Group ITM, 1.57±1.60 in Group HKA, p=0.011). There was no significant difference between the groups in terms of VAS values at the postoperative 24th and 48th hours. In Group PCA, total IV morphine (mg) consumption at the postoperative 24th and 48th hours was statistically significantly higher than the Group ITM (total morphine consumption at the postoperative 24th hour: 14.57±20.18 vs. 4.14±5.62, p Discussion The results of this study show that in the management of pain after thoracoscopic sympathectomy operations performed with this method, we believe that even though an adequate analgesia is provided through ITM, IV PCA morphine provided clinically acceptable analgesic efficacy, and a regional administration may not be required in patients who will be operated with this method.

Video-assisted thoracoscopic sympathectomy versus modified Wittmoser method in surgical management of primary hyperhidrosis

PurposesWe compared two different surgical methods evaluating the effectiveness of procedures and the quality of life (QoL) of patients.MethodsFrom January 2010 to November 2017 we carried out 476 biportal video-assisted thoracoscopic surgery (VATS) approaches of sympathetic chain in 238 patients. One hundred and twenty-nine (54%) patients underwent conventional sympathectomy (CS) while 109 (46%) patients underwent sympathicotomy associated with the division of the rami communicantes (MWT). Quality of Life (QoL) was classified as follows: from 20 to 35 excellent; from 36 to 51 very good; from 52 to 68 good; from 69 to 84 poor; and > 84 very poor.ResultsWe noticed statistical significant reduction of complications comparing CS with MWT approaches (chest pain from 36.4 to 4.5%; paresthesias from 8.5 to 3.6%; bradycardia from 28.6 to 10%, respectively). The preoperative and postoperative QoL index evaluation revealed a statistically significant improvement after surgery (CS: 86 ± 2 versus 35 ± 1, p = 0.00001; MWT: 85 ± 1 versus 33 ± 2, p = 0.00001), with general satisfaction of the two techniques.ConclusionModified Wittmoser method seems to be a valid alternative to conventional sympathectomy, minimizing the percentage rate of complications and showing significant effectiveness in the quality of life improvement.

TREATMENT OF PRIMARY PALMAR HYPERHIDROSIS WITH VIDEO-ASSISTED THORACOSCOPIC SYMPATHECTOMY IN CHILDREN: EFFECTIVENESS AND PATIENT SATISFACTION

TYPE: Abstract Publication TOPIC: Pediatrics PURPOSE: Hyperhidrosis is an embarrassing condition. We evaluated the effectiveness of video-assisted thoracoscopic sympathectomy to relieve symptoms in children with primary palmar hyperhidrosis and assessed patient satisfaction with the procedure. METHODS: After ethical approval, 30 children (228 females, 93%%) treated with bilateral thoracoscopic sympathectomy for primary palmar hyperhidrosis at a tertiary care hospital from May 2007 to June 2017 were evaluated. Median age at the time of surgery was 12 years (min 5; max 16 years). Using two 5-mm trocars, the sympathetic T3/T4 ganglia were sectioned bilaterally and resected. A hyperhidrosis-related questionnaire was administered to all children after the surgery to assess their satisfaction. RESULTS: Two children with persistent hyperhidrosis required reoperation, which was again performed using video-assisted thoracoscopy. Complete resolution of palmar hyperhidrosis was achieved in 22 (82%) children aAt a median follow- up of 60 months (min 7; max 118 months), 22 (82%) children had achieved complete resolution of palmar hyperhidrosis. In five (18%), symptoms were reduced, but bilateral palmar hyperhidrosis persisted. Postoperative compensatory hyperhidrosis occurred in 55.6%, but was regarded as not important. In relation to satisfaction, all children were very satisfied with the final result of surgery. All stated that they would have done it again, and that they would recommend the procedure for others with primary palmar hyperhidrosis. CONCLUSIONS: Video-assisted thoracoscopic sympathectomy at T3-T4 ganglia was effective to relieve symptoms with high levels of patient satisfaction. The compensatory hyperhidrosis observed in most children did not alter the perception of improvement in symptoms. CLINICAL IMPLICATIONS: Palmar Hyperhidrosis in children. DISCLOSURE: No significant relationships. KEYWORDS: hyperhidrosis, thoracic sympathectomy, patient satisfaction

