Endoscopic Toracic Sympathectomy with Flexible Toracoscopy under local anesthesia with Monitored anesthesia Care for 23 Patients with Primary Palmar Hyperhidrosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

NINGYe ¹ , WANGYa-nan ² , TANGHua ¹ , XUELei ¹ , TAOXian-dong ¹ , CHENYan ² ,  ZHAOXue-wei ¹

1. 第二军医大学附属长征医院麻醉科(上海 200003);
2. Department of Toracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P. R. China. 2. Department of anesthesia, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P. R. China;

Corresponding author：

ZHAOXue-wei, Email: xuewei-zhao@hotmail.com

Keywords：

Palmar hyperhidrosis; Endoscopic sympathectomy; Local anesthesia

DOI：

10.7507/1007-4848.20150119

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Objective To evaluate the efficiency and clinical outcomes of endoscopic thoracic sympathectomy (ETS) with flexible thoracoscopy under local anesthesia with monitored anesthesia care in primary palmar hyperhidrosis. Methods From March 2011 to March 2013, we performed ETS with flexible thoracoscopy under local anesthesia with monitored anesthesia in 23 patients with primary palmar hyperhidrosis (PH), including 10 males and 13 females with their age of 25.6±7.2 years (range, 17-32 years). T3 sympathectomy was performed with flexible endoscopy under local anesthesia with monitored anesthesia care. All patients were followed up until May 2014. Results During surgery, the vital signs of the patients remained stable. Operation time was 30-40 minites. The symptom of PH disappeared right in the surgery. All patients were discharged from the hospital on the 2nd postoperative day. One patient received unilateral sympathectomy because of pleural adhesion. Other 22 patients received follow-up to May 2014 and no reoccurrence was reported. Conclusion ETS with flexible thoracoscopy under local anesthesia with monitored anesthesia is a safe, microinvasive and effective method.

Citation： NINGYe, WANGYa-nan, TANGHua, XUELei, TAOXian-dong, CHENYan, ZHAOXue-wei. Endoscopic Toracic Sympathectomy with Flexible Toracoscopy under local anesthesia with Monitored anesthesia Care for 23 Patients with Primary Palmar Hyperhidrosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 454-458. doi: 10.7507/1007-4848.20150119 Copy

