Bilateral endoscopic thoracic sympathectomy via single incision for the treatment of palmar and axillar hyperhidrosis

Abstract

Aim: Video-assisted thoracoscopic sympathectomy (VATS) is a safe, minimally invasive and effective procedure for primer hyperhidrosis. In this research, we aimed to present the advantages of uniportal endoscopic thoracic sympathectomy (ETS) surgery on patients who had palmar and axillary hyperhidrosis and did not respond to medical treatment.

Methods: Between February 2012 and November 2018, 46 ETS surgeries were performed on 23 patients (12 female patients and 11 male patients; the average age was 21 [16-27]) and the outcomes were evaluated in this retrospective cohort study. Uniport (Richard Wolf) sympathicotripsy and Kuntz nerve ablation were performed. We presented all the data about surgical techniques, perioperative-postoperative complications and patient satisfaction with their long-term results.

Results: During the long term follow-ups of our patients, compensatory hyperhidrosis was the most frequently observed finding. Hyperhidrosis occurred in multiple areas of the body in 11 of the patients (47%). 22 patients were completely satisfied with ETS surgery, and one of our patient with compensatory back sweats reported partial satisfaction. Recurrent hyperhidrosis was observed on the left side of one of our patients at 33 months post-operative examination. Minimal pneumothorax was observed in one of the patients, and it was regressed with medical treatment. The average operation duration was recorded as 21 minutes (15-31) per each hemithorax. 

Conclusion: In conclusion, endoscopic thoracic sympathectomy is a treatment option with low mortality and morbidity. This approach should be considered for patients with palmar and axillar hyperhidrosis that medical treatment was not effective.

Keywords

• Hyperhidrosis,Quality of life,Uniportal thoracoscopic surgery,Sympathectomy

Palmar ve aksillar hiperhidrosis tedavisinde tek kesi ile bilateral endoskopik torakal sempatektomi

Abstract

Amaç: Video yardımlı torakoskopik cerrahi primer hiperhidroz tedavisinde güvenli, minimal invaziv ve etkili bir işlemdir. Biz bu çalışmamızda, medikal tedaviden fayda görmeyen palmar ve aksiller hiperhidroz hastalarında endoskopik torasik sempatektomi (ETS) operasyonlarının avantajlarını sunmayı amaçladık.

Yöntemler: 2012 Şubat-2018 Kasım arasında yirmi üç hastaya (12 kadın,11 erkek yaş ortalaması 21 [16-27] kırk altı ETS operasyonu uygulandı ve sonuçlar bu retrospektif kohort çalışmada değerlendirildi. Uniport (Richard Wolf) T2-T4 sempatik ganglionu ve Kuntz sinir ablasyonu yapıldı. Cerrahi teknik ve operasyon süresi ile ilgili tüm veriler, perioperatif ve postoperatif komplikasyonlar, hasta memnuniyeti ve uzun dönem sonuçları sunuldu.

Bulgular: Hastalarımızın uzun dönem takiplerinde en sık olarak vücudun çeşitli bölgelerinde kompansatuar terleme gördük ve 11 (%47) oranındaydı. Yirmi iki hasta ETS operasyonundan tamamıyla memnundu. Kompansatuar sırt terlemesi olan bir hasta kısmen memnunluk bildirdi. Otuz üç ay sonra hastalarımızdan birinin sol tarafında tekrarlayan hiperhidrozis gözlendi. Bir hastamızda minimal pnömotoraks izlendi ve medikal tedaviyle geriledi. Ortalama operasyon süresi her bir hemitoraks için 21 dk (15-31) olarak kaydedildi. 

Sonuç: Medikal tedaviden fayda görmeyen hiperhidrozisli hasta grubunda, endoskopik torasik sempatektomi düşük mortalite ve morbidite ile yüksek hasta memnuniyeti sebebiyle tercih edilmesi gereken bir tedavi seçeneği olduğu sonucuna vardık.

