Safety and feasibility of thoracic sympathectomy in the treatment of primary palmar hyperhidrosis based on ambulatory surgery / 中国胸心血管外科临床杂志

@#Objective    To investigate the clinical safety and feasibility of thoracic sympathectomy in the treatment of palmar hyperhidrosis based on ambulatory surgery. Methods    A retrospective analysis of 74 patients who underwent thoracoscopic sympathectomy in the Department of Thoracic Surgery of the First People's Hospital of Yunnan Province from January 2017 to April 2021 was performed, including 35 males and 39 females aged 12-38 (21.32±4.13) years. Patients were divided into two groups according to different treatments. There were 34 patients in a control group (adopting traditional surgery), and 40 patients in an observation group (adopting ambulatory surgery). The clinical effects of the two groups were compared. Results    No massive bleeding, conversion to thoracotomy, postoperative pneumo-thorax or severe pneumonia occured in all patients. Univariate analysis of intraoperative indexes showed that the two groups had no statistical difference in total hospitalization cost, operation time, anesthesia time or postoperative waiting time (P>0.05). The amount of intraoperative blood loss in the observation group was less than that in the control group (P<0.05). The time of postoperative out of bed and recovery of walking capacity and the incidence of electrolyte disturbance in the observation group were shorter or lower than those in the control group (P<0.05). There was no statistical difference in white blood count, neutrophils count or postoperative 24 h pulse oxygen saturation fluctuation peak between the two groups (P>0.05). Conclusion    Based on the optimized diagnosis and treatment model, thoraco-scopic sympathectomy with laryngeal mask airway which is performed during ambulatory surgery, is feasible and worth popularizing in thoracic surgery.

Calidad de vida luego de simpaticotomía toracoscópica por hiperhidrosis focal primaria / Quality of life after thoracoscopic sympathectomy for primary focal hyperhidrosis

RESUMEN Antecedentes: la simpaticotomía toracoscópica demostró ser una cirugía segura para el tratamiento de la hiperhidrosis focal primaria (HFP); sin embargo, la calidad de vida no es totalmente satisfactoria en algunos pacientes, teniendo en cuenta la sudoración compensatoria como principal efecto adverso. Objetivo: evaluar la calidad de vida de los pacientes operados por HFP mediante simpaticotomía toracoscópica utilizando una encuesta anónima posoperatoria. Material y métodos: se incluyó una serie consecutiva de pacientes operados de simpaticotomía toracoscópica entre agosto de 2016 y agosto de 2019. Se excluyeron pacientes que no respondieron a la encuesta de calidad de vida telefónica o cuyo tiempo de seguimiento fue menor de 6 meses. Se evaluaron variables clínicas, quirúrgicas y posoperatorias. Resultados: durante este período se operaron 61 pacientes; del total de la muestra se excluyeron 12 pacientes. El promedio de edad fue 28,9 años. Todos tenían hiperhidrosis primaria palmar y/o axilar moderada o grave, asociadas o no a rubor facial o hiperhidrosis plantar. La encuesta fue respondida por 49 pacientes; de esta observamos una resolución total de la HFP en 32 pacientes (65,3%) y parcial en 17 pacientes (34,6%), con un porcentaje de sudoración compensatoria del 61% (30 pacientes), de los cuales a 4 (8%) la sudoración compensatoria les alteró su calidad de vida, provocando malestar e insatisfacción, la mayoría transitorios. Con un tiempo promedio de 36 meses (6-72), el 97,9% (48 pacientes) sí recomendarían realizar el procedimiento. Conclusión: la simpaticotomía toracoscópica bilateral continúa siendo el tratamiento más eficaz para HFP. El nivel de satisfacción de los pacientes operados fue elevado. Si bien la sudoración compensatoria fue el efecto adverso más frecuente, generalmente se presentó de manera leve y transitoria.

ABSTRACT Background: Thoracoscopic sympathectomy demonstrated to be a safe surgical procedure for the management of primary focal hyperhidrosis (PFH); however, some patients are not completely satisfied with their quality of life as compensatory sweating is the main adverse event. Objective: The aim of this study was to evaluate the quality of life of patients with PFH undergoing thoracoscopic sympathectomy using an anonymous postoperative survey. Material and methods: Consecutive patients undergoing thoracoscopic sympathectomy between August 2016 and August 2019 were included. Patients who did not respond the telephone survey about their quality of life or who had been followed up for < 6 months. Clinical, intraoperative and postoperative variables were analyzed. Results: During this period 61 patients were operated on and 12 of them were excluded. Mean age was 28.9 years. All the patients presented moderate or severe primary palmar and/or axillary hyperhidrosis with or without facial flushing or plantar hyperhidrosis. Forty-nine patients responded the survey. Surgery completely solved PFH in 32 patients (65.3%) while 17 patients (34.6%) achieved a partial relief; 61% (30 patients) developed compensatory sweating affecting the quality of life in 4 (8%) causing transient discomfort and dissatisfaction in most cases. After a mean follow-up of 36 months (6-72), 97.9% (48 patients) recommended the procedure. Conclusion: Bilateral thoracoscopic sympathectomy is still the most efficient treatment for PFH with high level of satisfaction among the patients operated on. Compensatory sweating was the most common adverse effect and is mild and transient in most cases.

