Guidelines on Surgery of the Thoracic Sympathetic Nervous System

Balsalobre, Ramón Moreno; Mata, Nicolás Moreno; Ramos-Izquierdo, Ricard; Valverde, Francisco Javier Aragón; López-Rodó, Laureano Molins; Andrés, Juan José Rivas de; Fernández, José Luis García; Carretero, Miguel Á.; Loscertales, Miguel Congregado; Carbajo, M. Carbajo

doi:10.1016/s1579-2129(11)70020-9

Cited by 6 publications

(3 citation statements)

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“…Studies [17,18] have shown that R3 or R4 sympathicotomy alone can effectively treat primary palmar hyperhidrosis, and R2 sympathicotomy is therefore rarely performed. R4 or R3-R4 sympathicotomy can be used to treat palmar hyperhidrosis combined with plantar hyperhidrosis, and R5 additional sympathicotomy can be used to treat palmar hyperhidrosis combined with axillary hyperhidrosis [3,4]. In the present study, we performed R4 sympathicotomy to treat palmar hyperhidrosis, because this method can maximize the curative effect and minimize the rate of compensatory sweating.…”

Section: Segment Selection In Thoracic Sympathicotomy and Compensatormentioning

confidence: 99%

“…A positive family history is reported in 15.3 % of patients. Conventional therapies include astringents, antiperspirants, botulinum toxin injection, water-absorbing agents, anxiolytic agents, anticholinergic agents, and iontophoresis [3,4]. However, these therapies have limited usefulness because they are not curative.…”

Section: Introductionmentioning

confidence: 99%

“…However, these therapies have limited usefulness because they are not curative. Thoracoscopic thoracic sympathicotomy is reported to be the most effective method of treating primary palmar hyperhidrosis [3,4]. In this report, we describe 56 consecutive patients with primary palmar hyperhidrosis who underwent single-port microthoracoscopic thoracic sympathicotomy between January 2008 and March 2013.…”

Section: Introductionmentioning

confidence: 99%

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Single-Port Microthoracoscopic Sympathicotomy for the Treatment of Primary Palmar Hyperhidrosis: an Analysis of 56 Consecutive Cases

et al. 2015

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The objective of this study is to investigate the feasibility and safety of single-port microthoracoscopic thoracic sympathicotomy for the treatment of palmar hyperhidrosis. Between January 2008 and March 2013, 56 patients (36 male, 20 female; mean age 25.6 years, age range 16-39 years) underwent single-port microthoracoscopic thoracic sympathicotomy for palmar hyperhidrosis. Nineteen patients (33.9 %) had moderate palmar hyperhidrosis that could thoroughly wet a handkerchief, and 37 (66.1 %) had severe palmar hyperhidrosis with sweat dripping from the palm. Eight patients (14.3 %) had a positive family history, 34 (60.7 %) had plantar hyperhidrosis, 22 (39.3 %) had axillary hyperhidrosis, and 20 (35.7 %) had both plantar and axillary hyperhidrosis. In addition, 21 patients (37.5 %) had palmar pompholyx, five (8.9 %) had keratolysis exfoliativa, 10 (17.9 %) had chilblains, and nine (16.1 %) had palmar rhagades. A single 10-mm skin incision was made in the third intercostal space at the anterior axillary line, posterior to the pectoralis muscle. A 5-mm microthoracoscope and a 3-mm microelectrocautery hook were inserted through a single port into the thoracic cavity. The third and fourth ribs were identified, and the sympathetic chain was cut using the microelectrocautery hook. The bypassing nerve fibers, such as the Kuntz nerve fiber bundle, were ablated for 2-3 cm along the surface of the rib. The palmar temperature was recorded before and after sympathicotomy. All 56 procedures were completed using single-port microthoracoscopy. No postoperative complications such as hemorrhage, wound infection, hemopneumothorax, bradycardia, or Horner's syndrome were observed. Bilateral procedures were completed in 20-56 min (mean 30 min). The palmar temperature increased by 2.2±0.3°C after surgery. The postoperative hospital stay was 1-4 days (mean 2.5 days). Mild compensatory sweating of the back and thigh occurred in five patients (8.9 %) at 2-3 days after surgery and disappeared at 7-15 days. The patients were followed up for 28.5 months (range 1-62 months). Hyperhidrosis resolved in both hands after surgery, and the previously wet, cold hands became dry and warm. The efficacy rate was 100 %. Plantar hyperhidrosis was also significantly reduced in 33 of the 34 patients with this condition (remission rate 97.1 %), and axillary hyperhidrosis was significantly reduced in 19 of 22 patients (remission rate 86.4 %). Eighteen of the 20 patients (90.0 %) with both plantar and axillary hyperhidrosis experienced significant alleviation of their symptoms. Single-port microthoracoscopic thoracic sympathicotomy is a safe, convenient, and effective method of treating palmar hyperhidrosis. This procedure can accurately locate the sympathetic chain with a small incision, minimal invasiveness, and good cosmetic results. The procedure is suitable for extensive clinical use.

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