Keywords

• Hiperhidroz,Yaşam kalitesi,Uniportal torakoskopi,Sempatektomi

References

1. 1. Claes G, Drott C, Göthberg G. Thoracoscopy for autonomic disorders. Ann Thorac Surg. 1993;56:715–6. doi: 10.1016/0003-4975(93)90961-G
2. 2. Cerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, et al. The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011;91:1642-8. doi: 10.1016/j.athoracsur.2011.01.105
3. 3. Kaplan T, Ekmekçi P, Koçer B, et al. Tek akciğer ventilasyonu kullanmadan hiperhidroz için bilateral sempatikotomi . Turk J Med Sci. 2015;45:771–4.
4. 4. Yano M, Kiriyama M, Fukai I, Sasaki H, Kobayashi Y, Mizuno K, et al. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: efficacy of T2 and T3 ganglion resection. Surgery. 2005;138:40–5. doi: 10.1016/j.surg.2005.03.026
5. 5. Libson S, Kirshtein B, Mizrahi S, Lantsberg L. Evaluation of compensatory sweating after bilateral thoracoscopic sympathectomy for palmar hyperhidrosis. Surg Laparosc Endose Percutan Tech. 2007;17:511-3. doi: 10.1097/SLE.0b013e318136e3a1
6. 6. Connolly M, de Berker D. Management of primary hyperhidrosis: a summary of the different treatment modalities. Am J Clin Dermatol. 2003;4:681-97. doi: 10.2165/00128071-200304100-00003.
7. 7. Miller JL, Hurley HJ. Diseases of the eccrine and apocrine sweat glands. Dermatology. Ed. Bolognia JL, Jorizzo JL, Rapini RP. Second edition. Spain, Mosby Elsevier, 2008;531-48.
8. 8. Hornberger J, Grimes K, Naumann M, et al. Multi-specialty working group on the recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004;51:274–86. doi: 10.1016/j.jaad.2003.12.029

9. 9. Garcia Franco CE, Perez-Cajaraville J, Guillen-Grima F, España A. Prospective study of percutaneousradiofrequencysympathicolysis in severe hyperhidrosis and facial blushing: Efficacy and safety findings. Eur J Cardiothorac Surg. 2011;40:e146-51. doi: 10.1016/j.ejcts.2011.05.010
10. 10. Macía I, Moya J, Ramos R, Rivas F,Urena A,Rosado G,et al. Primary hyperhidrosis. Current status of surgical treatment. Cir Esp. 2010;88:146-51. doi: 10.1016/S2173-5077(10)70018-1
11. 11. Lee DY, Yoon YH, Shin HK, Kim HK, Hong YJ. Needle thoracic sympathectomy for essential hyperhidrosis: intermediate-term follow-up. Ann Thorac Surg. 2000;69:251–3. doi: 10.1016/S0003-4975(99)01191-1
12. 12. Yim AP, Liu HP, Lee TW, Wan S, Arifi AA.‘Needlescopic’ video-assisted thoracic surgery for palmar hyperhidrosis.Eur J Cardiothorac Surg. 2000;17:697–701. doi: 10.1016/S1010-7940(00)00378-X
13. 13. Gossot D, Kabiri H, Caliandro R, Debrosse D, Girard P, Grunenwlad D. Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures. Ann Thorac Surg. 2001;71:1116–9. doi: 10.1016/S0003-4975(01)02422-5
14. 14. Chen YB, Ye W, Yang WT, Shi L, Guo XF, Xu ZH, et al. Uniportal versus biportal video-assisted thoracoscopic sympatectomy for palmar hyperhidrosis. Chin Med J (Engl). 2009;122:1525-8. doi: 10.3760/cma.j.issn.0366-6999.2009.13.010
15. 15. Montessi J, Almeida EP, Vieira JP, AbreuMda M, Souza RL, Montessi OV. Videoassisted thoracic sympathectomy in thetreatment of primary hyperhidrosis: a retrospectivestudy of 521 cases comparing different levels of ablation. Bras Pneumol. 2007;33:248-54. doi: 10.1590/S1806-37132007000300004
16. 16. Miller DL, Force SD. Temporary thoracoscopic sympathetic block for hyperhidrosis. Ann Thorac Surg. 2008;85:1211-4. doi: 10.1016/j.athoracsur.2007.11.020
17. 17. Lyra Rde M, Campos JR, Kang DW, Loureiro MP, Furian MB, Costa MG, et al. Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis. J Bras Pneumol. 2008;34:967–77. doi: 10.1590/S1806-37132008001100013
18. 18. Rajesh YS, Pratap CP, Woodyer AB. Thoracoscopic sympathectomy for palmar hyperhidrosis and Raynaud’s phenomenon of the upper limb and excessive facial blushing: a five year experience. Postgrad Med J. 2002;78:682-4. doi: 10.1136/pmj.78.925.682
19. 19. Yücel O, Sapmaz E, Güler A, Alper G, Çaylak H, Gürkök S, et al. The effects of bilateral thoracic sympathectomy on cardiovascular system (An experimental study). Turk Klin J Med Sci. 2009;29:632-6.
20. 20. Apiliogullari B, Esme H, Yoldas B, Duran M, Duzgun N, Calik M. Early and midterm results of single-port video-assisted thoracoscopic sympathectomy. Thorac Cardiovasc Surg. 2012;60:285-9. doi: 10.1055/s-0032-1304541
21. 21. Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Girard P, et al. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg. 2003;75:1075–9. doi: 10.1016/S0003-4975(02)04657-X