Rotura espontánea de quiste hepático simple: éxito del tratamiento conservador / Spontaneous rupture of a simple liver cyst: success of a conservative approach

RESUMEN Los quistes hepáticos simples (QHS) son las lesiones hepáticas más frecuentes. Cursan habitualmente asintomáticas, aunque cuando alcanzan gran tamaño pueden causar síntomas. El objetivo del presente artículo es presentar una complicación excepcional de los QHS. Presentamos a una mujer de 61 años con historia de QHS múltiples que acude a Urgencias por dolor abdominal brusco sin antecedente traumático. Ante la sospecha de rotura quística espontánea, se realiza tomografía computarizada (TC) abdominal que confirma el diagnóstico. Se decide tratamiento conservador con buena evolución. Tras el episodio agudo es intervenida quirúrgicamente realizándose destechamiento de los quistes. a rotura de los QHS es una complicación excepcional que habitualmente cursa con dolor abdominal. Debido a su baja frecuencia no existe un tratamiento estándar. Se acepta que el tratamiento conservador es una buena opción en pacientes sin signos de peritonitis, mientras que la cirugía urgente está indicada en pacientes con abdomen agudo.

ABSTRACT Simple liver cysts (SLC) are the most common liver tumors. They are usually asymptomatic but large cysts may produce symptoms. The aim of this article is to report a rare complication of SLC. We report the case of a 61-year-old woman with a history of multiple SLCs who sought medical care due to sudden abdominal pain not associated with trauma. A probable diagnosis of spontaneous rupture was made, and the patient underwent computed tomography (CT) scan of the abdomen which confirmed the suspicion. Conservative treatment was decided, with favorable outcome. After the acute episode the patient underwent surgery and the cysts were unroofed. Rupture of SLC is a rare complication that usually presents with abdominal pain. There is no standard of care due to the low incidence of this complication. The conservative approach is a good option in patients without signs of peritonitis, while emergency surgery is indicated in patients with acute abdomen.

Thoracoscopic sympathectomy for palmar hyperhidrosis: a meta-analysis of studies published during the past decade / 中华胸心血管外科杂志

Objective To evaluate video-assisted thoracoscopic sympathectomy(VTS) for the treatment of palmar hyperhidrosis(PH),and to analyze curative efficacies for surgeries on different sympathetic segments.Methods Medline search was done on PubMed and data of randomized controlled trials(RCTs) about comparisons of surgeries on different segments over the past decade were collected.According to the inclusion criterion,relevant articles were screened.Then we extracted data,assessed trail quality,and performed Meta-analysis by using RevMan 5.2 with postoperative compensatory hyperhidrosis(CH) as the main evaluation index.Results A total of 11 RCTs involving 1 413 patients were included,among which all patients underwent bilateral VTS.Ef cacious rates were similar between multiple and single ganglia sympathectomy(97.7％ vs 98.8％,P ＜0.01).However,single-ganglia group showed a lower risk of CH compared to multiple-ganglia group.Meta-analysis suggested that,in the subgroups of the single-ganglia VTS,no significant difference was found between T2/T3 and other segments in the risk of CH [T2 segment vs other segments,RR =1.11,95 ％ CI(0.99,1.24) ; T3 segment vs other segments,RR =0.99,95％ CI(0.89,1.11)].The risk of CH was significantly lower in T4 sympathectomy than in other segments [RR =0.67,95％ CI(0.57,0.79)].By comparison of T2,T3 and T4 sympathectomy,we found that low segment had a lower risk of CH than high segment[RR =0.75,95％ CI(0.68,0.84)].Conclusion Single-ganglia and low segment sympathectomy can significantly reduce the incidence of CH,and T4 is supposed to be the best segment for the treatment of PH.

