Cohort study on 20 years’ experience of bilateral video-assisted thoracic sympathectomy (VATS) for treatment of hyperhidrosis in 2431 patients

Abstract

INTRODUCTIONPrimary hyperhidrosis (PH) is a condition characterized by excessive sweating that is inconsistent with thermoregulation needs. It has a large impact on patients' quality of life and affects their personal and professional relationships. 1,2 In the majority of cases, PH manifests in childhood and adolescence and persists throughout life. The typical clinical presentation is limited to the palms of the hands, the plantar region of the foot and/or the axilla, and it is symmetrical. It can also affect the head and face and often occurs in two or more regions of the body. The pathophysiology of PH is not fully understood, but it is known to result from stimulation of the sympathetic nervous system in its regulatory center. PH affects approximately 2.8% of the population, and there is a positive family history in 12.5% to 56.5% of the patients. 3 Patients generally seek medical care later in life, and more frequently at a more financially secure age. Thus, young people end up suffering for many years before being able to receive the current well-known medical treatment. 4,5 The initial treatment for patients with PH, until 2010, was sympathectomy. Thereafter, we began to use oxybutynin chloride as the first-line treatment. In patients for whom no adequate response to medication is attained, video-assisted thoracoscopic sympathectomy (VATS) becomes the treatment of choice.VATS is considered to be the gold standard for the definitive treatment of hyperhidrosis. It provides excellent clinical results (reduced sweating at specific sites) and leads to a significant improvement in quality of life. These positive results are, among other causes, based on factors that are known to influence the effectiveness of sympathectomy among patients with hyperhidrosis, 1 such as body mass index, resection level, 6,7 preoperative quality of life 8 and the number of resected ganglia. 9

Comparison of CT-guided thoracic sympathetic nerve block and radiofrequency in the treatment of primary palmar hyperhidrosis

“…The commonly used drugs include oral oxybutynin ( 15 ), local botulinum toxin injection ( 16 , 17 ), local iontophoresis ( 18 ), local microneedle radiofrequency ( 19 , 20 ), or other conservative treatments, but they have some limitations. Although ETS has high efficacy and long-term curative effects in the treatment of PPH and was once considered the “gold standard” treatment ( 4 , 5 , 21 ), its use is limited due to the high incidence of compensatory hyperhidrosis, which can be as high as 78% ( 5 , 22 ). Compensatory hyperhidrosis is a significant problem for both doctors and patients following ETS since there is currently no effective treatment.…”

Application of bilateral simultaneous sequential single-incision video-assisted thoracic surgery in multiple nodules both lungs: a single-center experience of 10 cases

“…Further exploration of this method after this, the majority of the lesions involved bilateral lungs disease like bilateral isolated metastases [ 14 ], bilateral pulmonary bullae with unilateral/bilateral pneumothorax and lung volume reduction surgery for patients with severe emphysema [ 15 ]. And may involve empyema [ 16 ], bilateral pleural biopsies, bilateral thoracic sympathectomy [ 17 , 18 ] and thymoma complicated with myasthenia gravis, etc.…”

“…The rationale for selection was based on surgical operator’ own clinical experience. After we managed the journals searches [ 2 – 7 , 9 , 14 , 15 , 17 – 24 ] and summaries of related work experience in our department, there are several caveats to our study that are noted throughout and summarized below. Such patients without a complicating pleural infection, thoracic trauma with hemopneumothorax and rib fractures, a history of prior pleurodesis or any subtle pleural nodularity or thickening is found on preoperative chest CT scans; With appropriate monitoring of cardiopulmonary parameters it can be performed safely and is well tolerated.…”

Changes in electrodermal activity following sympathicotomy in hyperhidrosis patients

“…Several treatment modalities have been attempted with limited success ( 1 , 7 ). Endoscopic thoracic sympathicotomy (ETS) is considered the treatment of choice for severe palmar hyperhidrosis ( 7 , 10 – 13 ) and facial blushing/hyperhidrosis ( 14 – 20 ). ETS yields satisfactory results for palmar hyperhidrosis, with most severe hand sweating cases being effectively resolved ( 9 , 10 , 21 , 22 ).…”

“…Endoscopic thoracic sympathicotomy (ETS) is considered the treatment of choice for severe palmar hyperhidrosis ( 7 , 10 – 13 ) and facial blushing/hyperhidrosis ( 14 – 20 ). ETS yields satisfactory results for palmar hyperhidrosis, with most severe hand sweating cases being effectively resolved ( 9 , 10 , 21 , 22 ). However, the ETS procedure is associated with potentially undesirable side effects, particularly compensatory hyperhidrosis (CH) ( 23 , 24 ).…”