1.	Baumgartner F. Clinical history and classic palmar hyperhidrosis. Clin Auton Res, 2009, 19(6):317-318.
2.	Moran KT, Brady MP. Surgical management of primary hyperhidrosis. Br J Surg, 1991, 78(11):279-283.
3.	Allen GM. Toracoscopic sympathectomy for palmar hyperhidrosis. Aorn J 2001, 74(2):178-182.
4.	Assalia A, Kopelman D, Markovits R, et al. Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis:a prospective, randomized trial. Surg Endosc, 2003, 17(6):921-922.
5.	De Campos JRM, Kauffman P, Werebe ED, et al. Quality of life, before and afer thoracic sympathectomy:report on 378 operated patients. Ann Torac Surg, 2003, 76(3):886-891.
6.	Lehman JS. Writer's block:'texting' impairment as a complication of botulinum toxin type A therapy for palmar hyperhidrosis. Arch Dermatol, 2011, 147(6):752.
7.	Ito K, Yanagishita T, Ohshima Y, et al. Terapeutic effectiveness of botulinum toxin type A based on severity of palmar hyperhidrosis. J Dermatol, 2011, 38(9):859-863.
8.	Ebrahim KS. Percutaneous chemical dorsal sympathectomy for hyperhidrosis. Minim Invasive Neurosurg, 2011, 54(5-6):29-32.
9.	Aguilar-Ferrándiz ME, Moreno-Lorenzo C, Matarán-Peñarrocha GA, et al. Effects of tapwater iontophoresis and psychological techniques on psychosocial aspects of primary palmar hyperhidrosis. Eur J Dermatol, 2011, 21(2):256-258.
10.	Levine IM, Harris OJ. Chemical sympathectomy:new approach to treatment of localized hyperhidrosis. AMA Arch Derm, 1955, 71(2):226-230.
11.	Gossot D, Kabiri H, Caliandro R, et al. Early complications of thoracic endoscopic sympathectomy:a prospective study of 940 procedures. Ann Torac Surg, 2001, 71(4):1116-1119.
12.	Neumayer CH, Bischof G, Fugger R, et al. Efficacy and safety of thoracoscopic sympathectomy for hyperhidrosis of the upper limb. Results of 734 sympathectomies. Ann Chir Gynaecol, 2001, 90(3):195-199.
13.	Herbst F, Plas EG, Fugger R, et al. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and longterm results of 480 operations. Ann Surg, 1994, 220(1):86-90.
14.	Wait SD, Killory BD, Lekovic GP, et al. Toracoscopic sympathectomy for hyperhidrosis:analysis of 642 procedures with special attention to Horner's syndrome and compensatory hyperhidrosis. Neurosurgery, 2010, 67(3):652-656.
15.	Tschopp JM, Purek L, Frey JG, et al. Titrated sedation with propofol for medical thoracoscopy:a feasibility and safety study. Respiration, 2011, 82(3):451-457.
16.	Lin TS. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis-with special emphasis on perioperative management (1360 cases analysis). Surg Neurol, 1999, 52(5):453-457.
17.	Schmidt J, Bechara FG, Altmeyer P, et al. Endoscopic thoracic sympathectomy for severe hyperhidrosis:impact of restrictive denervation on compensatory sweating. Ann Thorac Surg, 2006, 81(3):1048-1055.
18.	Kux E. Te endoscopic approach to the vegetative nervous system and its therapeutic possibilities; especially in duodenal ulcer, angina pectoris, hypertension and diabetes. Dis Chest, 1951, 20(2):139-147.
19.	Daniel TM. Toracoscopic sympathectomy. Chest Surg Clin N Am, 1996, 6(1):69-83.
20.	Kopelman D, Hashmonai M. Upper thoracic sympathetic surgery:open surgical techniques. Clin Auton Res, 2003, 13(suppl 1):10-15.
21.	Nüesch B, Ammann J, Hess P, et al. Toracic sympathectomy for palmar hyperhidrosis. Swiss Surgery, 1996, 2(3):112-115.
22.	Doolabh N, Horswell S, Williams M, et al. Toracoscopic sympathectomy for hyperhidrosis:indications and results. Ann Thorac Surg, 2004, 77(2):410-414.
23.	谢亮, 陈刚, 王庆, 等.非气管内插管麻醉监护下局部麻醉胸腔镜交感神经切断术治疗多汗症的随机对照试验.中国胸心血管外科临床杂志, 2014, 21(1):11-16.
24.	张瀚, 陈世云, 姜婉娜, 等.右旋美托咪啶在局部麻醉眼鼻微创外科手术中的应用.中国药物与临床, 2012, 13(3):355-356.
25.	Candiotti KA, Bergese SD, Bokesch PM, et al. Monitored anesthesia care with dexmedetomidine:a prospective, randomized, doubleblind, multicenter trial. Anesth Analg, 2010, 110(1):47-56.
26.	Berkenstadt H, Perel A, Hadani M, et al. Monitored anesthesia care using remifentanil and propofol for awake craniotomy. J Neurosurg Anesthesiol, 2001, 13(3):246-249.
27.	Busick T, Kussman M, Scheidt T, et al. Preliminary experience with dexmede to midine for monitored anesthesia care during ENT surgical procedures. Am J Ter, 2008, 15(6):520-527.
28.	Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy:an efcient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol, 1995, 33(1):78-81.
29.	Kao MC, Lin JY, Chen YL, et al. Minimal invasive surgery:video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore, 1996, 25(5):673-678.
30.	Herbst F, Plas EG, Fugger R, et al. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs-A critical analysis and long-term results of 480 operations. Ann Surg, 1994, 220(1):86-90.
31.	Orteu CH, Mcgregor JM, Almeyda JR, et al. Recurrence of hyperhidrosis after endoscopic transthoracic sympathectomy-case report and review of the literature. Clin Exp Dermatol 1995, 20(3):230-233.

