Clinical effect of 3 mm thoracoscope combined with needle electrocoagulation hook in the treatment of primary palmar hyperhidrosis: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Hongbin ^1,2,3,4 , LIN Ruijiang ^1,2,3,4 , MA Minjie ^1,2,3,4 , CAO Xiong ^1,3,4 ,  HAN Biao ^1,3,4

1. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;
2. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China;
3. Major in Research and Development and Application of Key Technologies in Thoracic Surgery Gansu International Science and Technology Cooperation Base, Lanzhou, 730000, P. R. China;
4. Gansu Provincial Medical Quality Control Center of Thoracic Surgery, Lanzhou, 730000, P. R. China;

Corresponding author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Endoscopic thoracic sympathicotomy (ETS); primary palmar hyperhidrosis (PPH); tubeless; retrospective cohort study

DOI：

10.7507/1007-4848.202108096

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Objective To explore the clinical effect of tubeless 3 mm ultra-fine thoracoscope combined with needle electrocoagulation hook thoracic sympathicotomy in the treatment of primary palmar hyperhidrosis. Methods The clinical data of 77 patients with primary palmar hyperhidrosis who underwent surgery in the First Hospital of Lanzhou University from September 2017 to July 2021 were retrospectively analyzed, including 50 males and 27 females, with an average age of 23.60±5.60 years. A total of 36 patients were treated with tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy (an observation group), and 41 patients were treated with conventional thoracoscopic thoracic sympathicotomy (a control group). The baseline data, perioperative data and the results of 12 hours after operation were compared between the two groups. Results All the 77 patients completed the operation successfully, no conversion to thoracotomy, no intraoperative bleeding, and no conversion to endotracheal intubation in the observation group. In the observation group, the time of anesthesia before operation [19.00 (17.00, 23.75) min vs. 25.00 (21.00, 27.00) min, P=0.001] and postoperative hospital stay [2.00 (1.00, 2.00) d vs. 2.00 (1.00, 3.00) d, P=0.012] were shorter than those in the control group. The operation time [22.50 (21.00, 25.75) min vs. 26.00 (23.50, 28.50) min, P=0.001], intraoperative blood loss [5.00 (2.25, 5.00) mL vs. 6.00 (5.00, 10.00) mL, P=0.003], postoperative pain index [2.00 (1.00, 2.00) vs. 3.00 (2.00, 3.00), P=0.001], hospitalization cost (14 246.58±879.28 yuan vs. 15 085.90±827.15 yuan, P<0.001) and postoperative inflammation index: white blood cell count [(12.96±2.32)×10⁹/L vs. (14.47±2.05)×10⁹/L, P=0.003], percentage of neutrophils (76.31%±5.40% vs. 79.97%±7.12%, P=0.014) were significantly lower or less than those in the control group. There was no significant difference in the incidence of major postoperative complications or adverse consequences between the two groups (P>0.05). In the evaluation of 12 hours after operation, the time of getting out of bed [2.00 (1.00, 2.00) h vs. 2.00 (2.00, 3.00) h, P=0.017], the time of drinking water after operation [1.50 (1.00, 2.00) h vs. 2.00 (1.00, 3.00) h, P=0.005], and the heart rate (80.25±14.42 bpm vs. 91.07±15.08 bpm, P=0.002), the incidence of dizziness, nausea and other uncomfortable symptoms (5.6% vs. 25.0%, P=0.040) at 12 hours after operation were shorter or lower than those in the control group. There was no significant difference in blood oxygen saturation (non-inhaled oxygen state) 12 hours after the operation between the two groups [97.00% (95.25%, 98.00%) vs. 97.00% (96.00%, 98.00%), P=0.763]. Conclusion Compared with conventional thoracoscopic thoracic sympathicotomy, tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy can significantly shorten the operation time, reduce postoperative pain and promote postoperative recovery, in line with the concept of accelerated rehabilitation surgery and minimally invasive surgery, and is worth popularizing in clinical practice.

