Single-port Video-assisted Thoracoscopic Sympathectomy for the Treatment of Palmar Hyperhidrosis in 48 Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGWen-xiong ¹ , XUJian-jun ¹ ,  XIONGLi-hua ²

1. Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, P. R. China;
2. Department of Cardiothoracic Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, P. R. China;

Corresponding author：

XIONGLi-hua, Email: lihuax211@163.com

Keywords：

Video-assisted thoracoscopic sympathectomy; Palmar hyperhidrosis; Compensatory sweating

DOI：

10.7507/1007-4848.20150062

Video：

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Objective To explore clinical outcomes of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of palmar hyperhidrosis (PH), and compare the results between T2 segment surgery and T2-T3 segment surgery. Methods From April 2009 to August 2012, 48 consecutive PH patients underwent single-port VATS in Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University. There were 18 male and 30 female patients with their age of 14-40 (22.1±5.4) years. According to different surgical procedures, all the patients were divided into T2 segment group (29 patients) and T2-T3 segment group (19 patients). Preoperative characteristics, surgical results and postoperative morbidity were compared between the 2 groups. Results PH symptoms disappeared after VATS in all the patients. Patients were followed up for 6-44(21.3±10.1)months, and 2 patients were lost in both T2 segment group and T2-T3 segment group. The incidence of postoperative compensatory sweating was 66.7% (18/29) in T2 segment group and 70.6% (12/19) in T2-T3 segment group. The incidence of moderate to severe compensatory sweating of T2 segment group was significantly higher than that of T2-T3 segment group (51.9% vs. 29.4%, P < 0.05). Twenty-six patients (96.3%) in T2 segment group and 16 patients (94.1%) in T2-T3 segment group were completely or partially satisfied with surgical results. Conclusion VATS is the only effective surgical procedure for the treatment of moderate to severe PH. Both T2 and T2-T3 segment sympathectomy can effectively reduce PH symptoms after VATS, but the incidence of postoperative compensatory sweating is high, which has negative influence on patients'satisfaction.

Citation： ZHANGWen-xiong, XUJian-jun, XIONGLi-hua. Single-port Video-assisted Thoracoscopic Sympathectomy for the Treatment of Palmar Hyperhidrosis in 48 Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(3): 220-224. doi: 10.7507/1007-4848.20150062 Copy

1.	LI X, Chen R, Tu YR, et al.Epidemiological survey of primary palmar hyperhidrosis in adolescents.Chin Med J, 2007, 120(24):2215-2217.
2.	Strutton DR, Kowalski JW, Glaser DA, et al.US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis:results from a national survey.J Am Acad Dermatol, 2004, 51(2):241-248.
3.	Connolly M, de Berker D.Management of primary hyperhidrosis:asummary of the different treatment modalities.Am J Clin Dermatol, 2003, 4(10):681-697.
4.	Sato K, Kang WH, Saga K, et al.Biology of sweat glands and their disorders.Ⅱ.disorder of sweat gland function.J Am Acad Dermatol, 1989, 20(5 Pt 1):713-726.
5.	涂远荣, 李旭, 林敏, 等.手汗症患者胸交感神经超微结构观察.中华实验外科杂志, 2006, 23(7):884.
6.	贾向波, 钱如林, 李向阳, 等.局部麻醉下电视胸腔镜手术治疗手汗症.中国胸心血管外科临床杂志, 2010, 17(5):434.
7.	Lai YT, Yang LH, Chio CC, et al.Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy.Neurosurgery, 1997, 41(1):110-113.
8.	Licht PB, Pilegaard HK.Severity of compensatory sweating after thoracoscopic sympathectomy.Ann Thorac Surg, 2004, 78(2):427-431.
9.	车国卫, 刘伦旭.单孔电视胸腔镜手术临床应用的现状与进展.中国胸心血管外科临床杂志, 2012, 19(2):181-184.
10.	涂远荣, 主编.手汗症现代微创治疗.福州:福建科学技术出版社, 2007.8-10.
11.	Kotzareff A.Resection partielle de trone sympathetique cervical droit pour hyperhidrose unilaterale.Rev Med Suisse Romande, 1992, 40(1):111-113.
12.	Landreneau RJ, Mack MJ, Hazelrigg SR, et al.Video-assisted thoracic surgery:basic technical concepts and intercostal approach strategies.Ann Thorac Surg, 1992, 54(4):800-807.
13.	杨劼, 刘彦国, 谭家驹, 等.不同位置胸交感链切断治疗手汗症与术后代偿性出汗的关系.中国胸心血管外科临床杂志, 2006, 13(5):315-317.
14.	Moran KT, Brady MP.Surgical management of primary hyperhidosis.Br J Surg, 1991, 78(2):279-283.
15.	Gothberg G, Drott C, Goran C.Thoracoscopic sympathicotomy for hyperhidrosis-surgical technique, complications and side effects.Eur J Surg, 1994(Suppl 572):51-53.
16.	Kao MC, Chen YL, Lin JY, et al.Endoscopic sympathectomy treatment for craniofacial hyperhidrosis.Arch Surg, 1996, 131(10):1091-1094.
17.	Andrews BT, Rennie JA.Predicting changes in the distribution of sweating following thoracoscopic sympathectomy.Br J Surg, 1997, 84(12):1702-1704.
18.	Lin CC, Telaranta T.Lin-Telaranta classification:the importance of different procedures for different indications in sympathetic surgery.Ann Chir Gyn, 2001, 90(2):161-166.
19.	Gossot D, Toledo L, Fritsch S, et al.Thoracoscopic sympathectomy for upper limb hyperhidrosis:looking for the right operation.Ann Thorac Surg, 1997, 64(4):975-978.
20.	Herbst F, Plas EG, Fugger R, et al.Endoscopic thoracic sympathec-tomy for primary hyperhidrosis of the upper limbs.Ann Surg, 1994, 220(1):86-94.
21.	Kim WO, Kil HK, Yoon KB, et al.Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis.Am J Surg, 2010, 199(2):166-169.