Tratamiento quirúrgico mínimamente invasivo de la hiperhidrosis palmar: reporte del primer caso realizado en la provincia de Ciego de Ávila / Minimally invasive surgery for palmar hyperhidrosis: report of the first case carried out in Ciego de Avila province

La hiperhidrosis es un raro trastorno de las glándulas sudoríparas de causa desconocida, se manifiesta mediante una sudoración excesiva de ciertas zonas del cuerpo, los pacientes portadores de esta enfermedad sufren de alteraciones psicológicas como limitaciones en su quehacer laboral o escolar así como en las actividades cotidianas. Esta enfermedad es tratada con métodos farmacológicos y no farmacológicos dentro de los cuales se encuentra la cirugía que es la variante terapéutica que mejores resultados exhibe. En este artículo se presenta el primer caso de esta rara enfermedad tratado con una simpatectomía videotoracoscópica en la provincia, además de los resultados obtenidos a corto plazo.

Hyperhidrosis is a rare disorder of the sweat glands of unknown cause, manifesting through excessive sweating of certain areas of the body, patients carriers of this disease suffer psychological disorders such as limitations in their work or school work and daily activities. This disease is treated with pharmacological and non-pharmacological methods such as surgery which is the therapeutic variant that exhibits best results. The first case of this rare disease is presented in this article treated with a video-assisted thoracoscopic sympathectomy in the province in addition to the results in the short term.

Treatment of Compensatory Hyperhidrosis with Botulinum Toxin A: A case report

Conventional thoracoscopic sympathectomy is an effective method in treating palmar-axillary hyperhidrosis. However, this may result in a postoperatively compensatory hyperhidrosis. Conservative treatments of compensatory hyperhidrosis consist of aluminum chloride, anticholinergics, iontrophoresis, and botulinum toxin A injections. Surgical treatments in compensatory hyperhidrosis include excision of axillary tissue, liposuction, and thoracoscopic sympathectomy. Intradermal injection of botulinum toxin A has used to treat focal axillary or palmar hyperhidrosis. Botulinum toxin A bestows significant benefits with few side-effects and is well-tolerated, with beneficial results lasting from 4-16 months. We report a case illustrating the beneficial use of botulinum toxin A in a 25-year-old healthy male patient with compensatory sweating of the flank after thoracoscopic sympathectomy. Modified Minor's starch iodine test was used to allow accurate assess the impact of hyperhidrosis on the patient. In conclusion, Botulinum toxin type A is a valuable therapy for compensatory sweating after endoscopic thoracic sympathectomy.

Brachial Plexus Injury after Thoracoscopic Sympathectomy: A case report / 대한마취과학회지

Unilateral brachial plexus injury is a rare complication of thoracoscopic sympathectomy, which is generally considered to be a simple and safe procedure. We report on a 20-year-old female patient who developed persistent pain and weakness of the left arm after thoracoscopic sympathectomy for hyperhidrosis. An electromyographic study revealed evidence of denervation at the C5-C7 level, and a nerve conduction study on the left brachial plexus showed decreased amplitude of the compound muscle action potential of the left musculocutaneous and axillary nerves. The above findings are compatible with left brachial plexopathy, with predominant involvement of the lateral and posterior cord. We suggest that this complication was caused by stretch and/or compression of the left brachial plexus when the arm was hyperabuducted upwards during the operation. Careful attention to positioning by the surgeon and anesthesiologist is needed to prevent this debilitating injury.

Mental Change with Seizure after Propofol-N2O Anesthesia for Thoracoscopic Sympathectomy: A case report / 대한마취과학회지

We experienced a case of postoperative mental change with seizure after propofol-N2O anesthesia for thoracoscopic sympathectomy. A 23-year-old male patient was anesthetized with N2O-O2-propofol, and postoperative pain control was achieved with intravenous morphine. Bilateral electrocauterization of the upper dorsal sympathetic chain at the T2 and T3 level was performed with thoracoscopy. Thoracoscopy was done with carbon dioxide insufflation. In the postoperative recovery room, the patient experienced seizure, fever and a mental change. He was transferred to the intensive care unit and treated with acyclovir, mannitol, diphenylhydantoin and dexamethasone. Fourteen days after the operation, the patient was discharged with a clear mentality.

