Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis
Keywords:
Hyperhidrosis, Thoracoscopy, SympathectomyAbstract
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.
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References
Krasna MJ, Jiao X. Thoracoscopic Neurologic Surgery and Tho- racoscopic Access for Spinal Surgery. In: Demmy TL, editor Video Assisted Thoracic Surgery (VATS). Georgetown: Landes Bioscience; 2001. p.164-74.
Kux E. Thorakoskopische Eingriffe am Nervensystem. Stutt- gart: George Thieme Verlag; 1954.
Leão LEV, Crotti PLR, Silva FM, Barros Jr N, Franco SB, Burihan E, editores. Simpatectomia cervicotorácica por torascoscopia - experiência inicial da UNIFESP-EPM. Anais do XXXII Congresso Brasileiro de Angiologia e Cirurgia Vas- cular; 1997, out, 14-18; Curitiba, Brasil. Curitiba; 1997. p. 69.
Kauffman P, Milanez JRC, Jatene FB, Leão PP. Simpatectomia cervicotoracica por videotoracoscopia: experiência inicial. [Tho- racoscopic cervicodorsal sympathectomy: initial results]. Rev Col Bras Cir 1998;25(4):235-9.
Leão LEV, Giuduci R, Crotti PLR, Barros Júnior N. Simpatectomia torácica por videotoracoscopia: um procedimento minimamente invasivo para o tratamento da hiperidrose. [Thoracoscopic sympathectomy: a minimally in- vasive procedure for treatment of hyperhidrosis]. Rev Bras Clin Terap 1999;25(4):146-50.
Leão LEV, Giudici R. Simpatectomia torácica por video- toracoscopia: tratamento atual da hiperidrose palmar. Revista Jovem Médico 1999;3(2):107-11.
Leão LEV. Simpatectomia torácica videotoracoscópica no tratamento da hiperidrose. Jornal Dermatológico 2000;100:18.
Leão LEV, Giudice R, Oliveira R. Videotoracoscopia nas massas tumorais do mediastino. In: Lopes AC, editor. Tópicos em Clínica Médica. Rio de Janeiro: Medsi; 2003. p.197-202.
Johnson JP, Ahn SS, Choi WC, et al. Thoracoscopic sympathec- tomy: techniques and outcomes. Available from URL: http:// www.neurosurgery.org/focus/feb98/4-2-4.html. Accessed on 25/06/03.
Claes G, Drott C, Göthberg G. Endoscopic electrocautery of the thoracic sympathetic chain. A minimally invasive way to treat palmar hyperhidrosis. Scand J Plast Reconstr Hand Surg 1993;27(1):29-33.
Kao MC, Lin JY, Chen YL, Hsieh CS, Cheng LC, Huang SJ. Minimally invasive surgery: video endoscopic thoracic sym- pathectomy for palmar hyperhidrosis. Ann Acad Med Singa- pore 1996;25(5):673-8.
Gossot D, Toledo L, Fritsch S, Célérier M. Thoracoscopic sym- pathectomy for upper limb hyperhidrosis: looking for the right operation. Ann Thorac Surg 1997;64(4):975-8.
Zacherl J, Huber ER, Imhof M, Plas EG, Herbst F, Függer R. Long-term results of 630 thoracoscopic sympathicotomies for primary hyperhidrosis: the Vienna experience. Eur J Surg Suppl 1998;(580):43-6.
Aldohayan A. Highly Selective Thoracoscopic Sympathectomy. Eur J Cardio-thorac Surg 1999;16(suppl 1):s129.
Telaranta T. Treatment of social phobia by endoscopic thoracic sympathicotomy. Eur J Surg Suppl 1998;(580):27-32.
Lin CC, Mo LR, Lee LS, Ng SM, Hwang MH. Thoracoscopic T2-sympathetic block by clipping – a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases. Eur J Surg Suppl 1998;(580):13-6.
Fox AD, Hands L, Collin J. The results of thoracoscopic sym- pathetic trunk transection for palmar hyperhidrosis and sym- pathetic ganglionectomy for axillary hyperhidrosis. Eur J Vasc Endovasc Surg 1999;17(4):343-6.
Hsia JY, Chen CY, Hsu CP, Shai SE, Yang SS. Outpatient tho- racoscopic limited sympathectomy for hyperhidrosis palmaris. Ann Thorac Surg 1999;67(1):258-9.
Yim AP, Liu HP, Lee TW, Wan S, Arifi AA. ‘Needlescopic’ video- assisted thoracic surgery for palmar hyperhidrosis. Eur J Cardiothorac Surg 2000;17(6):697-701.
Okura T, Suzuki T, Suzuki S, Kitami A, Hori G. Endoscopic transthoracic sympathectomy with a fine (2-mm) thoracoscope in palmar hyperhidrosis: a case report. J Laparoendosc Adv Surg Tech A 1998;8(3):161-5.
Andrews BT, Rennie JA. Predicting changes in the distribution of sweating following thoracoscopic sympathectomy. Br J Surg 1997;84(12):1702-4.
Yilmaz EN, Dur AH, Cuesta MA, Rauwerda JA. Endoscopic versus transaxillary thoracic sympathectomy for primary axil- lary and palmar hyperhidrosis and/or facial blushing: 5-year experience. Eur J Cardiothorac Surg 1996;10(3):168-72.
Adson AW. Changes in technique of cervicothoracic ganglionec- tomy and trunk resection. Am J Surg 1934;23(2):287-8.
Little JM, May J. A comparison of the supraclavicular and axillary approaches to upper thoracic sympathectomy. Aust N Z J Surg 1975;45(2):143-6.
Kux M. Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 1978;113(3):264-6.
Telford ED. The technique of sympathectomy. Br J Surg 1935;23(90):448-50.
Hazellrigg SR, Mack MJ. Surgery for Autonomic Disorders. In: Kaiser LR, Daniel TM, editors. Thoracoscopic Surgery. Bos- ton: Little, Brown & Co; 1993. p.189-202.
Geoghegan JG, Broe PJ. Thoracic Sympathectomy and Splanch- nicectomy. In: Walker WS, editor. Video Assisted Thoracic Surgery. Oxford: Isis Medical Media; 1999. p.39-52.
Gossot D, Debrosse D, Grunenwald D. Endoscopic thoracic sympathectomy for isolated axillary hyperhidrosis. Ann Dermatol Venereol 2000;127(12):1065-7.
Gossot D, Kabiri H, Caliandro R, Debrosse D, Girard P, Grunenwald D. Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures. Ann Thorac Surg 2001;71(4):1116-9.
Hsu CP, Chen CY, Lin CT, Wang JH, Chen CL, Wang PY. Video-assisted thoracoscopic T2 sympathectomy for hyperhid- rosis palmaris. J Am Coll Surg 1994;179(1):59-64.
Park YJ, Shin MS. What is the best method for treating osmid- rosis? Ann Plast Surg 2001;47(3):303-9.