Video Yardımlı Torakoskopik ID Sempatektomilerde Entübe ve Non-entübe Tekniklerin Karşılaştırılması

Video Yardımlı Torakoskopik ID Sempatektomilerde Entübe ve Non-entübe Tekniklerin Karşılaştırılması

Impact of Video-Assisted Thoracoscopic Sympathectomy and Related Complications on Quality of Life According to the Level of Sympathectomy

Primary hyperhidrosis is defined as excessive sweating of idiopathic etiology, associated with sympathetic hyperactivity, which greatly impacts patients' quality of life (QoL). The definitive treatment for palmar and axillary hyperhidrosis (PAH) is video-assisted thoracic sympathectomy (VATS). The objective of this study was to evaluate the quality of life of patients with PAH before and after VATS according to the level of sympathectomy performed, as well as the presence of compensatory hyperhidrosis (CH) and other complications. All patients who underwent VATS in our vascular surgery department between January 2011 and December 2016 were included in the analysis. From 120 contact attempts, 88 interviews were carried out. Patients were divided into 2 groups according to the intervened thoracic level: high thoracic ganglion (HTG; T2, T2-T3, T2-T3-T4; n=68) and low thoracic ganglion (LTG; T3, T3-T4, T4; n=20). The questionnaire evaluated preoperative PAH severity, the presence of CH, preoperative and postoperative QoL, and postoperative satisfaction. The median age of patients was 29years, and the median follow-up period was 32months (IQR of 34months). Most patients had severe or very severe PAH (97.7%) and preoperative QoL was bad or very bad (95.5%). Postoperatively, QoL was significantly improved in all domains evaluated, with no differences observed between the groups. The overall percentage of complications was 11.4%, mostly pneumothorax, but there was a significantly lower incidence of complications in the HTG group (P=0.029). Compensatory hyperhidrosis developed in 85.2% of cases, but it was only considered intolerable in 10.2%. The incidence of CH was 82.4% in the HTG group and 95% in the LTG group, with no statistically significant differences between the groups (P=0.147). Palmar and axillary hyperhidrosis severely affects QoL, and video-assisted thoracic sympathectomy was proven to be effective regardless of the target ganglion resected. Although CH was frequent, it was tolerated in most cases.

T3 versus T4 video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: A protocol for a systematic review and meta-analysis.

Background:Palmar hyperhidrosis (PH) is a common sympathetic disorder that reduces patient’ quality of life. Video-assisted thoracoscopic sympathectomy (VTS) is a popular and effective treatment for PH. However, there is substantial controversy about the treatment of PH with VTS at the T3 or T4 level. We will compare the quality metrics of VTS at T3 versus T4 to determine the optimal level for VTS.Methods:We will search PubMed, Scopus, Web of Science, Embase, Cancerlit, the Cochrane Central Register of Controlled Trials, and the Google Scholar databases for relevant clinical trials published in any language before March 31, 2019. Randomized controlled trials (RCTs), quasi-RCTs, propensity score-matched comparative studies, and prospective cohort studies of interest, published or unpublished, that meet the inclusion criteria will be included. Subgroup analysis of the type of operation, sex of patient, and ethnicity of patient will be performed.Results:The results of this study will be published in a peer-reviewed journal.Conclusions:The results of this study will provide reliable evidence for the development of optimal treatment strategies for patients with PH. Owing to the characteristics of disease and intervention methods, randomized controlled trials may not be sufficient. We will include high-quality nonrandomized controlled trials, but this may lead to high heterogeneity and may affect the reliability of the results.PROSPERO registration number:CRD42018116607.