Video-assisted Thoracic Surgery Sympathectomy under Monitored Anesthesia Care and Local Analgesia for the Treatment of Palmar Hyperhidrosis without Endotracheal Intubation: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIELiang ¹ , CHENGang ¹ , WANGQing ² , CUICan ² , YEXiong ¹ , ZHANGDong-kun ¹ , ZHOUZi-hao ¹ , TANGJi-ming ¹ , BENXiao-song ¹ , WANGGang ² , LINWen-liang ¹ , MAOYu-hong ¹

1. Department of Thoracic Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, P. R. China;
2. Department of Anesthesiology, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou 510080, P. R. China;

Corresponding author：

Keywords：

Palmar hyperhidrosis; Video-assisted thoracic surgery sympathectomy; Monitored anesthesia care; Local anesthesia; Fast track recovery surgery; Randomized controlled trial

DOI：

10.7507/1007-4848.20140005

Video：

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Objective To investigate the feasibility, safety and effectiveness of video-assisted thoracic surgery (VATS) sympathectomy under monitored anesthesia care (MAC) and local anesthesia (LA) without endotracheal intubation as a new fast track recovery surgical strategy for the treatment of palmar hyperhidrosis. Methods A total of 124 patients with intermediate or severe hyperhidrosis who were admitted to Guangdong General Hospital were enrolled in this study. With SPSS18 random number generator, all the patients were divided into MAC+LA group and general anesthesia (GA) group with 62 patients in each group. There were 43 males and 19 females in MAC+LA group with their age of 22.25±6.22 years, and 42 males and 20 females in GA group with their age of 23.98±6.67 years. During the surgery, MAC+LA group patients received MAC and oxygen via nasal tube or face mask instead of endotracheal intubation, and GA group patients received GA, endotracheal intubation and controlled ventilation. Clinical outcomes were compared between the 2 groups. Results All the patients received their operations safely. None of MAC+LA group patients received conversion to GA and controlled ventilation. There was statistical difference in operation time (47.18±12.06 minutes vs. 39.33±13.21 minutes, P=0.002) and length of theatre stay 84.52±22.56 minutes vs. 134.68±26.12 minutes, P=0.000) between MAC+LA and GA group patients. There was no statistical difference in blood loss, incidence of intraoperative SpO₂ lower than 95% (2 patients vs. 0 patient), postoperative hospital stay, incidence of postoperative compensatory sweating (86.5% vs. 89.0%) and patient satisfaction rate (94.59% vs.95.12%) between the 2 groups. No intraoperative pain, postoperative complication or symptom recurrence was observed in either group. There was statistical difference in anesthetic preparation time (20.52±10.55 minutes vs. 36.47±12.16 minutes), duration between operation finish and returning to ward (11.26±7.09 minutes vs. 59.39±19.89) minutes and hospitalization cost (RMB 6 376.86±746.00 yuan vs. RMB 8 812.04±867.93 yuan) between the 2 groups. The incidence of postoperative sore throat (0% vs. 100%), monitor time (4 hours vs. 12 hours) and time to resume oral intake (2 hours vs. 6 hours) of MAC+LA group were significantly lower or shorter than those of GA group. Conclusion VATS sympathectomy under MAC and LA can avoid complications of GA and endotracheal intubation, and provide a safe, feasible, effective and more minimally invasive fast track alternative for the treatment of palmar hyperhidrosis.

