Download PDF
Thorac Cardiovasc Surg 2019; 67(05): 395-401
DOI: 10.1055/s-0038-1645872
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Needlescopic Video-Assisted Thoracic Bilateral T4 Sympathicotomy for the Treatment of Primary Palmar Hyperhidrosis: An Analysis of 200 Cases

Xing Feng
1   Department of Thoracic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
,
Xiaoling Xiong
2   Department of Nephrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
,
Er Jin
3   Department of Respiratory Disease, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
,
Wen Meng
1   Department of Thoracic Surgery, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
› Author Affiliations
Further Information

Publication History

02 January 2018

14 March 2018

Publication Date:
01 May 2018 (online)

    Permissions and Reprints All articles of this category

Abstract

Background Primary palmar hyperhidrosis (PPH) is featured by aberrantly perspiration of the hands, which may bring a lot of inconvenience to patient's daily life and work. The purpose of this study is to summarize the clinical effect of needlescopic video-assisted thoracic bilateral T4 sympathicotomy for the treatment of PPH.

Patients and Methods Between January 2009 and March 2014, 200 patients received needlescopic video-assisted thoracic bilateral T4 sympathicotomy. We, respectively, took two 5-mm incisions in the third intercostal space on the anterior axillary line and in the fifth intercostal space on the middle axillary line. After collapsing left lung, needlescopic exploration was the first step to determine the targeted sympathetic chain through the third intercostal space. Electric coagulation hook was inserted from another port to cut T4 sympathetic chain and the bypassing nerve fibers for 2 to 3 cm along the surface of the fourth rib. Right thoracic cavity was also administered the same procedure. The palmar temperature was recorded before and after sympathicotomy. The symptom improvement, operative complications, patients' recovery, and satisfaction were evaluated.

Finding One hundred and ninety-seven patients uneventfully received two 5-mm port bilateral sympathicotomy, and another 3 patients with extensive pleural adhesions completed the surgery through enlarging the third intercostal incision to 2 cm without conversion to open surgery. All operative procedures were completed in 15 to 35 minutes. The hospital stay was 2 to 4 days. The palmar temperature increased by 2.0 ± 0.5°C, and hyperhidrosis immediately disappeared in both hands after surgery. The efficacy rate was 100%. The postoperative complications such as hemorrhage, hemopneumothorax, bradycardia, or Horner's syndrome had no occurrence. During 6 to 60 months follow-up, mild compensatory sweating of buttock, back, and thigh occurred in 30 patients (15%) at 2 to 5 days after surgery and gradually disappeared at postoperative 15 to 30 days or longer time. All patients were greatly satisfied with the effect with better confidence and quality of life. Until now, no recurrent palmar hyperhidrosis happened.

Conclusion Needlescopic video-assisted thoracic bilateral T4 sympathicotomy could reach an excellent and immediate result of treating PPH. It is a safe, convenient, and minimally invasive method appropriate for wide clinical use.

Keywords

needlescope - primary palmar hyperhidrosis - thoracic sympathicotomy - compensatory sweating
 