Changes in Cardiovascular Function and Arterial Oxygenation during One Lung Anesthesia for Thoracoscopic Sympathectomy / 대한마취과학회지

BACKGROUND: Essential hyperhidrosis is caused by an unexplained over activity of the high thoracic sympathetic nervous system. Since the development of video endoscopic surgery, the use of thoracoscopic sympathectomy has gradually increased. However, reports on major anesthetic problems related to bilateral thoracic symathectomy and one lung ventilation (reventilation of a collapsed lung), which are commonly used for this operation are few. The aim of this study was to evaluate changes in cardiovascular function and arterial oxygenation during reventilation of the collapsed lung for bilateral thoracoscopic sympathectomy. METHODS: Twenty one patients with essential hyperhidrosis in ASA physical status class 1, undergoing bilateral thoracoscopic T2-3 sympathectomy in the semi-Fowler's position were selected. Mean arterial blood pressure (MBP) of both radial arteries, skin temperature of both palmar area, and heart rate (HR) were recorded just before and after, 5 min and 10 min after sympathectomy. Simultaneously, arterial oxygen tension was obtained 30 min after left lung ventilation (LLV, baseline) and right lung ventilation (RLV, left lung collapse) and 10, 20, 30, 40, 50 and 60 min after LLV (reventilation of the collapsed left lung) under general anesthesia (isoflurane-100% oxygen). RESULTS: MBPs of bilateral radial arteries were significantly reduced after sympathectomy. However, there were no difference in the percent change of the MBP between both sides. HR was reduced only after right sympathectomy. The skin temperature of ipsilateral thenar area was significantly elevated after sympathectomy. Aterial oxygen tension was markedly reduced after 10 min of reventilation of the collapsed left lung (246.9 +/- 11.3 --< 102.3 +/- 5.7 mmHg) and then slowly returned to the baseline value after 50 min of reventilation. CONCLUSIONS: Thoracic sympathectomy in patients with essential hyperhidrosis causes a marked decrease of HR and MBP of the bilateral radial arteries and an increase of skin temperature of the ipsilateral palmar area. Reventilation of the collapsed lung for bilateral thoracoscopic T2-3 sympathectomy, causes a marked reduction in the arterial oxygen tension.

The Changes of Skin Temperature and Sympathetic Skin Response after Thoracic Sympathectomy in Patients with Palmar Hyperhidrosis

OBJECTIVE: The purposes of these study were to evaluate the changes of temperature and sympathetic skin response (SSR) before and after sympathectomy in patients with palmar hyperhidrosis and to quantify long standing effect of sympathectomy. METHOD: The SSR and skin temperature were measured before, one day and 30 days after thoracoscopic sympathectomy. SSR was recorded from palm and sole bilaterally. Temperature was recorded on 9 sites of each hand and 11 site of each sole. Patient's satisfaction with operation was assessed by 10-point scale. RESULTS: One day after sympathectomy, the amplitude of SSR was significantly decreased and latency of SSR was delayed in all cases on bilateral palm and sole. However, after sympathectomy 30 days, the amplitude of SSR was normalized in all cases on bilateral sole. All patients who had undergone sympathectomy showed significant clinical improvement. The temperature increased dramatically over 3degrees C on postoperation 1 day and maintained 1.72degrees C higher in post-operation 30 days than pre-operation on both hands. There was no significant difference of temperature among pre-operation and post-operation 1 day and post-operation 30 days on sole. CONCLUSION: Our study proved effect of thoracoscopic sympathectomy to the patients with palmar hyperhidrosis objectively and quantified the decrement of sympathetic tone. Further study is needed for long term follow up over 2 months or more.

Sympathectomy for Raynaud disease / 中国微创外科杂志

Objective To study the effect of thoracoscopic sympathectomy and/or chemical lumbar sympa- thectomy performed on patients with Raynaud disease. Methods Five patients, 1 male,4 females, aged from 30 to 65(mean 45. 3 ). Raynaud phenomenon appeared only on both hands in one patient, only on feet with a toe gangrene in another one , the other 3 cases on all limbs. Thoracoscopic symathectomy was performed for those whose hands were af- fected and chemical lumbar sympathectomy(12-3 ) was pererformed for those whose feet were affected. Results All patients were followed up from 12 to 48 months(mean 24 months). All experinced improvement with hands warm and satisfactory results after thoracoscopic sympathectomy. However, the original symptoms reccurred in two patients after postoperatire six months. All 4 patients performed chemical lumbar sympathectomy experienced improved symptoms with feet warm and satisfactory results and the symptoms did not recur up to now. The sympathectomy showed different results for hands and for feet. Conclusions Thoracoscopic sympathectomy for hands affected by Raynaud disease has efficiency temporarily, but is not satisfactory. The chemical lumbar sympathectomy for the feet affected by Raynaud disease has dramatically disappearence of symptoms and the results are very good

