Video-Assisted Thoracic Sympathectomy for Hyperhidrosis

Campos, José Ribas Milanez de; Kauffman, Paulo; Gomes, Oswaldo; Wolosker, Nelson

doi:10.1016/j.thorsurg.2016.04.010

Cited by 14 publications

(10 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Die palmare Form beginnt meist in der 2.-3. Lebensdekade, Estevan et al [5] fanden bei 615 Patienten ein mittleres Alter von 22 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) Jahren. Die Therapie der leichten bis mittelschweren Hyperhidrosis liegt primär in den Händen der konservativen Medizin, wobei die topische Behandlung mit Antiperspiranzien, die Leitungswasser-Iontophorese, die systemische Gabe von Anticholinergika und eine Psychotherapie (Biofeedback) infrage kommen [1,13].…”

Section: Introductionunclassified

“…Die Therapie der leichten bis mittelschweren Hyperhidrosis liegt primär in den Händen der konservativen Medizin, wobei die topische Behandlung mit Antiperspiranzien, die Leitungswasser-Iontophorese, die systemische Gabe von Anticholinergika und eine Psychotherapie (Biofeedback) infrage kommen [1,13]. Für die schwere Form der Hyperhidrosis palmaris stehen dann die lokale Botulinum-Injektion [14] und die Ausschaltung des thorakalen Grenzstrangs mittels video-thorakoskopischer Sympathektomie [6,15,16], CTSy [8,17,18] oder CT-gesteuerte Radiofrequenzneurolyse [19] zur Verfügung. Vor jeder Therapie und auch zur Verlaufskontrolle ist eine möglichst objektive Schweregradeinteilung sowie Erfassung der subjektiven Beeinträchtigung unerlässlich (▶ Tab.…”

Section: Introductionunclassified

See 1 more Smart Citation

CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects

Andresen

Scheer

Schlöricke

et al. 2020

Rofo

View full text Add to dashboard Cite

Purpose The objective of the present study was to evaluate the benefit of a thoracic, computed tomography-guided sympathicolysis (CTSy) in patients with primary, focal hyperhidrosis of the hands. In addition, the influence of the amount and distribution of the administered sympathicolytic agent was to be assessed. Patients and Methods Retrospectively, 78 patients [13 (16.7 %) men, mean age 31.2 ± 9 years and 65 (83.3 %) women, mean age 34.2 ± 12 years], who had been treated using CTSy, were included in the study. The indication for treatment was primary focal palmar hyperhidrosis grade II and grade III after exhaustion of all conservative treatment options and a continued high level of suffering. CTSy was performed after establishing the entry plane at the level of the intervertebral space T2 / T3 via a dorsolateral approach using a 22-G coaxial needle. On average 5 (2–10) ml of a sympathicolytic mixture (10 ml consisting of 8 ml 96 % alcohol, 1.6 ml 0.5 % Carbostesin and 0.4 ml 0.9 % NaCl solution, with added amounts of contrast medium) were instilled. The volume of distribution of the sympathicolytic agent was determined in craniocaudal direction using CT images. The patients evaluated their sense of discomfort preinterventionally, 2 days postinterventionally, and 6 and 12 months after the intervention, on the basis of a Dermatology life Quality Index (DLQI) as well as the side effects that occurred. Results The technical success rate of CTSy was 100 %. No major complications occurred. The interventions performed led to a significant reduction (p < 0.001) in the preinterventional sense of discomfort 2 days, 6 and 12 months after CTSy. As the most common side effect, compensatory sweating was reported by 16/78 (20.5 %) of the patients over the further course. In all of these patients, the volume of sympathicolytic agent administered was below 5 ml. In no case did the sympathicolytic agent extend caudally beyond the base plate of Th 3. No compensatory sweating of the back was observed in 5/78 (6.4 %) patients; here the sympathicolytic volume was above 5 ml and extended significantly caudally below the baseplate of T3.Transient miosis and ptosis was found in 8/78 (10.3 %) patients. In all of these patients, the volume of sympathicolytic agent administered was above 5 ml and it extended markedly cranially beyond the upper plate of T2. A mild to moderate recurrent sweating developed in 35/78 (44.9 %) patients, which was more marked if the volume of sympathicolytic administered was below 5 ml and slightly more pronounced on the left than on the right. Given a high level of satisfaction overall, 71/78 (91.0 %) patients said that they would undergo the intervention again. Conclusion For patients with primary, focal palmar hyperhidrosis CTSy represents a therapeutic option that offers good benefit and has few side effects. The amount and spatial distribution of the sympathicolytic agent has an influence on the therapeutic outcome and the side effects. Key Points: Citation Format