1. LI X, Chen R, Tu YR, et al.Epidemiological survey of primary palmar hyperhidrosis in adolescents.Chin Med J, 2007, 120(24):2215-2217.
2. Strutton DR, Kowalski JW, Glaser DA, et al.US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis:results from a national survey.J Am Acad Dermatol, 2004, 51(2):241-248.
3. Connolly M, de Berker D.Management of primary hyperhidrosis:asummary of the different treatment modalities.Am J Clin Dermatol, 2003, 4(10):681-697.
4. Sato K, Kang WH, Saga K, et al.Biology of sweat glands and their disorders.Ⅱ.disorder of sweat gland function.J Am Acad Dermatol, 1989, 20(5 Pt 1):713-726.
5. 涂远荣, 李旭, 林敏, 等.手汗症患者胸交感神经超微结构观察.中华实验外科杂志, 2006, 23(7):884.
6. 贾向波, 钱如林, 李向阳, 等.局部麻醉下电视胸腔镜手术治疗手汗症.中国胸心血管外科临床杂志, 2010, 17(5):434.
7. Lai YT, Yang LH, Chio CC, et al.Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy.Neurosurgery, 1997, 41(1):110-113.
8. Licht PB, Pilegaard HK.Severity of compensatory sweating after thoracoscopic sympathectomy.Ann Thorac Surg, 2004, 78(2):427-431.
9. 车国卫, 刘伦旭.单孔电视胸腔镜手术临床应用的现状与进展.中国胸心血管外科临床杂志, 2012, 19(2):181-184.
10. 涂远荣, 主编.手汗症现代微创治疗.福州:福建科学技术出版社, 2007.8-10.
11. Kotzareff A.Resection partielle de trone sympathetique cervical droit pour hyperhidrose unilaterale.Rev Med Suisse Romande, 1992, 40(1):111-113.
12. Landreneau RJ, Mack MJ, Hazelrigg SR, et al.Video-assisted thoracic surgery:basic technical concepts and intercostal approach strategies.Ann Thorac Surg, 1992, 54(4):800-807.
13. 杨劼, 刘彦国, 谭家驹, 等.不同位置胸交感链切断治疗手汗症与术后代偿性出汗的关系.中国胸心血管外科临床杂志, 2006, 13(5):315-317.
14. Moran KT, Brady MP.Surgical management of primary hyperhidosis.Br J Surg, 1991, 78(2):279-283.
15. Gothberg G, Drott C, Goran C.Thoracoscopic sympathicotomy for hyperhidrosis-surgical technique, complications and side effects.Eur J Surg, 1994(Suppl 572):51-53.
16. Kao MC, Chen YL, Lin JY, et al.Endoscopic sympathectomy treatment for craniofacial hyperhidrosis.Arch Surg, 1996, 131(10):1091-1094.
17. Andrews BT, Rennie JA.Predicting changes in the distribution of sweating following thoracoscopic sympathectomy.Br J Surg, 1997, 84(12):1702-1704.
18. Lin CC, Telaranta T.Lin-Telaranta classification:the importance of different procedures for different indications in sympathetic surgery.Ann Chir Gyn, 2001, 90(2):161-166.
19. Gossot D, Toledo L, Fritsch S, et al.Thoracoscopic sympathectomy for upper limb hyperhidrosis:looking for the right operation.Ann Thorac Surg, 1997, 64(4):975-978.
20. Herbst F, Plas EG, Fugger R, et al.Endoscopic thoracic sympathec-tomy for primary hyperhidrosis of the upper limbs.Ann Surg, 1994, 220(1):86-94.
21. Kim WO, Kil HK, Yoon KB, et al.Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis.Am J Surg, 2010, 199(2):166-169.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Single-port Video-assisted Thoracoscopic Sympathectomy for the Treatment of Palmar Hyperhidrosis in 48 Patients

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