Bilateral sympathicotomy for hyperhidrosis without using single-lung ventilation

Abstract

Background/aim: The goal of this retrospective study was to evaluate the outcomes and complications of bilateral videothoracoscopic sympathicotomy without using single-lung ventilation in the treatment of primary hyperhidrosis and facial blushing. Materials and methods:We retrospectively reviewed 154 consecutive patients (70 females and 84 males) who underwent bilateral sympathicotomy for palmar, axillary, and facial/scalp hyperhidrosis or facial blushing from February 2005 to June 2013. The patients were intubated with single-lumen endotracheal tube, and then sympathicotomies were performed via videothoracoscopy during controlled apnea periods.Results: Sympathicotomies were performed at costal levels 2, 3, and 4. No perioperative mortality or conversion to open surgery was recorded. Mean operation time was 31.2 ± 2.4 min and mean hospital stay was 1.1 ± 0.6 days. One patient experienced a unilateral pneumothorax that required treatment. There were no abnormal hemodynamic parameters measured during the perioperative apnea periods. The long term follow-up period was 21.4 ± 5 months. Twenty-nine cases (18.8%) were complicated by compensatory sweating. No recurrence was observed during the follow-up period. Conclusion:Video-assisted thoracoscopic sympathicotomy without lung isolation provides effective cure of primary hyperhidrosis and facial blushing. This procedure can shorten the operative time without any aberrant hemodynamic shifts.

Comparison of T2 and T3 sympathectomy for compensatory sweating on palmar hyperhidrosis

“…This approach decreases the synaptic reorganization at the sympathetic chain level. [1] Although the rate of CS occurrence was more in T2 level ETS than in T3 level ETS in this study, the difference was not statistically significant. This indicates that rather than the level of ETS, the procedures carried out to protect the ganglia caused less frequent and severe CS.…”

“…With a prevalence ranging from 0.3% to 4.5% in the general population, PH occurs equally in men and women and conservative therapy is usually unsatisfactory. [1] …”

“…It has become a standard, well-tolerated treatment for PH as it is a safe, effective, and minimally invasive method. [1,2] However, the symptoms may relapse in some patients after their ETS, and more importantly side effects such as compensatory sweating (CS) can occur in different regions of the body. CS is the most common and undesirable long-term complication of ETS, which occurs at a rate of between 3% and 98%, and is considered to be the “quality marker” of an ETS.…”

“…Results vary from study to study. [1,3,10,11] For this reason, the present randomized study was performed to determine the relationship (if any) between the level of ETS and the occurrence and severity of CS.…”

Single-port bilateral endoscopic thoracic sympathectomy for the treatment of hyperhidrosis

“…Endoskopik torakal sempatektomi (ETS) son yıllarda torasik cerrahi girişim olarak giderek daha fazla kullanılmaktadır. Güvenli, etkili ve minimal invaziv bir yöntem olması hastalığın tedavisinde standart, iyi tolere edilen bir seçenek haline getirmiştir (5,6). Başlangıçta birden fazla portun kullanılması ile gerçekleştirilen ETS ameliyatı son yıllarda tek port yaklaşımın diğer cerrahi alanlarda kazandığı popülerlik ile birlikte tek port olarak da uygulanır olmuştur.…”