Upper dorsal endoscopic thoracic sympathectomy: a comparison of one- and two-port ablation techniques

Murphy, Maureen; Ghosh, Jonathan; Khwaja, Nadeem; Murray, David; Halka, Anastassi; Carter, Andrew; Turner, Neill J.; Walker, Michael G.

doi:10.1016/j.ejcts.2006.04.016

Cited by 31 publications

(28 citation statements)

References 22 publications

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“…(12) Selective T3 sympathectomy resulted in a lower rate of compensatory sweating rate (17%), compared with conventional T2 and T3 sympathectomy (46%). (17) These results are consistent with our findings, since our patients who underwent more limited denervation, especially when the sympathectomy was performed at the lower levels, were more likely to have a favorable outcome.…”

Section: Discussionsupporting

confidence: 82%

“…It was found that one-ganglion thoracoscopic sympathectomy resulted in a fewer disturbing side effects than did the two-ganglion version of the procedure. (17) The severity of compensatory sweating might be reduced by limiting the extent of the denervation. When denervation is restricted, compensatory sweating is expected to be mild.…”

Section: Discussionmentioning

confidence: 99%

“…(3,9,13,16,17) One study showed that patients submitted to oneport sympathectomy present better outcomes in terms of length of hospital stay, rate of postoperative pneumothorax, and the need for chest tube placement, although the number of ports was not found to correlate with the level of patient satisfaction. (16) Another study analyzed the effectiveness of and complications following one-and two-ganglion resection in patients with palmar hyperhidrosis.…”

Section: Surgical Techniquementioning

confidence: 99%

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Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction

et al. 2009

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Objective: This prospective study aimed at investigating predictive factors for compensatory sweating after thoracoscopic sympathectomy. Methods: From 2000 to 2002, 80 patients (53 females and 27 males) underwent thoracoscopic sympathectomy to treat hyperhidrosis. Patient ages ranged from 12 to 56 years, and the mean postoperative follow-up period was 42.51 ± 5.98 months. Patient satisfaction with the results was evaluated through the use of a rating scale. The procedure was performed bilaterally: at the T2 level for facial hyperhidrosis; at the T3-T4 level for axillary hyperhidrosis; and at the T3 level for palmar hyperhidrosis. Results: Post-operatively, 68 patients (85.0%) presented compensatory sweating, which was classified as mild in 23 (33.8%), moderate in 23 (33.8%) and severe in 22 (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, whereas 10 patients (12.5%) were dissatisfied. The level of patient satisfaction varied according to gender, age, body mass index (BMI) and extent of denervation. The compensatory sweating was more severe on the abdomen and back than on the legs. Conclusions: Although compensatory sweating, which is a common adverse effect of sympathectomy, occurred in the majority of cases, the level of patient satisfaction was high. The best candidates for thoracoscopic sympathectomy are young adult women with a BMI ≤ 24.9 kg/m 2 .Keywords: Sympathectomy; Hyperhidrosis; Thoracoscopy; Postoperative complications; Thoracic surgery, video-assisted. ResumoObjetivo: Este estudo prospectivo visou investigar fatores preditivos para a hiperidrose compensatória após a simpatectomia toracoscópica. Métodos: De 2000 a 2002, 80 pacientes (53 mulheres e 27 homens), com idade entre 12 e 56 anos, foram submetidos à simpatectomia toracoscópica para o tratamento de hiperidrose e acompanhados em média por 42,51 ± 5,98 meses. A satisfação destes pacientes quanto aos resultados do procedimento foi aferida por meio de uma escala de avaliação. O procedimento foi executado bilateralmente: no nível de T2 para a hiperidrose facial; de T3 e T4 para a hiperidrose axilar; e de T3 para a hiperidrose palmar. Resultados: No período pós-operatório, 68 pacientes (85,0%) apresentaram hiperidrose compensatória, que foi classificada como leve em 23 (33,85%), moderada em 23 (33,8%) e grave em 22 (32,4%). Quanto aos resultados da cirurgia, na avaliação dos pacientes, 70 deles (87,5%) se consideraram satisfeitos, enquanto 10 pacientes (12,5%) disseram estar insatisfeitos. O grau de satisfação do paciente variou de acordo com o sexo, a idade, o índice de massa corpórea (IMC) e a extensão da operação. A hiperidrose compensatória foi mais intensa no abdome e dorso do que nas pernas. Conclusões: Embora a hiperidrose compensatória seja um efeito adverso frequente após a simpatectomia, o grau de satisfação dos pacientes foi elevado. Os melhores candidatos para simpatectomia toracoscópica são mulheres adultas jovens com IMC ≤ 24,9 kg/m 2 .

