Thoracoscopic T2-sympathetic block by clipping-a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases

Lin, Chien-Chih; Mo, Lein‐Ray; Lee, Lim‐Sim; Ng, Seok‐Mun; Hwang, Ming‐Huo

doi:10.1080/11024159850191067

Cited by 127 publications

(166 citation statements)

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“…[10][11][12][13][14][15][16][17][18][19][20][21][22] This access route, after the surgeon has acquired adequate experience through training in videoassisted thoracoscopy, allows well-directed surgery to be performed, with minimal risk of the disagreeable complications that occurred in the past when the transcervical route was used, as well as the sequelae and scars of classical thoracotomy. [23][24][25][26] In using the transcervical route, injury to the stellate ganglion is in fact very frequent and expected, producing significant sequelae: the so-called Claude-Bernard-Horner syndrome (palpebral ptosis, miosis and enophthalmos).…”

Section: Total 743mentioning

confidence: 99%

“…In some centers, the surgery is performed using two punctures through which a 2-mm scope and the tip of a cauterizer are introduced with the objective of selectively destroying the second thoracic ganglion (T 2 ). 10,12,[14][15][16][18][19][20] For this strategy, CO 2 insufflation is required in order to deviate the lung. The scar so produced is minimal and the procedure is esthetically excellent, with a scar the size of a percutaneous puncture (needlescopic sympathectomy).…”

Section: Total 743mentioning

confidence: 99%

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Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis

et al. 2003

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CONTEXT: Essential hyperhidrosis is a frequent disorder causing significant functional impairment. The advent and development of video-assisted thoracoscopic techniques now allows thoracic sympathectomy to be carried out precisely and safety with good results and minimal morbidity. OBJECTIVE: To assess the impact of video-assisted thoracic sympathectomy in patients diagnosed as presenting severe and disabling hyperhidrosis. TYPE OF STUDY: This was a longitudinal study of the clinical course of all hyperhidrosis cases selected for surgery between May 1999 and January 2003. SETTING: Division of Thoracic Surgery, Universidade Federal de São Paulo (UNIFESP). PARTICIPANTS: 743 patients with surgery indicated due to palmar hyperhidrosis (49.8%), palmar-axillary hyperhidrosis (38.1%), craniofacial hyperhidrosis (8.9%) or isolated axillary hyperhidrosis (2.8%). PROCEDURES: Video-thoracoscopic sympathectomy was performed, isolating the second thoracic ganglion (T2) in all patients, with additional sympathectomy of T3 and T4 if necessary. MAIN MEASUREMENTS:The clinical course was followed up via questionnaires, phone calls, letters and statements. Simple questions were asked regarding the disappearance of symptoms and presence and intensity of compensatory sweating. RESULTS: The surgery was regarded as efficient in all cases of palmar hyperhidrosis. In the craniofacial hyperhidrosis cases, partial recurrence of the symptoms occurred in 2 cases (3.0%). Partial recurrence or persistence of symptoms occurred in 20% of the patients with predominantly axillary symptomatology. The compensatory sweating was considered disagreeable or uncomfortable by about 30% of the patients, but it only reached the level of regretting the operation for 3% of them. This occurred more frequently in patients with axillary hyperhidrosis. Ten cases of complications occurred. CONCLUSION: Thoracoscopic sympathectomy provides very good results in most patients, with a very low complication rate. However, the assessment of surgical results using conventional methods is imprecise and inaccurate. Different methodology, including quality of life assessment, must be used for comparing results and providing objective data on the results of this operation.

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Section: Total 743mentioning

confidence: 99%

Section: Total 743mentioning

confidence: 99%

Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis

et al. 2003

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“…7) In 2001, Lin and Wu first reported a significant reduction in compensatory sweating when T4 thoracic sympathicotomy was employed to treat palmar hyperhidrosis. 8) Several studies later confirmed that T4 sympathicotomy avoided compensatory sweating, patients were highly satisfied, and that this approach was preferred in the treatment of palmar hyperhidrosis. [1][2][3][4]9) In some patients, however, improvement in palmar sweating was less defined and its efficacy was incomplete.…”