Citation： XIELiang, CHENGang, WANGQing, CUICan, YEXiong, ZHANGDong-kun, ZHOUZi-hao, TANGJi-ming, BENXiao-song, WANGGang, LINWen-liang, MAOYu-hong. Video-assisted Thoracic Surgery Sympathectomy under Monitored Anesthesia Care and Local Analgesia for the Treatment of Palmar Hyperhidrosis without Endotracheal Intubation: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 11-16. doi: 10.7507/1007-4848.20140005 Copy

1.	涂远荣, 杨劼, 刘彦国.中国手汗症微创治疗专家共识.中华胸心血管外科杂志, 2011, 27 (8):449-451.
2.	Chen JS, Hsu HH, Kuo SW, et al.Needlescopic versus conventional video-assisted thoracic surgery for primary spontaneous pneumothorax:a comparative study.Ann Thorac Surg, 2003, 75 (4):1080-1085.
3.	Smith I, Taylor E.Monitored anesthesia care.Int Anesthesiol Clin, 1994, 32 (3):99-112.
4.	Wilmore DW, Kehlet H.Recent advances:Management of patients in fast track surgery.BMJ, 2001, 322 (7284):473-476.
5.	Cerfolio RJ, De Campos JR, Bryant AS, et al.The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis.Ann Thorac Surg, 2011, 91 (5):1642-1648.
6.	Freixinet J L, Rodríguez P M.Fast track in thoracic surgery.Asian Cardiovasc Thorac Ann, 2008, 16 (3):187-188.
7.	许胜水, 段明科, 吴艺根, 等.二孔法胸腔镜下T3胸交感神经链切断术治疗手汗症(附52例报告).中国微创外科杂志, 2010, 10 (6):499-500.
8.	Bouma W, Klinkenberg TJ, Mariani MA.Bilateral single-port thoracoscopic sympathectomy with the VasoView device in the treatment of palmar and axillary hyperhidrosis.Interact Cardiovasc Thorac Surg, 2011, 12 (2):106-109.
9.	Scognamillo F, Serventi F, Attene F, et al.T2-T4 sympathectomy versus T3-T4 sympathicotomy for palmar and axillary hyperhidrosis.Clinical Autonomic Research, 2011, 21 (2):97-102.
10.	Kim WO, Kil HK, Yoon KB, et al.Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis.Am J Surg, 2010, 199 (2):166-169.
11.	张文斌, 林高翔, 杜振宗, 等.不同气管插管在电视胸腔镜胸交感神经切断术中的应用.中国内镜杂志, 2009, 15 (6):604-606, 609.
12.	郭涛, 韩哲, 苏莉, 等.喉罩通气在胸腔镜胸交感神经链切断术中的临床研究.心肺血管病杂志, 2012, 31 (3):315-317.
13.	Al-Abdullatief M, Wahood A, Al-Shirawi N, et al.Awake anaesthesia for major thoracic surgical procedures:an observational study.Eur J Cardiothorac Surg, 2007, 32 (2):346-350.
14.	Elia S, Guggino G, Mineo D, et al.Awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis:a safe outpatient procedure.Eur J Cardiothorac Surg, 2005, 28 (2):312-317.
15.	郭绍红, 王晶晶.麻醉学监护下的局部麻醉胸腔镜胸交感神经阻断术114例.中国内镜杂志, 2012, 18 (1):21-25.
16.	贾向波, 钱如林, 李向阳, 等.局部麻醉下电视胸腔镜手术治疗手汗症.中国胸心血管外科临床杂志, 2010, 17 (5):35.
17.	Jeong JY, Park HJ.Sympathicotomy under local anesthesia:a simple way to treat primary hyperhidrosis.Ann Thorac Surg, 2010, 90 (5):1730-1731.
18.	李增玉, 耿清胜, 贺聿国, 等.腰硬联合麻醉下妇科腹腔镜手术中呼吸末二氧化碳浓度监测.实用医学杂志, 2007, 23 (18):2871-2872.
19.	李简, 王晓新, 贺钢枫, 等.局麻下经电视胸腔镜肺肿物切除术.中国肿瘤临床, 2001, 28 (6):428-430.
20.	Tejedor A, Anglada MT, Pons M, et al.Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy:anesthesia in 445 cases.Rev Esp Anestesiol Reanim, 2010, 57 (9):553-558.