Citation： WANG Hongbin, LIN Ruijiang, MA Minjie, CAO Xiong, HAN Biao. Clinical effect of 3 mm thoracoscope combined with needle electrocoagulation hook in the treatment of primary palmar hyperhidrosis: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 311-317. doi: 10.7507/1007-4848.202108096 Copy

1.	Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Etiology and clinical work-up. J Am Acad Dermatol, 2019, 81(3): 657-666.
2.	Abu Arab WS, Elhamami MM. Plantar hyperhidrosis associated with primary palmar hyperhidrosis: Outcome following video-assisted thoracoscopic sympathectomy. Asian Cardiovasc Thorac Ann, 2021, 29(4): 310-317.
3.	Romero FR, Haddad GR, Miot HA, et al. Palmar hyperhidrosis: Clinical, pathophysiological, diagnostic and therapeutic aspects. An Bras Dermatol, 2016, 91(6): 716-725.
4.	Klein SZ, Hull M, Gillard KK, et al. Treatment patterns, depression, and anxiety among US patients diagnosed with hyperhidrosis: A retrospective cohort study. Dermatol Ther (Heidelb), 2020, 10(6): 1299-1314.
5.	Li DC, Hulbert A, Waldbaum B, et al. Endoscopic thoracic sympathectomy for primary focal hyperhidrosis: Impact on psycho-social symptomatology and psychotropic medication use. Eur J Cardiothorac Surg, 2018, 54(5): 904-911.
6.	Rohleder S, Münsterer O, Gödeke J. Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis. Zentralbl Chir, 2020, 145(5): 421-424.
7.	Slim K, Theissen A. Enhanced recovery after elective surgery. A revolution that reduces post-operative morbidity and mortality. J Visc Surg, 2020, 157(6): 487-491.
8.	Agamia NF, Sobhy N, Abd-Elraouf A, et al. Fractional CO₂ laser for transcutaneous drug delivery of onabotulinum toxin in palmar hyperhidrosis. Dermatol Surg, 2021, 47(5): 678-683.
9.	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.
10.	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.
11.	涂远荣, 刘彦国, 中国手汗症微创治疗临床指南编写委员会. 中国手汗症微创治疗临床指南 (2021年版). 中国胸心血管外科临床杂志, 2021, 28(10): 1133-1139.
12.	Ho YL, Fauzi M, Sothee K, et al. Diagnosis, impact and management of hyperhidrosis including endoscopic thoracic sympathectomy. Med J Malaysia, 2020, 75(5): 555-560.
13.	Dogru MV, Sezen CB, Girgin O, et al. Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience. Gen Thorac Cardiovasc Surg, 2020, 68(3): 273-279.
14.	Chen J, Liu Y, Yang J, et al. Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China. Surgery, 2019, 166(6): 1092-1098.
15.	李冬, 沈琦斌, 陈超. 日间喉罩全麻联合单孔胸腔镜交感神经切断术治疗手汗症效果观察. 浙江医学, 2019, 41(10): 1059-1061.
16.	Gálvez C, Bolufer S, Gálvez E, et al. Anatomic segmentectomy in nonintubated video-assisted thoracoscopic surgery. Thorac Surg Clin, 2020, 30(1): 61-72.
17.	王俊彬, 刘继先, 李灼, 等. 3 mm胸腔镜联合免trocar电凝钩经乳晕切口治疗男性手汗症. 中国微创外科杂志, 2018, 18(12): 1121-1124.
18.	Motus IY, Bazhenov AV. Hyperhidrosis: Treatment, results, problems. Khirurgiia (Mosk), 2021, (7): 12-17.
19.	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.
20.	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.
21.	Horslen LC, Wilshire CL, Louie BE, et al. Long-term impact of endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. Ann Thorac Surg, 2018, 106(4): 1008-1012.
22.	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.
23.	Liu Y, Yang J, Liu J, 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.
24.	Li X, Tu YR, Lin M, et al. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: A randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg, 2008, 85(5): 1747-1751.

1. Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Etiology and clinical work-up. J Am Acad Dermatol, 2019, 81(3): 657-666.
2. Abu Arab WS, Elhamami MM. Plantar hyperhidrosis associated with primary palmar hyperhidrosis: Outcome following video-assisted thoracoscopic sympathectomy. Asian Cardiovasc Thorac Ann, 2021, 29(4): 310-317.
3. Romero FR, Haddad GR, Miot HA, et al. Palmar hyperhidrosis: Clinical, pathophysiological, diagnostic and therapeutic aspects. An Bras Dermatol, 2016, 91(6): 716-725.
4. Klein SZ, Hull M, Gillard KK, et al. Treatment patterns, depression, and anxiety among US patients diagnosed with hyperhidrosis: A retrospective cohort study. Dermatol Ther (Heidelb), 2020, 10(6): 1299-1314.
5. Li DC, Hulbert A, Waldbaum B, et al. Endoscopic thoracic sympathectomy for primary focal hyperhidrosis: Impact on psycho-social symptomatology and psychotropic medication use. Eur J Cardiothorac Surg, 2018, 54(5): 904-911.
6. Rohleder S, Münsterer O, Gödeke J. Thoracoscopic sympathectomy for palmar and axillary hyperhidrosis. Zentralbl Chir, 2020, 145(5): 421-424.
7. Slim K, Theissen A. Enhanced recovery after elective surgery. A revolution that reduces post-operative morbidity and mortality. J Visc Surg, 2020, 157(6): 487-491.
8. Agamia NF, Sobhy N, Abd-Elraouf A, et al. Fractional CO₂ laser for transcutaneous drug delivery of onabotulinum toxin in palmar hyperhidrosis. Dermatol Surg, 2021, 47(5): 678-683.
9. 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.
10. 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.
11. 涂远荣, 刘彦国, 中国手汗症微创治疗临床指南编写委员会. 中国手汗症微创治疗临床指南 (2021年版). 中国胸心血管外科临床杂志, 2021, 28(10): 1133-1139.
12. Ho YL, Fauzi M, Sothee K, et al. Diagnosis, impact and management of hyperhidrosis including endoscopic thoracic sympathectomy. Med J Malaysia, 2020, 75(5): 555-560.
13. Dogru MV, Sezen CB, Girgin O, et al. Is there any relationship between quality of life and the level of sympathectomy in primary palmar hyperhidrosis? Single-center experience. Gen Thorac Cardiovasc Surg, 2020, 68(3): 273-279.
14. Chen J, Liu Y, Yang J, et al. Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China. Surgery, 2019, 166(6): 1092-1098.
15. 李冬, 沈琦斌, 陈超. 日间喉罩全麻联合单孔胸腔镜交感神经切断术治疗手汗症效果观察. 浙江医学, 2019, 41(10): 1059-1061.
16. Gálvez C, Bolufer S, Gálvez E, et al. Anatomic segmentectomy in nonintubated video-assisted thoracoscopic surgery. Thorac Surg Clin, 2020, 30(1): 61-72.
17. 王俊彬, 刘继先, 李灼, 等. 3 mm胸腔镜联合免trocar电凝钩经乳晕切口治疗男性手汗症. 中国微创外科杂志, 2018, 18(12): 1121-1124.
18. Motus IY, Bazhenov AV. Hyperhidrosis: Treatment, results, problems. Khirurgiia (Mosk), 2021, (7): 12-17.
19. 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.
20. 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.
21. Horslen LC, Wilshire CL, Louie BE, et al. Long-term impact of endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. Ann Thorac Surg, 2018, 106(4): 1008-1012.
22. 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.
23. Liu Y, Yang J, Liu J, 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.
24. Li X, Tu YR, Lin M, et al. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: A randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg, 2008, 85(5): 1747-1751.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effect of 3 mm thoracoscope combined with needle electrocoagulation hook in the treatment of primary palmar hyperhidrosis: A retrospective cohort study

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