The Effect of Upper Dorsal Thoracoscopic Sympathectomy on the Total Amount of Body Perspiration

Kopelman, Doron; Assalia, Ahmad; Ehrenreich, M.; Ben-Amnon, Yuval; Bahous, H; Hashmonai, M

doi:10.1007/s005950070006

Cited by 13 publications

(11 citation statements)

References 22 publications

(23 reference statements)

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“…They suggested that the increased sweating in other parts of the body occurring after surgery compensated the abolition of palmar perspiration. On the other hand, Kopelman et al [10] found no correlation between the preand post-sympathectomy amounts of total body perspiration. They thus questioned the compensatory nature of increased perspiration in other areas of the body developing after sympathectomy.…”

Section: Discussionmentioning

confidence: 97%

Treatment of palmar hyperhidrosis by endoscopic clipping of the upper part of the T4 sympathetic ganglion

Choi¹,

Lee²,

Sim

2003

Clinical Autonomic Research

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Endoscopic thoracic sympathetic surgery is a safe and effective method of treating palmar hyperhidrosis. Although hand dryness is the positive outcome of surgery, a residual amount of moisture in the hand is believed to improve the quality of life. Reflex sweating is a well-recognized and annoying complication that surgeons endeavor to avoid. From May 1, 2002 to July 31, 2002, 52 patients suffering from palmar hyperhidrosis were operated on by means of endoscopic clipping of the upper part of the T4-sympathetic ganglion (Upper ESB4). There were 24 males and 28 females with a mean age of 25 years. The mean follow-up period was 8.3 months. The patients answered a detailed questionnaire addressing the following issues: the recurrence rate, the degree of hand dryness, the extent of and areas of reflex sweating, the occurrence of gustatory and facial sweating, and the degree of satisfaction. The surgical outcome was satisfactory. Most patients demonstrated no or only slight hand sweating. Moderate sweating without discomfort was experienced in 9% of patients. Only 25% of patients required the use of lotion for hand dryness. Reflex sweating was observed in 87.5% of the patients but extremely uncomfortable in only 3.2%. Ninety-four percent of patients were satisfied. The remaining 6% were not satisfied but did not regret the operation. Although the duration of the follow-up period in this study was relatively short, we could obtain results comparable to other data in the literature. This is a simpler procedure and less damaging to the sympathetic system.

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Section: Discussionmentioning

confidence: 97%

Treatment of palmar hyperhidrosis by endoscopic clipping of the upper part of the T4 sympathetic ganglion

Choi¹,

Lee²,

Sim

2003

Clinical Autonomic Research

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“…The opposite effect, namely reduced sweating in other parts of the body -not those affected by the sympathectomy, has also been reported [8,20]. A recent study [24], which examined the correlation between the amount of compensatory hyperhidrosis and the total amount of pre-and postoperative body perspiration, found no correlation between them. The mechanism of compensatory hyperhidrosis thus appears to be more complex than simple compensation for thermoregulatory purposes, and remains obscure.…”

Section: S Evaluation Based On Postoperative Sequelsmentioning

confidence: 89%

Upper thoracic sympathetic surgery

Kopelman

Hashmonai

2003

Clinical Autonomic Research

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Four open surgical approaches have been used to perform upper thoracic sympathectomy. The posterior approach requires access through the posterior muscles of the back, and rib transection. It is a painful operation that has been practically abandoned in favor of the other techniques. The anterior transthoracic approach consists of a formal thoracotomy and never gained popularity. The supraclavicular approach involves dissection of several important anatomical structures. It requires excellent surgical dexterity, but ensures the easiest postoperative recovery. The last approach involves a small transaxillary thoracotomy. Technically, it is the easier procedure. Both the supraclavicular and the transaxillary approaches were widely used until the advent of thoracoscopic surgery. The results (rate of success, recurrences, and sequelae) were similar for all techniques, depending on the procedure performed on the sympathetic chain, not on the access route. Open approaches for upper dorsal sympathectomy are not used any more except in the very rare cases in which thoracoscopy is unfeasible.

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“…2,13,15 It has been suggested that the severity of RS is highly associated with the number of denervated segments or resected ganglia, and the severity of RS may change FIGURE 1. [16][17][18] According to several reports on RS, 5,14-16,18 there is a wide variation for RS rates among the different techniques that are used to treat patients with PH. A Ushaped endoclip is suitable for clipping along with suture sling, retrieving, and pulling back (unclipping).…”

Section: Discussionmentioning

confidence: 99%

New Protocol for a Reversal Operation in Endoscopic Thoracic Sympathetic Clamping: Pulling Back the Suture Sling Linked to the Clip Under Local Anesthesia

Moon

Kim

et al. 2007

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Endoscopic thoracic sympathetic clamping (ETC) has widely been used for treating the patients with primary hyperhidrosis, as it offers the potential of reversal operation (unclipping) under general anesthesia (GA) when severe reflex sweating would occur. However, we modified ETC to unclip under local anesthesia. From March 2002 to January 2005, we performed ETC in 87 patients with primary hyperhidrosis. From September 2002 on, the suture sling which was made with a 3-0 propylphylene suture was additionally placed between the endoclip and the subcutaneous tissue of the thoracoport. When unclipping was needed, the endoclip was removed by being pulled back under portable fluoroscopy. Four of 53 patients (7.5%) who underwent ETC alone underwent unclipping under GA. By contrast, unclipping was successfully performed under local anesthesia in 5 of 34 patients (14.7%) who underwent the modified ETC. ETC will be more effective operation if it is modified concomitantly with the suture sling; otherwise the reversal operation will need GA for the unclipping.

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The Effect of Upper Dorsal Thoracoscopic Sympathectomy on the Total Amount of Body Perspiration

Cited by 13 publications

References 22 publications

Treatment of palmar hyperhidrosis by endoscopic clipping of the upper part of the T4 sympathetic ganglion

Treatment of palmar hyperhidrosis by endoscopic clipping of the upper part of the T4 sympathetic ganglion

Upper thoracic sympathetic surgery

New Protocol for a Reversal Operation in Endoscopic Thoracic Sympathetic Clamping: Pulling Back the Suture Sling Linked to the Clip Under Local Anesthesia

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