Clinical guideline for minimally invasive treatment of palmar hyperhidrosis in China (2021)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 TU Yuanrong ¹ ,  LIU Yanguo ² , Writing Board of Clinical Guidelines for Minimally Invasive Treatment of Palmar Hyperhidrosis in China

1. Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P.R.China;
2. Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China;

Corresponding author：

TU Yuanrong, Email: tuyuanrong@hotmail.com; LIU Yanguo, Email: liuyanguo@pkuph.edu.cn

Keywords：

Palmar hyperhidrosis; endoscopic thoracic sympathicotomy; compensatory hyperhidrosis; guideline

DOI：

10.7507/1007-4848.202104104

Video：

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This guideline systematically reviewed and summarized the 20 years' clinical and basic research experience of minimally invasive treatment of palmar hyperhidrosis (PH) in China, and discussed the hot and difficult issues of minimally invasive treatment of PH. We have formed a new consensus of PH in terms of its definition, clinical manifestations, diagnostic criteria and classification, surgical indications and contraindications, surgical procedures and management of complications, especially in the area of postoperative compensatory hyperhidrosis (CH). This guideline confirmed that endoscopic thoracic sympathicotomy (ETS) was the most effective treatment for PH and that CH was the most common side effect. In order to reduce the incidence of CH, eliminate patient's distress and improve patient's satisfaction, the guideline emphasized that the keys to prevent CH were to pay attention to pre-operative interview, communicate with patients, select patients carefully, avoid the enlargement of operative indication and optimize operative procedure. This guideline also introduced the advantages and disadvantages of various methods to reduce the incidence of CH. We provided this authoritative guidance document in order to avoid the surgical risk, strengthen the perioperative management and improve the sugery effect.

Citation： TU Yuanrong, LIU Yanguo, Writing Board of Clinical Guidelines for Minimally Invasive Treatment of Palmar Hyperhidrosis in China . Clinical guideline for minimally invasive treatment of palmar hyperhidrosis in China (2021). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1133-1139. doi: 10.7507/1007-4848.202104104 Copy

