Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis

Abstract

CONTEXT: Essential hyperhidrosis is a frequent disorder causing significant functional impairment. The advent and development of video-assisted thoracoscopic techniques now allows thoracic sympathectomy to be carried out precisely and safety with good results and minimal morbidity. OBJECTIVE: To assess the impact of video-assisted thoracic sympathectomy in patients diagnosed as presenting severe and disabling hyperhidrosis. TYPE OF STUDY: This was a longitudinal study of the clinical course of all hyperhidrosis cases selected for surgery between May 1999 and January 2003. SETTING: Division of Thoracic Surgery, Universidade Federal de São Paulo (UNIFESP). PARTICIPANTS: 743 patients with surgery indicated due to palmar hyperhidrosis (49.8%), palmar-axillary hyperhidrosis (38.1%), craniofacial hyperhidrosis (8.9%) or isolated axillary hyperhidrosis (2.8%). PROCEDURES: Video-thoracoscopic sympathectomy was performed, isolating the second thoracic ganglion (T2) in all patients, with additional sympathectomy of T3 and T4 if necessary. MAIN MEASUREMENTS:The clinical course was followed up via questionnaires, phone calls, letters and statements. Simple questions were asked regarding the disappearance of symptoms and presence and intensity of compensatory sweating. RESULTS: The surgery was regarded as efficient in all cases of palmar hyperhidrosis. In the craniofacial hyperhidrosis cases, partial recurrence of the symptoms occurred in 2 cases (3.0%). Partial recurrence or persistence of symptoms occurred in 20% of the patients with predominantly axillary symptomatology. The compensatory sweating was considered disagreeable or uncomfortable by about 30% of the patients, but it only reached the level of regretting the operation for 3% of them. This occurred more frequently in patients with axillary hyperhidrosis. Ten cases of complications occurred. CONCLUSION: Thoracoscopic sympathectomy provides very good results in most patients, with a very low complication rate. However, the assessment of surgical results using conventional methods is imprecise and inaccurate. Different methodology, including quality of life assessment, must be used for comparing results and providing objective data on the results of this operation.

Sympathectomy for Palmar Hyperhidrosis

“…In previous studies, postoperative pain was reported between 0.8 and 93 % for thoracoscopic surgeries [2,10,11,13,[17][18][19]. Pain at the time of discharge affected 20 % of the patients, which decreased to 10 % at the tenth day of postoperation in our study.…”

“…Palmar hyperhidrosis is a relatively frequent situation, which causes social embarrassment, psychological problems, and interruption in daily activities [5,[9][10][11]. Although nonoperative treatment modalities such as topical agents, iontophoresis, antidepressants, and botox may provide some benefits, they have short effect duration and some side effects [8].…”

“…Carbon dioxide insufflation was not used in our operations like in most of the studies that were done before [2,5,[8][9][10][12][13][14]. Semi-seated position of the patient and lowvolume high-frequency ventilation provide enough visualization of sympathetic chain.…”

Interventional management of intractable sympathetically mediated pain by computed tomography‐guided catheter implantation for block and neuroablation of the thoracic sympathetic chain: technical approach and review of 322 procedures

“…The incidence of permanent Horner's syndrome was 0.3%, probably induced by misidentification of the T2 ganglion, excessive traction on the chain or excessive use of diathermy. Another problem arising during thoracoscopic sympathectomy is that of postoperative pain requiring opioid analgesia [25] or tricyclic antidepressants [26]. None of the above events was found during our CT-guided method.…”

Simpatectomia torácica por videotoracoscopia

“…(4) The authors of the aforementioned Editorial cited recidivism rates of 8.2% for palmar hyperhidrosis and 13% for axillary hyperhidrosis. (2,5) Finally, it is of note that we carried out between 3 and 10 sympathectomies per week and always taught our graduate students and residents that professional and scientific ethics are incompatible with deviations.…”