Long-Term Impact of Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis

Horslen, L.C.; Wilshire, Candice L.; Louie, Brian E.; Vallières, Eric

doi:10.1016/j.athoracsur.2018.04.063

Cited by 30 publications

(30 citation statements)

References 9 publications

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“…A common clinical scenario involves a sympathetic trunk rupture from a thoracic or lumbar sympathectomy, performed by mainly regional hyperhidrosis treatment, also for nerve regeneration, pain control, and ischemic leg prevention. [10][11][12][13] The main challenge with the reconstruction of the ruptured sympathetic trunk is because sympathetic trunk is located deep within the thoracic cage near the spine, and posterior to the heart, aorta, and lung, hence creating a difficult and dangerous approach. From literature review, the sympathetic nerve reconstruction (STR) could be traced back to 1998, where an open thoracotomy was used by Telaranta.…”

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confidence: 99%

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

Chen

Goh

Goh³

et al. 2021

J Reconstr Microsurg

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Background Robotic-assisted techniques are a tremendous revolution in modern surgery, and the advantages and indications were well discussed in different specialties. However, the use of robotic technique in plastic and reconstructive surgery is still very limited, especially in the field of peripheral nerve reconstruction. This study aims to identify current clinical applications for peripheral nerve reconstruction, and to evaluate the advantages and disadvantages to establish potential uses in the future. Methods A review was conducted in the literatures from PubMed focusing on currently published robotic peripheral nerve intervention techniques. Eligible studies included related animal model, cadaveric and human studies. Reviews on robotic microsurgical technique unrelated to peripheral nerve intervention and non-English articles were excluded. The differences of wound assessment and nerve management between robotic-assisted and conventional approach were compared. Results Total 19 studies including preclinical experimental researches and clinical reports were listed and classified into brachial plexus reconstruction, peripheral nerve tumors management, peripheral nerve decompression or repair, peripheral nerve harvesting, and sympathetic trunk reconstruction. There were three animal studies, four cadaveric studies, eight clinical series, and four studies demonstrating clinical, animal, or cadaveric studies simultaneously. In total 53 clinical cases, only 20 (37.7%) cases were successfully approached with minimal invasive and intervened robotically; 17 (32.1%) cases underwent conventional approach and the nerves were intervened robotically; 12 (22.6%) cases converted to open approach but still intervened the nerve by robot; and 4 (7.5%) cases failed to approach robotically and converted to open surgery entirely. Conclusion Robotic-assisted surgery is still in the early stage in peripheral nerve surgery. We believe the use of the robotic system in this field will develop to become popular in the future, especially in the fields that need cooperation with other specialties to provide the solutions for challenging circumstances.

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confidence: 99%

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

Chen

Goh

Goh³

et al. 2021

J Reconstr Microsurg

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“…Just after the TS patients are pleased as they do not longer sweat in the areas where it was incredibly cumbersome (hands and axillae) [9], but as time goes by, especially during the summer, they notice sweating in areas that did not sweat before or not to such an extent, such as the abdomen, torso, buttocks, and thighs [10]. This new sweating is known as compensatory hyperhidrosis (CH) and is the fundamental cause of long-term patients' dissatisfaction [11][12][13]. Another problem, although patients do not complain so often about it [14], is the over-dryness of the sympathetically denervated area (head/face, hands, and axillae) [15,16].…”

Section: Introductionmentioning

confidence: 99%

Selective T3-T4 Sympathicotomy Versus Gray Ramicotomy On Outcome And Quality Of Life In Hyperhidrosis Patients. A Randomized Clinical Trial.