1.	Strutton DR, Kowalski JW, Glaser DA, et al. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: Results from a national survey. J Am Acad Dermatol, 2004, 51(2): 241-248.
2.	Doolittle J, Walker P, Mills T, et al. Hyperhidrosis: An update on prevalence and severity in the United States. Arch Dermatol Res, 2016, 308(10): 743-749.
3.	Tu YR, Li X, Lin M, et al. Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China. Eur J Cardiothorac Surg, 2007, 31(4): 737-739.
4.	Lai FC, Tu YR, Li YP, et al. Nation wide epidemiological survey of primary palmar hyperhidrosis in the People's Republic of China. Clin Auton Res, 2015, 25(2): 105-108.
5.	Tu Y, Luo R, Li X, et al. Hypermyelination and overexpression of neuregulin-1 in thoracic sympathetic nerves in patients with primary palmar hyperhidrosis. J Clin Neurosci, 2012, 19(12): 1651-1653.
6.	涂远荣, 主编. 手汗症现代微创治疗. 福州: 福建科技出版社, 2007. 11-17.
7.	Solish N, Bertucci V, Dansereau A, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg, 2007, 33(8): 908-923.
8.	Chen J, Lin M, Chen X, et al. A novel locus for primary focal hyperhidrosis mapped on chromosome 2q31.1. Br J Dermatol, 2015, 172(4): 1150-1153.
9.	涂远荣, 林敏, 陈剑锋, 等. 胸交感神经切断术治疗原发性手汗症 2206 例 10 年结果和分析. 中国微创外科杂志, 2017, 17(2): 99-103.
10.	刘彦国, 石献忠, 王俊. 上胸段交感神经链切断手术的应用解剖研究. 中华胸心血管外科杂志, 2005, 21(2): 75-77.
11.	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.
12.	Chow TC, Tan CT, Hwang YS, et al. Sudden cardiac arrest during left thoracoscopic T2 sympathectomy. Ma Zui Xue Za Zhi, 1992, 30(4): 277-282.
13.	Lin CC, Mo LR, Hwang MH. Intraoperative cardiac arrest: A rare complication of T2, 3-sympathicotomy for treatment of hyperhidrosis palmaris. Two case reports. Eur J Surg Suppl, 1994, 572: 43-45.
14.	Gossot D. Chylothorax after endoscopic thoracic sympathectomy. Surg Endosc, 1996, 10(9): 949.
15.	涂远荣, 赖繁彩, 李旭, 等. 胸腔镜经乳晕单切口胸交感神经切断术治疗手汗症. 中华医学杂志, 2011, 91(44): 3131-3133.
16.	林敏, 涂远荣, 赖繁彩, 等. 经腋窝隐痕单切口胸腔镜下胸交感神经切断术治疗手汗症. 中华医学杂志, 2013, 93(41): 3300-3301.
17.	Yang J, Tan JJ, Ye GL, et al. T3/T4 thoracic sympathictomy and compensatory sweating in treatment of palmar hyperhidrosis. Chin Med J (Engl), 2007, 120(18): 1574-1577.
18.	Li X, Tu YR, Lin M, et al. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: A randomized control trial comparing T₃ and T_2-4 ablation. Ann Thorac Surg, 2008, 85C57: 1747-1751.
19.	Liu YG, Yang J, Yang F, et al. Surgical treatment of primary palmar hyperhidrosis: A prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg, 2009, 35(3): 398-402.
20.	Abd Ellatif ME, Hadidi AE, Musa AM, et al. Optimal level of sympathectomy for primary palmar hyperhidrosis: T3 versus T4 in a retrospective cohort study. Int J Surg, 2014, 12(8): 778-882.
21.	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.
22.	Fredman B, Zohar E, Shachor D, et al. Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: Friend or foe? Surg Laparosc Endosc Percutan Tech, 2000, 10(4): 226-229.
23.	Chen J, Liu Y, Yang J, et al. Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China. Surg, 2019, 166(6): 1092-1098.
24.	de Campos JR, Wolosker N, Yazbek G, et al. Comparison of pain severity following video-assisted thoracoscopic sympathectomy: Electric versus harmonic scalpels. Interact Cardiovasc Thorac Surg, 2010, 10(6): 919-922.
25.	Lee DY, Paik HC, Kim DH, et al. Comparative analysis of T3 selective division of rami communicantes (ramicotomy) to T3 sympathetik clipping intreatment of palmar hyperhidrosis. Clin Autor Res, 2003, 13(suppl 1): 145-147.
26.	Akil A, Semik M, Fischer S. Efficacy of miniuniportal video-assisted thoracoscopic selective sympathectomy (ramicotomy) for the treatment of severe palmar and axillar hyperhidrosis. Thorac Cardiovasc Surg, 2019, 67(5): 415-419.
27.	Han JW, Kim JJ, Kim YH, et al. New sympathicotomy for prevention of severe compensatory hyperhidrosis in patients with primary hyperhidrosis. J Thorac Dis, 2020, 12(3): 765-772.
28.	Mostafa TAH, Hamed AA, Mohammed BM, et al. C-arm guided percutaneous radiofrequency thoracic sympathectomy for treatment of primary palmar hyperhidrosis in comparison with local botulinum toxin type a injection, randomized trial. Pain Physician, 2019, 22(6): 591-599.
29.	García-Barquín P, Aquerreta Beola JD, Bondía Gracía JM, et al. Percutaneous CT-guided sympathicolysis with radiofrequency for the treatment of palmar hyperhidrosis. J Vasc Interv Radiol, 2017, 28(6): 877-885.