Sympathetic Skin Response in Patients with Palmar Hyperhidrosis

OBJECTIVE: To observe the change of sympathetic skin response (SSR) before and after sympathectomy in patients with idiopathic palmar hyperhidrosis and to find the usefulness of SSR for assessment of the effects of sympathectomy. METHOD: The SSR was measured in 20 patients with palmar hyperhidrosis and 20 normal control group. Ten days after thoracoscopic sympathectomy, SSR was also measured. A 50~150 V stimulus was applied over the median nerve and SSR was recorded on bilateral palms and soles with Viking IV (Nicolet Biomedical Ins., U.S.A.). Patient's satisfaction with operation was assessed by questionnaire. RESULTS: Absent or unstable SSR recordings rate was increased and amplitudes of SSR were significantly decreased in patients with palmar hyperhidrosis compared with control group. After sympathectomy, SSR was absent in all cases on bilateral palms and these results were correlated with clinical improvment. All patients who had undergone surgery showed significant clinical improvement for palmar hyperhidrosis and about 75% of the cases were found to have compensatory sweating from other site of the body. CONCLUSION: Abnormal sympathetic nerve system responses were observed in patients with palmar hyperhidrosis. SSR recordings and clinical manifestations were influenced by sysmpathectomy.

The Adequate Extent of Thoracic Sympathectomy for Essential Palmar Hyperhidrosis

Essential palmar hyperhidrosis is a disease characterized by excessive perspiration on the palms and hands due to the hyperaction of sympathetic nervous discharge. In severe cases, excessive sweating is seen on the face, axilla, trunk, and soles. Several therapeutic modalities were applied but surgical resection of the sympathetic ganglion is the only curative method. Numerous open surgeries of the thoracic sympathetic ganglia for the treatment of palmar hyperhidrosis have been advocated, but they have also produced several complications. A new therapeutic technique for this disorder has been introduced by combining a thoracoscope and video system. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential palmar hyperhidrosis. This technique is safe and easy. It also reduces the operating time and admission period. It has also very few complications. Compensatory hyperhidrosis on the trunk, back, and thigh, etc. is commonly an unwanted and unsolved complication after thoracic sympathectomy. Through my experience of thoracic sympathectomy, I thought that the incidence of compensatory hyperhidrosis was closely related to the extent of thoracic sympathectomy. So I restricted the extent of thoracic sympathectomy as a T2 sympathetic ganglion from September 1995. From Mar., 1989 To Aug., 1995, T2, T3 sympathetic ganglionectomies were performed for palmar hyperhidrosis patients and from Sept. 1995 T2 sympathetic ganglionectomies were performed. Using questionnaires, I compared these 2 groups. The results of this study are summarized as follows; 1) Using thoracoscopic transthoracic sympathectomy, operating time, admission period and complications could be reduced. 2) The risk of bleeding during the operation(especially bleeding from the hemiazygous vein) could be reduced in the T2 sympathectomy group. 3) The treatment effect of T2 sympathectomy is no different from T2, T3 sympathectomy for essential palmar hyperhidrosis. 4) The incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than in the T2, T3 sympathectomy group. From the above results, I concluded thoracoscopic transthoracic sympathectomy is the treatment of choice for essential palmar hyperhidrosis and the adequate extent for sympathectomy is T2 sympathetic ganglion.

Dose Thoracoscopic Sympathectomy for Hyperhidrosis Increase Airway Pressure? / 대한마취과학회지

BACKGROUND: Bilateral interruption of the upper thoracic sympathetic chain at T2 level represents a selective cure for essential hyperhidrosis. Following the surgical sympathectomy, significant changes in pulmonary function has been observed. Our hypothesis was that thoracic sympathectomy may increase airway resistance during mechanical ventilation and which may be attenuated by the anticholinergics. METHODS: 21 patients with essential hyperhidrosis in ASA physical status class 1 under going thoracoscopic sympathectomy, they were randomizely divided into two groups: glycopyrrolate premedication group (n=13) and non-premedication, control group (n=9). Glycopyrrolate 0.2 mg was administered 30 minutes before the induction of anesthesia. Blood pressure, heart rate, peak airway pressure, plateau pressure were measured at before and immediate after sympathectomy. Respiratory compliance and resistance were calculated. RESULTS: After thoracoscopic sympathectomy, there was significant increase in mean peak airway pressure (15 +/- 3 vs 18 +/- 3 cmH2O, P<0.05) and decrease in respiratory compliance (52 +/- 12 vs 45 +/- 10 ml/cmH2O, P<0.05) compared to baseline. However there was no significant difference between glycopyrolate premedication group and non-premedication group. Conclusion: Thoracoscopic upper dorsal sympathectomy in patients with essential hyperhidrosis causes increase peak airway pressure and decrease the compliance of respiratory system during mechanical ventilation.