show abstract

Section: Introductionunclassified

CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects

Andresen

Scheer

Schlöricke

et al. 2020

Rofo

View full text Add to dashboard Cite

show abstract

“…Several studies have attempted to identify predictive factors of severe compensatory hyperhidrosis, since affected patients may have worse clinical status and quality of life postoperatively, making them regret having had the surgery. 29,30 The indication of sympathectomy level has changed over the years as the technique has evolved, as has been observed in the literature and based on our own experience. The approach is defined by the patient's most uncomfortable area of complaint, and T2 is the most appropriate level for FH.…”

Section: Surgical Treatmentmentioning

confidence: 85%

Section: Surgical Treatmentmentioning

confidence: 99%

Current treatment options for craniofacial hyperhidrosis

et al. 2020

Self Cite

View full text Add to dashboard Cite

Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.

show abstract

“…4 Surgical elimination of the thoracic sympathetic trunk by video-assisted thoracoscopic sympathectomy (VATS) was technically improved over the years from the 1990s onward, with the further development of optical technology, to become a safe and effective procedure and, on the basis of the comprehensive experience gained, represents the standard method at present. [5][6][7][8][9] The method of computed tomography (CT)-guided thoracic sympathicolysis (CTSy) was first described in 1987 by Dondelinger and Kurdziel and was discussed as a possible treatment option for palmar hyperhidrosis. 10 In the meantime, CTSy also represents a safe, effective, and minimally invasive technique.…”

Section: Introductionmentioning

confidence: 99%

CT-guided Thoracic Sympathicolysis versus VATS Sympathectomy in the Therapeutic Concept for Severe Primary Palmar Hyperhidrosis

Andresen

Scheer

Schlöricke

et al. 2021

Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Background The objective was to compare computed tomography (CT)-guided thoracic sympathicolysis (CTSy) and video-assisted thoracoscopic sympathectomy (VATS) with regard to their feasibility, the occurrence of minor and major complications, and the clinical outcome. Materials and Methods In this study, 88 patients treated by CTSy and 86 patients treated by VATS were retrospectively included. CTSy was performed after establishing the entry plane below the level of the intervertebral space T2/3 via a dorsolateral approach using a 22-G coaxial needle. On average of 5 mL of a sympathicolytic mixture was instilled. VATS was performed under intubation anesthesia. After insertion of the instruments via a minithoracotomy, the parietal pleura was dissected and the sympathetic trunk severed below T2. The interventions were performed unilaterally, the contralateral side being treated after approximately 6 weeks. All patients evaluated their sense of discomfort before treatment as well as 2 days, 6, and 12 months after, on the basis of a Dermatology Quality of Life Index and additionally the side effects that occurred. Results Both treatments led to a marked reduction of symptoms, whereby mild recurrent sweating occurred over the further course, significantly higher in the CTSy patient group. Short-term miosis and ptosis were rarely found in both groups. As the most common side effect, transient compensatory sweating was reported by 16/88 patients after CTSy and 10/86 patients after VATS. Pneumothoraces developed postoperatively in 7/86 cases. Temporary pain after thoracotomy was experienced by 12/86 patients. Conclusion For patients with palmar hyperhidrosis, CTSy and VATS represented a minimally invasive treatment option that provided a high and largely equivalent level of benefit.

show abstract

Video-Assisted Thoracic Sympathectomy for Hyperhidrosis

Cited by 14 publications

References 34 publications

CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects

CT-assisted thoracic sympathicolysis for therapy of primary hyperhidrosis palmaris-retrospective analysis of the influence of the amount and position of the sympathetic agent on the therapeutic outcome and side effects

Current treatment options for craniofacial hyperhidrosis

CT-guided Thoracic Sympathicolysis versus VATS Sympathectomy in the Therapeutic Concept for Severe Primary Palmar Hyperhidrosis

Contact Info

Product

Resources

About