1. Strutton DR, Kowalski JW, Glaser DA, et al. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: Results from a national survey. J Am Acad Dermatol, 2004, 51(2): 241-248.
2. Doolittle J, Walker P, Mills T, et al. Hyperhidrosis: An update on prevalence and severity in the United States. Arch Dermatol Res, 2016, 308(10): 743-749.
3. Tu YR, Li X, Lin M, et al. Epidemiological survey of primary palmar hyperhidrosis in adolescent in Fuzhou of People's Republic of China. Eur J Cardiothorac Surg, 2007, 31(4): 737-739.
4. Lai FC, Tu YR, Li YP, et al. Nation wide epidemiological survey of primary palmar hyperhidrosis in the People's Republic of China. Clin Auton Res, 2015, 25(2): 105-108.
5. Tu Y, Luo R, Li X, et al. Hypermyelination and overexpression of neuregulin-1 in thoracic sympathetic nerves in patients with primary palmar hyperhidrosis. J Clin Neurosci, 2012, 19(12): 1651-1653.
6. 涂远荣, 主编. 手汗症现代微创治疗. 福州: 福建科技出版社, 2007. 11-17.
7. Solish N, Bertucci V, Dansereau A, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg, 2007, 33(8): 908-923.
8. Chen J, Lin M, Chen X, et al. A novel locus for primary focal hyperhidrosis mapped on chromosome 2q31.1. Br J Dermatol, 2015, 172(4): 1150-1153.
9. 涂远荣, 林敏, 陈剑锋, 等. 胸交感神经切断术治疗原发性手汗症 2206 例 10 年结果和分析. 中国微创外科杂志, 2017, 17(2): 99-103.
10. 刘彦国, 石献忠, 王俊. 上胸段交感神经链切断手术的应用解剖研究. 中华胸心血管外科杂志, 2005, 21(2): 75-77.
11. 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.
12. Chow TC, Tan CT, Hwang YS, et al. Sudden cardiac arrest during left thoracoscopic T2 sympathectomy. Ma Zui Xue Za Zhi, 1992, 30(4): 277-282.
13. Lin CC, Mo LR, Hwang MH. Intraoperative cardiac arrest: A rare complication of T2, 3-sympathicotomy for treatment of hyperhidrosis palmaris. Two case reports. Eur J Surg Suppl, 1994, 572: 43-45.
14. Gossot D. Chylothorax after endoscopic thoracic sympathectomy. Surg Endosc, 1996, 10(9): 949.
15. 涂远荣, 赖繁彩, 李旭, 等. 胸腔镜经乳晕单切口胸交感神经切断术治疗手汗症. 中华医学杂志, 2011, 91(44): 3131-3133.
16. 林敏, 涂远荣, 赖繁彩, 等. 经腋窝隐痕单切口胸腔镜下胸交感神经切断术治疗手汗症. 中华医学杂志, 2013, 93(41): 3300-3301.
17. Yang J, Tan JJ, Ye GL, et al. T3/T4 thoracic sympathictomy and compensatory sweating in treatment of palmar hyperhidrosis. Chin Med J (Engl), 2007, 120(18): 1574-1577.
18. Li X, Tu YR, Lin M, et al. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: A randomized control trial comparing T₃ and T_2-4 ablation. Ann Thorac Surg, 2008, 85C57: 1747-1751.
19. Liu YG, Yang J, Yang F, et al. Surgical treatment of primary palmar hyperhidrosis: A prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg, 2009, 35(3): 398-402.
20. Abd Ellatif ME, Hadidi AE, Musa AM, et al. Optimal level of sympathectomy for primary palmar hyperhidrosis: T3 versus T4 in a retrospective cohort study. Int J Surg, 2014, 12(8): 778-882.
21. 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.
22. Fredman B, Zohar E, Shachor D, et al. Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: Friend or foe? Surg Laparosc Endosc Percutan Tech, 2000, 10(4): 226-229.
23. Chen J, Liu Y, Yang J, et al. Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China. Surg, 2019, 166(6): 1092-1098.
24. de Campos JR, Wolosker N, Yazbek G, et al. Comparison of pain severity following video-assisted thoracoscopic sympathectomy: Electric versus harmonic scalpels. Interact Cardiovasc Thorac Surg, 2010, 10(6): 919-922.
25. Lee DY, Paik HC, Kim DH, et al. Comparative analysis of T3 selective division of rami communicantes (ramicotomy) to T3 sympathetik clipping intreatment of palmar hyperhidrosis. Clin Autor Res, 2003, 13(suppl 1): 145-147.
26. Akil A, Semik M, Fischer S. Efficacy of miniuniportal video-assisted thoracoscopic selective sympathectomy (ramicotomy) for the treatment of severe palmar and axillar hyperhidrosis. Thorac Cardiovasc Surg, 2019, 67(5): 415-419.
27. Han JW, Kim JJ, Kim YH, et al. New sympathicotomy for prevention of severe compensatory hyperhidrosis in patients with primary hyperhidrosis. J Thorac Dis, 2020, 12(3): 765-772.
28. Mostafa TAH, Hamed AA, Mohammed BM, et al. C-arm guided percutaneous radiofrequency thoracic sympathectomy for treatment of primary palmar hyperhidrosis in comparison with local botulinum toxin type a injection, randomized trial. Pain Physician, 2019, 22(6): 591-599.
29. García-Barquín P, Aquerreta Beola JD, Bondía Gracía JM, et al. Percutaneous CT-guided sympathicolysis with radiofrequency for the treatment of palmar hyperhidrosis. J Vasc Interv Radiol, 2017, 28(6): 877-885.

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