Thoracoscopic sympathicolysis for essential hyperhidrosis: effects on pulmonary function

Abstract

Bilateral interruption of the upper dorsal sympathetic chain at the D2 and D3 level represents the only permanent cure for essential hyperhidrosis. Following surgical sympathectomy, significant and symptomatic changes in pulmonary function have been observed. Since functional effects of the surgical intervention cannot be excluded, we wondered whether such alterations also occurred after thoracoscopic sympathicolysis; these should then be attributable to the surgical denervation itself.Pulmonary function tests (PFTs), including spirometry and body plethysmographic measurement of lung volumes and airway resistance and conductance, were compared before and 6 weeks after thoracoscopic sympathicolysis in 47 patients. In order to virtually exclude any effects of thoracoscopy on the test results, PFTs were repeated 6 months after thoracoscopic sympathicolysis in 35 patients.Essential hyperhidrosis was completely relieved in all patients, thereby confirming the interruption of the D2-D3 sympathetic chain. None of the patients developed respiratory symptoms after thoracoscopic sympathicolysis. Forced expiratory volume in one second (FEV1) (-3%), forced expiratory flow after exhaling 75% of vital capacity (FEF75) (-8%) and total lung capacity (TLC) (-3%) were slightly but significantly reduced at six weeks after thoracoscopic sympathicolysis; whereas airway resistance (Raw) had increased (+12%). After correction for the small decrease in lung volume (FEV1/forced vital capacity (FVC), specific airway resistance (sRaw), specific airway conductance (sGaw))significant changes in "volume-dependent" PFT parameters were no longer observed. Smoking status had no influence on the reduction in FEF75. At 6 months after thoracoscopic sympathicolysis, TLC had returned to preoperative values, whereas FEF75 remained decreased (-8.6%). The decrease in airway calibre was confirmed by small but significant changes in FEV1/FVC (-2%) and Raw (+29%).We conclude that thoracoscopic sympathicolysis in patients with essential hyperhidrosis causes only minimal and subclinical changes in pulmonary function secondary to a temporary small decrease in lung volume, which in turn is probably inherent to the thoracoscopic procedure. D2-D3 sympathicolysis, in itself, is responsible only for a small and permanent decrease in forced expiratory flow, which suggests that, at least in essential hyperhidrosis patients, airway bronchomotor tone is influenced by sympathetic innervation. Eur Respir J., 1996Respir J., , 9, 1660Respir J., -1664 Essential hyperhidrosis (EH) is a disorder characterized by excessive sweating of the palms of the hands and often the armpits and soles of the feet [1]. It is caused by a poorly understood overactivity of the sympathetic nervous system at the level of the D2 and D3 dorsal sympathetic ganglia [2]. Anatomical interruption of the sympathetic innervation at this level, preferably by minimally invasive techniques, such as percutaneous ablation or thoracoscopy, provides a permanent cure in patients with severe EH refr...

Effect of Thoracic Sympathectomy on Arm and Leg Exercise Capacity and on Lung Function

“…However, these authors did not assess arm exercise capacity, which is also likely to be affected. Our findings are in agreement with those of Noppen and Vincken [6]and we expanded the results to arm exercise.…”

“…However, in both studies TS was performed through a thoracotomy and the changes could have resulted from the inherent thoracic wall trauma. When chest wall trauma was minimized by using the thoracoscopic approach, Noppen and Vincken [6]still found a small fall in flow rates 6 months following TS, and in the diffusion capacity 6 weeks after surgery [12]. These findings suggest that in contrast to the common belief, neurosympathetic output may play a role in regulating the airway tone, at least in some subjects [3, 4, 6].…”

“…That study [7]can be criticized since the evaluation was performed only 30 days following a transthoracic operation, when recovery from the thoracotomy had probably not been completed. In contrast, Noppen and Vincken [6]found in a recent study that leg exercise capacity was not reduced at 1 month after thoracoscopic TS. However, these authors did not assess arm exercise capacity, which is also likely to be affected.…”

“…When chest wall trauma was minimized by using the thoracoscopic approach, Noppen and Vincken [6]still found a small fall in flow rates 6 months following TS, and in the diffusion capacity 6 weeks after surgery [12]. These findings suggest that in contrast to the common belief, neurosympathetic output may play a role in regulating the airway tone, at least in some subjects [3, 4, 6]. In a previous study in which only 3 of the subjects had a past history of asthma [13], TS caused on average no effect on bronchial reactivity.…”

“…Interruption of these pathways by transthoracic operations has been associated with reduced lung functions [3, 4]. Even after thoracoscopic sympathectomy, in which the chest wall trauma is minimal [5], expiratory flow rates are slightly reduced [6]. These respiratory effects as well as the alteration of the chronotropic input to the heart and the reduced blood pressure [7]after thoracic sympathectomy (TS) may be considered important if they are associated with reduced exercise capacity.…”