Single-port one-stage bilateral thoracoscopic sympathicotomy for severe hyperhidrosis: prospective analysis of a standardized approach

Abstract

BackgroundPrimary palmar and/or axillary focal hyperhidrosis is a frequent disorder characterized by excessive sweating beyond physiological needs, often leading to a substantial impairment of quality of life. Over the years several minimally invasive surgical treatments have been described, however results vary, and due to a lack of uniform surgical approach, technique and nomenclature are often difficult to compare. In this prospective study we sought to evaluate the safety and effectiveness of our standardized technique of single-port, one-stage bilateral thoracoscopic sympathicotomy.MethodsOn a prospective basis a hundred consecutive patients with severe or intolerable primary hyperhidrosis underwent one-stage bilateral single-port thoracoscopic sympathicotomy. Primary outcome was measured in pre- vs. post-operative Hyperhidrosis Disease Severity Scale scores. Location and extend of compensatory hyperhidrosis, and satisfaction with the procedure were registered.ResultsA significant reduction in mean Hyperhidrosis Disease Severity Scale score (3.69 ± 0.47 preoperatively vs. 1.06 ± 0.34 postoperatively) (p < 0.001) was observed. In 97 (97%) out of the 100 enrolled patients a >80% reduction in sweat production was achieved. Compensatory hyperhidrosis was seen in 27 patients (27%). It was rated as mild by 21 patients (78%) and as moderate by 6 (22%) of these patients. No severe compensatory hyperhidrosis was reported. Major complications, such as intraoperative bleeding, infections, and Horner’s syndrome were not observed.ConclusionsHighly selective sympathicotomy at well-defined levels with a one-stage bilateral single-port transaxillary thoracoscopic approach is a save procedure, with excellent and reproducible immediate results in the treatment of primary palmar and/or axillary hyperhidrosis.

Management of hyperhidrosis

“…LC successfully relieves HH and, by virtue of the suctioning mechanism, may be superior to curettage alone for lasting results 14,49,52. Sympathotomy and sympathectomy are the most invasive procedures for HH, but for those patients whose daily lives are disrupted by HH, despite trials of other therapeutic options, sympathetic chain disruption may present an appealing opportunity for treatment 19,57,63,70–73. Certainly, the risk of CH should be discussed thoroughly with patients considering this intervention 58,62,63.…”

Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; A Narrative Review

“…Recently, it has become more accepted to disconnect the sympathetic chain (sympathicotomy) at appropriate levels [6,21,22]. The new nomination system uses the number of ribs upon which the sympathetic chain is cut (R) instead of the number of sympathetic ganglion (T) [1,6,22].…”

“…Recently, it has become more accepted to disconnect the sympathetic chain (sympathicotomy) at appropriate levels [6,21,22]. The new nomination system uses the number of ribs upon which the sympathetic chain is cut (R) instead of the number of sympathetic ganglion (T) [1,6,22]. These manipulations on the sympathetic chain are carried out via different devices and techniques, such as electrocautery (monopolar or bipolar), the Harmonic scalpel, radiofrequency, and clamping [23][24][25][26].…”

“…Its diagnosis is established upon excessive local sweating without a known cause for more than 6 months in conjunction with at least two of the following criteria: bilateral and rather symmetrical hyperhidrosis, frequency of at least one episode a week, impairment of daily activities, onset before the age of 25 years, a positive family history, and cessation of excessive sweating during sleep [6]. PH causes psychological problems for patients mostly through wet hands at work and in other social relationships [7].…”

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

“…143,227,[281][282][283] The Lessa et al 284 study used . The studies included two quality-of-life reviews, a RCT, a single case series, a case report and a surgical observational 285 The tool's design was based on findings from a review of the literature and focus group interviews with patients and clinicians to construct the initial framework for the ways in which patients are affected by skin disease.…”