1. Baumgartner F. Clinical history and classic palmar hyperhidrosis. Clin Auton Res, 2009, 19(6):317-318.
2. Moran KT, Brady MP. Surgical management of primary hyperhidrosis. Br J Surg, 1991, 78(11):279-283.
3. Allen GM. Toracoscopic sympathectomy for palmar hyperhidrosis. Aorn J 2001, 74(2):178-182.
4. Assalia A, Kopelman D, Markovits R, et al. Intrapleural analgesia following thoracoscopic sympathectomy for palmar hyperhidrosis:a prospective, randomized trial. Surg Endosc, 2003, 17(6):921-922.
5. De Campos JRM, Kauffman P, Werebe ED, et al. Quality of life, before and afer thoracic sympathectomy:report on 378 operated patients. Ann Torac Surg, 2003, 76(3):886-891.
6. Lehman JS. Writer's block:'texting' impairment as a complication of botulinum toxin type A therapy for palmar hyperhidrosis. Arch Dermatol, 2011, 147(6):752.
7. Ito K, Yanagishita T, Ohshima Y, et al. Terapeutic effectiveness of botulinum toxin type A based on severity of palmar hyperhidrosis. J Dermatol, 2011, 38(9):859-863.
8. Ebrahim KS. Percutaneous chemical dorsal sympathectomy for hyperhidrosis. Minim Invasive Neurosurg, 2011, 54(5-6):29-32.
9. Aguilar-Ferrándiz ME, Moreno-Lorenzo C, Matarán-Peñarrocha GA, et al. Effects of tapwater iontophoresis and psychological techniques on psychosocial aspects of primary palmar hyperhidrosis. Eur J Dermatol, 2011, 21(2):256-258.
10. Levine IM, Harris OJ. Chemical sympathectomy:new approach to treatment of localized hyperhidrosis. AMA Arch Derm, 1955, 71(2):226-230.
11. Gossot D, Kabiri H, Caliandro R, et al. Early complications of thoracic endoscopic sympathectomy:a prospective study of 940 procedures. Ann Torac Surg, 2001, 71(4):1116-1119.
12. Neumayer CH, Bischof G, Fugger R, et al. Efficacy and safety of thoracoscopic sympathectomy for hyperhidrosis of the upper limb. Results of 734 sympathectomies. Ann Chir Gynaecol, 2001, 90(3):195-199.
13. Herbst F, Plas EG, Fugger R, et al. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs. A critical analysis and longterm results of 480 operations. Ann Surg, 1994, 220(1):86-90.
14. Wait SD, Killory BD, Lekovic GP, et al. Toracoscopic sympathectomy for hyperhidrosis:analysis of 642 procedures with special attention to Horner's syndrome and compensatory hyperhidrosis. Neurosurgery, 2010, 67(3):652-656.
15. Tschopp JM, Purek L, Frey JG, et al. Titrated sedation with propofol for medical thoracoscopy:a feasibility and safety study. Respiration, 2011, 82(3):451-457.
16. Lin TS. Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis-with special emphasis on perioperative management (1360 cases analysis). Surg Neurol, 1999, 52(5):453-457.
17. Schmidt J, Bechara FG, Altmeyer P, et al. Endoscopic thoracic sympathectomy for severe hyperhidrosis:impact of restrictive denervation on compensatory sweating. Ann Thorac Surg, 2006, 81(3):1048-1055.
18. Kux E. Te endoscopic approach to the vegetative nervous system and its therapeutic possibilities; especially in duodenal ulcer, angina pectoris, hypertension and diabetes. Dis Chest, 1951, 20(2):139-147.
19. Daniel TM. Toracoscopic sympathectomy. Chest Surg Clin N Am, 1996, 6(1):69-83.
20. Kopelman D, Hashmonai M. Upper thoracic sympathetic surgery:open surgical techniques. Clin Auton Res, 2003, 13(suppl 1):10-15.
21. Nüesch B, Ammann J, Hess P, et al. Toracic sympathectomy for palmar hyperhidrosis. Swiss Surgery, 1996, 2(3):112-115.
22. Doolabh N, Horswell S, Williams M, et al. Toracoscopic sympathectomy for hyperhidrosis:indications and results. Ann Thorac Surg, 2004, 77(2):410-414.
23. 谢亮, 陈刚, 王庆, 等.非气管内插管麻醉监护下局部麻醉胸腔镜交感神经切断术治疗多汗症的随机对照试验.中国胸心血管外科临床杂志, 2014, 21(1):11-16.
24. 张瀚, 陈世云, 姜婉娜, 等.右旋美托咪啶在局部麻醉眼鼻微创外科手术中的应用.中国药物与临床, 2012, 13(3):355-356.
25. Candiotti KA, Bergese SD, Bokesch PM, et al. Monitored anesthesia care with dexmedetomidine:a prospective, randomized, doubleblind, multicenter trial. Anesth Analg, 2010, 110(1):47-56.
26. Berkenstadt H, Perel A, Hadani M, et al. Monitored anesthesia care using remifentanil and propofol for awake craniotomy. J Neurosurg Anesthesiol, 2001, 13(3):246-249.
27. Busick T, Kussman M, Scheidt T, et al. Preliminary experience with dexmede to midine for monitored anesthesia care during ENT surgical procedures. Am J Ter, 2008, 15(6):520-527.
28. Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy:an efcient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol, 1995, 33(1):78-81.
29. Kao MC, Lin JY, Chen YL, et al. Minimal invasive surgery:video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore, 1996, 25(5):673-678.
30. Herbst F, Plas EG, Fugger R, et al. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs-A critical analysis and long-term results of 480 operations. Ann Surg, 1994, 220(1):86-90.
31. Orteu CH, Mcgregor JM, Almeyda JR, et al. Recurrence of hyperhidrosis after endoscopic transthoracic sympathectomy-case report and review of the literature. Clin Exp Dermatol 1995, 20(3):230-233.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Endoscopic Toracic Sympathectomy with Flexible Toracoscopy under local anesthesia with Monitored anesthesia Care for 23 Patients with Primary Palmar Hyperhidrosis

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