A Simplified T₂–T₃Thoracoscopic Sympathicolysis Technique for the Treatment of Essential Hyperhidrosis: Short-Term Results in 100 Patients

Abstract

A simplified one-time bilateral thoracoscopic T2-T3 sympathicolysis technique using single-lumen endotracheal intubation with high frequency jet ventilation and electrocautery destruction ("sympathicolysis") of the sympathetic ganglia was applied in 100 consecutive patients with severe essential hyperhidrosis (EH). Providing a pleural space can be created, this technique was proven simple and safe, and short-term clinical results were excellent: palmar hyperhidrosis was cured in 98% of patients, and axillar and plantar improvement was achieved in 62 and 65% of patients, respectively. Side-effects and complications were minor (compensatory hyperhidrosis) or self-limiting (pain). These data confirm the safety and efficacy of thoracoscopic sympathetic interventions for the treatment of EH, and support the evolution toward simplified methodologies.

Advanced techniques in medical thoracoscopy

“…Although very few comparative studies are available, shortand long-term results are excellent in hyperhidrosis patients; relief of palmar, axillar and/or facial sweating is obtained in 90-100% of cases [77]. Recurrence rates vary between 5-10%, but repeat interventions are often successful.…”

“…T3) depends upon the indication and the desired therapeutic effects (e.g. treatment of essential hyperhidrosis) [77].…”

“…Recently, however, there has been a trend towards less cumbersome, less extensive, simplified one-time bilateral surgical approaches using clipping or diathermy cauterisation, single-lumen intubation, and smaller diameter trocars [80][81][82]. It is worth noting that thoracoscopic sympathicolysis using simple medical thoracoscopic instrumentation and techniques can be safely performed by trained interventional pulmonologists [77][78][79][80][81][82][83].…”

Advanced medical interventions in pleural disease

“…There are limited data relating to the use of medical thoracoscopy in the diagnosis and treatment of other conditions including recurrent symptomatic benign effusions, notably hepatic hydrothorax [139][140][141], sympathectomy for palmar hyperhidrosis [142,143], and forceps lung biopsy for suspected interstitial lung disease [144]. Whilst these are worth mentioning as areas that might be explored further in future studies, thoracic surgeons continue to perform the majority of these procedures and there is no current evidence to suggest a definitive role in routine clinical practice for the interventional pulmonologist.…”

Simpatectomía toracoscópica: una revisión de la literatura

“…Consiste en un incremento de la sudoración ecrina por encima de lo requerido para el control de la termorregulación en una o más áreas corporales, sobre todo a nivel palmar, siendo también frecuente a nivel axilar, plantar y facial. Habitualmente su causa es desconocida (idiopática) y se estima una incidencia inferior al 1%, siendo mayor en Estados Unidos (2.8%) y poblaciones asiáticas (4-5%) 2,11,55,59,82 . En un 70% o más de los casos se inicia en la niñez y en un 16-20% en la adolescencia, siendo poco frecuente su comienzo en adultos 28,46,62,72 .…”