1. 涂远荣, 杨劼, 刘彦国.中国手汗症微创治疗专家共识.中华胸心血管外科杂志, 2011, 27 (8):449-451.
2. Chen JS, Hsu HH, Kuo SW, et al.Needlescopic versus conventional video-assisted thoracic surgery for primary spontaneous pneumothorax:a comparative study.Ann Thorac Surg, 2003, 75 (4):1080-1085.
3. Smith I, Taylor E.Monitored anesthesia care.Int Anesthesiol Clin, 1994, 32 (3):99-112.
4. Wilmore DW, Kehlet H.Recent advances:Management of patients in fast track surgery.BMJ, 2001, 322 (7284):473-476.
5. Cerfolio RJ, De Campos JR, Bryant AS, et al.The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis.Ann Thorac Surg, 2011, 91 (5):1642-1648.
6. Freixinet J L, Rodríguez P M.Fast track in thoracic surgery.Asian Cardiovasc Thorac Ann, 2008, 16 (3):187-188.
7. 许胜水, 段明科, 吴艺根, 等.二孔法胸腔镜下T3胸交感神经链切断术治疗手汗症(附52例报告).中国微创外科杂志, 2010, 10 (6):499-500.
8. Bouma W, Klinkenberg TJ, Mariani MA.Bilateral single-port thoracoscopic sympathectomy with the VasoView device in the treatment of palmar and axillary hyperhidrosis.Interact Cardiovasc Thorac Surg, 2011, 12 (2):106-109.
9. Scognamillo F, Serventi F, Attene F, et al.T2-T4 sympathectomy versus T3-T4 sympathicotomy for palmar and axillary hyperhidrosis.Clinical Autonomic Research, 2011, 21 (2):97-102.
10. Kim WO, Kil HK, Yoon KB, et al.Influence of T3 or T4 sympathicotomy for palmar hyperhidrosis.Am J Surg, 2010, 199 (2):166-169.
11. 张文斌, 林高翔, 杜振宗, 等.不同气管插管在电视胸腔镜胸交感神经切断术中的应用.中国内镜杂志, 2009, 15 (6):604-606, 609.
12. 郭涛, 韩哲, 苏莉, 等.喉罩通气在胸腔镜胸交感神经链切断术中的临床研究.心肺血管病杂志, 2012, 31 (3):315-317.
13. Al-Abdullatief M, Wahood A, Al-Shirawi N, et al.Awake anaesthesia for major thoracic surgical procedures:an observational study.Eur J Cardiothorac Surg, 2007, 32 (2):346-350.
14. Elia S, Guggino G, Mineo D, et al.Awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis:a safe outpatient procedure.Eur J Cardiothorac Surg, 2005, 28 (2):312-317.
15. 郭绍红, 王晶晶.麻醉学监护下的局部麻醉胸腔镜胸交感神经阻断术114例.中国内镜杂志, 2012, 18 (1):21-25.
16. 贾向波, 钱如林, 李向阳, 等.局部麻醉下电视胸腔镜手术治疗手汗症.中国胸心血管外科临床杂志, 2010, 17 (5):35.
17. Jeong JY, Park HJ.Sympathicotomy under local anesthesia:a simple way to treat primary hyperhidrosis.Ann Thorac Surg, 2010, 90 (5):1730-1731.
18. 李增玉, 耿清胜, 贺聿国, 等.腰硬联合麻醉下妇科腹腔镜手术中呼吸末二氧化碳浓度监测.实用医学杂志, 2007, 23 (18):2871-2872.
19. 李简, 王晓新, 贺钢枫, 等.局麻下经电视胸腔镜肺肿物切除术.中国肿瘤临床, 2001, 28 (6):428-430.
20. Tejedor A, Anglada MT, Pons M, et al.Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy:anesthesia in 445 cases.Rev Esp Anestesiol Reanim, 2010, 57 (9):553-558.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Video-assisted Thoracic Surgery Sympathectomy under Monitored Anesthesia Care and Local Analgesia for the Treatment of Palmar Hyperhidrosis without Endotracheal Intubation: A Randomized Controlled Trial

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