  • References

  • 1 Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004; 51 (02) 241-248
    CrossrefPubMedGoogle Scholar
  • 2 Tu YR, Li X, Lin M. , et al. Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China. Eur J Cardiothorac Surg 2007; 31 (04) 737-739
    CrossrefPubMedGoogle Scholar
  • 3 Birner P, Heinzl H, Schindl M, Pumprla J, Schnider P. Cardiac autonomic function in patients suffering from primary focal hyperhidrosis. Eur Neurol 2000; 44 (02) 112-116
    CrossrefPubMedGoogle Scholar
  • 4 Liu Y, Yang J, Liu J. , et al. Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg 2009; 35 (03) 398-402
    CrossrefPubMedGoogle Scholar
  • 5 Cerfolio RJ, De Campos JR, Bryant AS. , et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 2011; 91 (05) 1642-1648
    CrossrefPubMedGoogle Scholar
  • 6 Pariser DM, Ballard A. Iontophoresis for palmar and plantar hyperhidrosis. Dermatol Clin 2014; 32 (04) 491-494
    CrossrefPubMedGoogle Scholar
  • 7 Kuijpers M, Klinkenberg TJ, Bouma W, DeJongste MJ, Mariani MA. Single-port one-stage bilateral thoracoscopic sympathicotomy for severe hyperhidrosis: prospective analysis of a standardized approach. J Cardiothorac Surg 2013; 8: 216-221
    CrossrefPubMedGoogle Scholar
  • 8 Ravari H, Rajabnejad A. Unilateral sympathectomy for primary palmar hyperhidrosis. Thorac Cardiovasc Surg 2015; 63 (08) 723-726
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Tulay CM. Sympathectomy for palmar hyperhidrosis. Indian J Surg 2015; 77 (Suppl. 02) S327-S329
    PubMedGoogle Scholar
  • 10 Lai YT, Yang LH, Chio CC, Chen HH. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery 1997; 41 (01) 110-113 , discussion 113–115
    CrossrefPubMedGoogle Scholar
  • 11 Li X, Tu YR, Lin M, Lai FC, Chen JF, Miao HW. Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow. Ann Thorac Surg 2009; 87 (02) 427-431
    CrossrefPubMedGoogle Scholar
  • 12 Licht PB, Pilegaard HK. Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg 2004; 78 (02) 427-431
    CrossrefPubMedGoogle Scholar
  • 13 Rajagopal R, Mallya NB. Comparative evaluation of botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in treatment of palmar hyperhidrosis. Med J Armed Forces India 2014; 70 (03) 247-252
    CrossrefPubMedGoogle Scholar
  • 14 Andrade PC, Flores GP, Uscello JdeF, Miot HA, Morsoleto MJ. Use of iontophoresis or phonophoresis for delivering onabotulinumtoxinA in the treatment of palmar hyperidrosis: a report on four cases. An Bras Dermatol 2011; 86 (06) 1243-1246
    CrossrefPubMedGoogle Scholar
  • 15 Nagar R, Sengar SS. A simple user-made iontophoresis device for palmoplantar hyperhidrosis. J Cutan Aesthet Surg 2016; 9 (01) 32-33
    CrossrefPubMedGoogle Scholar
  • 16 Grabell DA, Hebert AA. Current and emerging medical therapies for primary hyperhidrosis. Dermatol Ther (Heidelb) 2017; 7 (01) 25-36
    CrossrefPubMedGoogle Scholar
  • 17 Murray CA, Cohen JL, Solish N. Treatment of focal hyperhidrosis. J Cutan Med Surg 2007; 11 (02) 67-77
    CrossrefPubMedGoogle Scholar
  • 18 Yanagihara TK, Ibrahimiye A, Harris C, Hirsch J, Gorenstein LA. Analysis of clamping versus cutting of T3 sympathetic nerve for severe palmar hyperhidrosis. J Thorac Cardiovasc Surg 2010; 140 (05) 984-989
    CrossrefPubMedGoogle Scholar
  • 19 Lesèche G, Castier Y, Thabut G. , et al. Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: limited sympathectomy does not reduce postoperative compensatory sweating. J Vasc Surg 2003; 37 (01) 124-128
    CrossrefPubMedGoogle Scholar
  • 20 Yoon DH, Ha Y, Park YG, Chang JW. Thoracoscopic limited T-3 sympathicotomy for primary hyperhidrosis: prevention for compensatory hyperhidrosis. J Neurosurg 2003; 99 (1, Suppl): 39-43
    CrossrefPubMedGoogle Scholar
  • 21 Shi H, Shu Y, Shi W, Lu S, Sun C. Single-port microthoracoscopic sympathicotomy for the treatment of primary palmar hyperhidrosis: an analysis of 56 consecutive cases. Indian J Surg 2015; 77 (04) 270-275
    PubMedGoogle Scholar
  • 22 Romero FR, Haddad GR, Miot HA, Cataneo DC. Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects. An Bras Dermatol 2016; 91 (06) 716-725
    CrossrefPubMedGoogle Scholar
  • 23 Yoon SH, Rim DC. The selective T3 sympathicotomy in patients with essential palmar hyperhidrosis. Acta Neurochir (Wien) 2003; 145 (06) 467-471 , discussion 471
    CrossrefPubMedGoogle Scholar
  • 24 Neumayer C, Zacherl J, Holak G, Jakesz R, Bischof G. Experience with limited endoscopic thoracic sympathetic block for hyperhidrosis and facial blushing. Clin Auton Res 2003; 13 (01) (Suppl. 01) I52-I57
    PubMedGoogle Scholar