Section: Discussionmentioning

confidence: 91%

Sympathicotomy for Palmar Hyperhidrosis: The Association between Intraoperative Palm Temperature Change and the Curative Effect

Liu

Zheng

et al. 2015

ATCS

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Purpose: To investigate the association between intraoperative palm temperature change and the curative effect of sympathicotomy. Methods: 49 patients with palmar hyperhidrosis were treated with bilateral endoscopic sympathicotomy. Ipsilateral palm temperature was monitored before and at 3-5 min increments after the sympathetic trunk was transected. The maximum temperature elevation (Tmax) was calculated and used to evaluate the effect on postoperative cure rates. Results: Forty-nine patients underwent 98 sympathicotomies. There were 77 T4 sympathicotomies, 15 T4 + T5 sympathicotomies, and six T3 sympathicotomies due to pleural adhesions or neurovascular proximity. The Tmax was ≤1°C in 49 (50.0%), 1-1.5°C in 17 (17.3%), and >1.5°C in 32 (32.7%) palms. Ninety-two palms of 46 patients were followed with complete efficacy, and three patients were lost to follow up. Cure was achieved in 86 palms (93.4%). Of the 71 palms which underwent T4 sympathicotomy, cure was achieved in 67 palms (94.3%). In those palms which did not achieve cure, the Tmax was less than 1°C in each case, while in palms with a Tmax ≤1°C, 32 of 36 (88.9%) were cured. Conclusion: There is an association between intraoperative palmar temperature change and curative effect. However, palmar temperature change cannot be used to predict cure or guide surgical approach.

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“…There are several observational studies on the effect of clamping of the sympathetic chest chain 3,4,7,10,11 . They show block conduction but without showing the histological lesion.…”

Section: Assessment Of Inflammation and Necrosismentioning

confidence: 99%

“…Several series were published for the treatment of hyperhidrosis of the upper limb [3][4][5][6][7][8][9][10][11] . One of the problems encountered in all surgical techniques was the individuality, tending to justify the side effects by saying: "it seems to work on my hands" 12 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits

MARINHO¹,

Filho²,

Malafaia

et al. 2012

Acta Cir. Bras.

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PURPOSE: To study the macro and microscopic evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits, quantifying the collagen in the lesions. METHODS: Twenty rabbits were divided into two groups of ten, doing in group 1 (section) section of the right cervical sympathetic nerve, while in group 2 (clipping) clipping of the nerve. All rabbits were induced to death on the seventh day after surgery. The macroscopic variables were: consequences of nerve lesion, clip appearance, presence of infection and adhesions around the nerve. Microscopy used hematoxylin-eosin staining to evaluate the stages and the degree of inflammation and necrosis, and F3BA Picrosirius red staining to quantify collagen. Mann-Whitney test was used for comparisons of collagen types I and III between groups. Fisher exact test analyzed the macroscopic variables, the degree of inflammation and necrosis. RESULTS: There was no discontinuity of nerve injury in the clipping group, as well as the clip was closed in all animals. The presence of severe adhesions was significantly higher in the clipping group (p<0.05). There was no significant difference on other variables macroscopically analyzed. There was no significant difference between groups regarding the type of inflammatory process and its intensity, as well as the presence of necrosis and collagen deposition in the nerves. CONCLUSIONS: In the macroscopic evaluation, the section caused discontinuity, which did not occur in the clamping group; there was no development of local infection; the clipping of the cervical sympathetic nerve was linked to the presence of a greater number of adhesions in comparison to the section group. Microscopically, no difference existed in relation to the type and intensity of inflammation reaction between the groups; occurred predominance of chronic and severe inflammation on the specimens; the necrosis was noticed equally in both groups; there was predominance of type I collagen deposition in relation to type III in both groups.

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Thoracoscopic T2-sympathetic block by clipping-a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases

Abstract: Forced air warming intraoperatively can preserve normothermia during extensive thoracoabdominal operations.

Cited by 127 publications

References 0 publications

Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis

Role of video-assisted thoracoscopic sympathectomy in the treatment of primary hyperhidrosis

Sympathicotomy for Palmar Hyperhidrosis: The Association between Intraoperative Palm Temperature Change and the Curative Effect

Evaluation of the damage caused by clamping or section of cervical sympathetic nerve in rabbits

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