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

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Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction

et al. 2009

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“…After surgery, 93.21% of patients reported mild or moderate hyperhidrosis, and 84.56% reported a significant improvement in quality of life. These data were similar to other studies (14,15,21), emphasizing the effectiveness of thoracoscopic sympathectomy in the treatment of primary focal hyperhidrosis.…”

Section: Discussionsupporting

confidence: 80%

“…Open surgical techniques (posterior, supraclavicular, transthoracic or transaxillary approaches) are nowadays almost completely abandoned. They were substituted by minimally invasive procedures, such as videothoracoscopic sympathectomy or percutaneous radiofrequency ablation (15,17). The advantages of this minimally invasive surgical procedure include: excellent visualization of the sympathetic chain, facilitating the surgical procedure itself, a significant reduction of hospital stay, reduction in analgesic medications, as well as extraordinary postoperative results.…”

Section: Discussionmentioning

confidence: 99%

Videothoracoscopic sympathectomy - a standard treatment for primary hyperhidrosis at the Clinic of Thoracic Surgery in Sremska Kamenica / Videotorakoskopska simpatektomija – standarna hirurška metoda za lečenje primarne hiperhidroze na Klinici za grudnu hirurgiju u Sremskoj Kamenici

Kuhajda¹,

Milos²,

Đurić³

et al. 2010

Serbian Journal of Dermatology and Venerology

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Primary hyperhidrosis affects approximately 3% of the world's population, particularly young female adults. It is defined as excessive, profuse sweating of the palms, soles, armpits and face. Conservative treament includes diverse modalities, however, surgical treatment has shown the best long-term results. The objective of this study was to assess some disease-specific epidemiological characteristics in a pre-selected group of patients seeking surgical therapy, as well as outcomes of thoracoscopic sympathectomy. The severity and impact of hypehidrosis was assessed, using Hyperhidrosis Disease Severity Scale (HDSS: patients rate the serverity of symptoms on a scale from 1 to 4). Thoracoscopic sympathectomy was performed using a double lumen endotracheal tube, via bilateral 5 mm dual port videothoracoscopic camera 0°, and an endoscopic ultrasound activated harmonic scalpel. The sympathetic chain was resected on both sides at the level of the second and the third thoracic ganglion (T2 and T3), using an ultrasound knife. The extirpated chain was also at the level T3-T4 and sent for ex tempore analysis. There were 162 patients undergoing thoracoscopic sympathectomy: 39.51% were males and 60.49% females; at presentation their mean age (± SD) was 30.5 (±8.3), range 16 -58 years. Axillary hyperhidrosis occurs later than palmar-axillary-plantar (p<0.05). A total of 35.18% of the evaluated patients were able to name at least one member of their families who also suffered from hyperhidrosis. The most commonly affected area was palmar-axillary-plantar (30.25%). Fifty patients (30.86%) received conservative therapy before surgery. The most commonly used conservative therapy modalities included different kinds of ointments/tinctures (11.73%), botox (8.02%) and iontophoresis (2.47%). Prior to surgery, 91.36% of patients reported severe sweating (HDSS score 3 or 4). The highest mean score was given for a combination of facial-palmar-axillaryplantar hyperhidrosis (3.80±0.24). All surgeries were successfully performed, with no complications, or perioperative morbidity. The mean hospital stay was 1.28±0.68 days long. After surgery, 93.21% of patients reported mild or moderate hyperhidrosis (HDSS score 1 or 2). Compensatory sweating (lower part of the back, and abdomen) was reported by 34.57% of patients after the surgery. All patients had a 6-months long follow-up: a significant improvement in quality of life was reported by 84.56% of patients (Yates corrected c 2 (1) = 228.42; p=0.0000)); due to compensatory sweating, only 4.94% and 1.85% of patients reported bad and very bad quality of life, respectively. In conclusion, nowadays videothoracoscopic sympathectomy is a standard treatment for primary hyperhidrosis with a high success rate. T5, and to lower limbs at T2 and T7. Videothoracoscopic sympathectomy -a standard treatment for primary hyperhidrosis at the Clinic of Thoracic Surgery in Sremska KamenicaExcessive sweating or hyperhidrosis affects approximately 3% of the world population (1, 2), predominantly young femal...

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The Extent of Surgery for Palmar Hyperhidrosis

Smith

Vallières

2020

Difficult Decisions in Surgery: An Evidence-Based Approach

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Upper dorsal endoscopic thoracic sympathectomy: a comparison of one- and two-port ablation techniques

Abstract: Endoscopic thoracic sympathectomy can be safely and effectively carried out using a single port with similar results to the traditional two-port procedure. The one-port procedure may allow for a shorter duration of stay and lower complication rate.

Cited by 31 publications

References 22 publications

Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction

Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction

Videothoracoscopic sympathectomy - a standard treatment for primary hyperhidrosis at the Clinic of Thoracic Surgery in Sremska Kamenica / Videotorakoskopska simpatektomija – standarna hirurška metoda za lečenje primarne hiperhidroze na Klinici za grudnu hirurgiju u Sremskoj Kamenici

The Extent of Surgery for Palmar Hyperhidrosis

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