Vanaclocha

Guijarro-Jorge

Saiz-Sapena

et al. 2021

Preprint

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Background: compensatory hyperhidrosis is the leading cause of patients' dissatisfaction after thoracic sympathicotomy.Objective: to reduce compensatory hyperhidrosis to increase patients' satisfaction. Patients and methods: a prospective randomized study on palmar hyperhidrosis, May 2016-September, 2019. Twenty-one patients T3-T4 sympathicotomy and 21 T3-T4 gray ramicotomy. Data prospectively collected. Analysis at study's end. Focus on the sweating, temperature, quality of life baseline and postoperatively, compensatory hyperhidrosis, hand dryness, patients' satisfaction, and if they would undergo the procedure again and would recommend it.Results: No baseline differences between groups. Hyperhidrosis was controlled postoperatively in all patients. No mortality, serious complications, or recurrences. Sympathicotomy worse postoperative quality of life (49.05 (SD: 15.66, IR: 35.50-63.00) versus ramicotomy 24.30 (SD: 6.02, IR: 19.75-27.25). After ramicotomy, some residual sweating on the face, hands, and axillae. Compensatory sweating worse with sympathicotomy. Satisfaction higher with ramicotomy. Better results with ramicotomy than sympathicotomy regarding hand dryness, how many times a day the patients had to shower or change clothes, intention to undergo the procedure again or recommend it to somebody else, and how bothersome compensatory hyperhidrosis was.Conclusions: T3-T4 gray ramicotomy had better results than T3-T4 sympathicotomy, with less compensatory sweating and higher patients' satisfaction.

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“…[1][2][3] Although conservative treatments may be tried first, most patients resort to surgical treatment due to such reasons as the side effects of the treatments, the short duration of action, and unsatisfactory outcomes. [1][2][3][4][5][6][7] Previous studies have identified endoscopic thoracic sympathicotomy (ETS) as an effective method for the treatment of both palmar and axillary hyperhidrosis (PH and AH). Questionnaires evaluating postoperative quality of life have reported success rates exceeding 90%, especially for PH.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes and Course of Compensatory Sweating after Endoscopic Sympathicotomy

Turhan

Kavurmacı

Akçam

et al. 2021

Thorac Cardiovasc Surg

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Background Endoscopic thoracic sympathicotomy is an effective approach to the treatment of idiopathic localized hyperhidrosis, and compensatory sweating is the main reason for patient dissatisfaction. Our study discusses both the long-term outcomes of sympathicotomy and the course of compensatory sweating. Methods Patients with palmar and/or axillary hyperhidrosis who were operated by the same surgical team between January 2008 and December 2014 were included in the study. After at least 5 years (60 months) from operation, patients were questioned about their treatment outcomes by using an original survey form. Results Of the 137 patients included in the study, 88 (64.2%) were female and 49 (35.8%) were male. The mean time from the operation to the survey interview was 80.9 ± 14.1 (64–136) months. After operation, complaints disappeared in 95.1% of the patients, and decreased in 4.9% with palmar hyperhidrosis. Complaints completely disappeared in 12.9% and decreased in 81.7% of the patients with axillary hyperhidrosis. Ninety-seven (70.8%) of the patients described increased sweating in some parts of their body after operation but only 47 reached an uncomfortable intensity. The number of patients who regretted the operation due to the compensatory sweating was 13 (9.5%). The patients' overall scoring of the operation and procedure was calculated as 8.0 ± 2.1 (0–10 points) out of 10. Conclusion Endoscopic thoracic sympathicotomy's long-term outcomes are also satisfactory in the treatment of palmar and axillary hyperhidrosis. Compensatory sweating may decrease over time, only a minority of patients will express regret at undergoing the treatment.

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Long-Term Impact of Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis

Abstract: This study confirms that the benefits of ETS are maintained in the long term. Although CS is the main cause for discontent postoperatively, it is still preferred over the distress experienced from palmar or axillary hyperhidrosis and QOL is increased despite CS.

Cited by 30 publications

References 9 publications

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

Selective T3-T4 Sympathicotomy Versus Gray Ramicotomy On Outcome And Quality Of Life In Hyperhidrosis Patients. A Randomized Clinical Trial.

Long-Term Outcomes and Course of Compensatory Sweating after Endoscopic Sympathicotomy

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