BACKGROUNDVideo-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis.

METHODSBetween April 2006 and February 2008, 20 cases underwent video-assisted thoracoscopic sympathectomy through one port (uniportal group) and 25 cases through two ports (biportal group). The variables including the operating time, hospital stay, pain scores, postoperative complications, incidence of symptom recurrence and patient satisfaction were compared. The mean postoperative follow-up period was 11.5 months (range, 3 - 25 months).

RESULTSThe hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group (1.2 +/- 0.6) than that in the uniportal group (0.8 +/- 0.5, P = 0.025). For the first three weeks after operation, four out of 20 (20%) patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 (32%) cases in the biportal group (P = 0.366). Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics. Our mean operative time (bilateral sympathectomy) in the uniportal group ((39.5 +/- 10.0) minutes) was shorter than that in biportal group ((49.7 +/- 10.6) minutes, P = 0.02). There were no significant differences between two groups in terms of the mean hospital stay, compensatory sweating, and patient satisfaction. Two patients in the biportal group and three in the uniportal group experienced a unilateral pneumothorax. None of them required chest drainage. No patient experienced Horner's syndrome, and no recurrent symptoms were observed in either groups.

CONCLUSIONSBoth uniportal and biportal video-assisted thoracoscopic sympathectomy are effective, safe, and minimally invasive for palmar hyperhidrosis. Comparing with the biportal approach, the uniportal approach causes less postoperative pain and less operative time, and is a more reasonable procedure in treatment of palmar hyperhidrosis.

Adult ; Female ; Hand ; surgery ; Humans ; Hyperhidrosis ; surgery ; Male ; Sympathectomy ; methods ; Thoracic Surgery, Video-Assisted ; methods

This study was undertaken to determine if better results could be achieved by comparing the results of a thoracic sympathetic ramicotomy (division of rami communicantes) with a conventional thoracic sympathicotomy (division of sympathetic trunk) for treating essential hyperhidrosis. From August 2001 to February 2002, 29 consecutive patients underwent surgery of the sympathetic nerves in order to treat severe essential hyperhidrosis. Of these patients, a ramicotomy was performed under VATS (VATS-R) in 13 patients, sympathicotomy under VATS (VATS-S) in 13, a unilateral ramicotomy and contralateral sympathicotomy under VATS (VATS-RS) in 2 and a sympathicotomy via a thoracotomy (T-S) in 1. There was no significant difference between the VATS ramicotomy group (VATS-R, n=13) and VATS sympathicotomy group (VATS-S, n=13) in terms of gender, pleural adhesions or comorbidities. However, the age of the VATS-S group at surgery was higher than that of the VATS-R group (p=0.050). The operation times, and hospital stays of the groups were 51.5 and 41.9 minutes, and 2.0 and 2.3 days, respectively. The recurrence rate of the operated sites according to the surgical methods (ramicotomy and sympathicotomy regardless of VATS) was 21.4% (6/28) in the ramicotomy group and 6.7% (2/30) in the sympathicotomy group, but there was no statistical significance (p=0.101). This study compared the dryness of the enervated sites and the severity of compensatory sweating among the ramicotomy (n=11, excluded 2 re-operated cases from 13 VATS-R), sympathicotomy (n=14, VATS-S 13 and T-S 1) and the synchronous or metachronous ramicotomy/sympathicotomy groups (n=4, included 2 reoperated cases of VATS-R). The sympathicotomy group had an over-dryness of the enervated sites (dryness 1.4, from 1 to 3; 1: over-dried, 2: humid, 3: persistent sweating) and complained of severe compensatory sweating (severity 3.5, from 1 to 4; 1: absent, 2: mild, 3: embarrassing, 4: disabling). However, the patients whounderwent a ramicotomy maintained some humidity of the enervated sites (dryness 2.0, p=0.012) and showed milder compensatory sweating (severity 2.7, p=0.056) than those in the sympathicotomy group. Furthermore, the dryness of the ramicotomy side was different from that of the sympathicotomy side in 3 out of 4 ramicotomy / sympathicotomy (R+S) patients (the side of the ramicotomy was humid and that of the sympathicotomy was over-dried). The average dryness and the compensatory sweating at these sites were in the midst of the two groups (dryness and severity 1.6 and 3.0, respectively). A ramicotomy can prevent over-dryness of the enervated area and decrease the severity of compensatory sweating through the selective division of the rami communicantes of the thoracic sympathetic ganglia. Postoperatively, almost all ramicotomy patients had no functional problems in daily life or in their occupational activity, because they could maintain hand humidity. Moreover, they showed no more than a mild degree of compensatory sweating and reported high long-term satisfaction rates. Therefore, a sympathetic ramicotomy rather than a conventional sympathicotomy is recommended as a more selective and physiologic modality for treating essential hyperhidrosis.
Adolescent ; Adult ; Comparative Study ; Female ; Human ; Hyperhidrosis/*surgery ; Male ; Middle Aged ; *Sympathectomy ; *Thoracic Surgery, Video-Assisted

Video-assisted thoracoscopic surgery has recently evolved as an alternative to thoracotomy for several thoracic disorders. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indication. Using video-assisted operative thoracoscopy, we operated on 33 patients during the 2 years of our experience from June 1993 to June 1995. They were diagnosed as recurrent pneumothorax in 16, visible bulla on X-ray in 6, prolonged air leakage (longer than 7days) in 4, bilataral pneumothorax in 3, hyperhidrosis in 2, previous contralateral pneumothorax in 1, primary hemopneumothorax 1. The average duration of chest tube placement was 2.1+/-0.4 days. The mean postoperative hospital stay was 3.4+/-0.6 days. The complication was persistent air leakage (longer than 48 hours) in 3 case. Video-assisted thoracic surgery is safe, decreased pain, and shortens hospital stay.
Chest Tubes ; Hemopneumothorax ; Humans ; Hyperhidrosis ; Length of Stay ; Pneumothorax ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy

Resectional surgery of sympathetic nerves has been known to be the most effective treatment for essential hyperhidrosis and the application of thoracoscopic electrocauterization has provided a minimally-invasive procedure with the least morbidity and a resultant higher satisfaction rate. This paper describes our experience on the 1,167 cases of thoracoscopic sympathetic surgery for the treatment of essential hyperhidrosis. A total of 1,167 patients (674 males (58%) and 493 females (42%), mean age of 26.4 years with palmar (930), craniofacial (190) or axillary (47) hyperhidrosis underwent thoracoscopic sympathetic surgery from July 1992 to March 1999. Since the T2-4 sympathectomy, first performed in July 1992 for a patient of palmar hyperhidrosis, the operative methods have been altered to achieve a higher satisfaction level with the least complication by adopting less invasive procedures. Our current standard procedures being performed are T3 and T2 clipping for palmar and craniofacial hyperhidrosis and T3,4 sympathicotomy for axillary hyperhidrosis, all using a 2 mm needle thoracoscope. As the surgical procedures have been transited to a less invasive method with limited resection using the newest endoscopic devices, the average operation time and complications such as Horner's syndrome and compensatory hyperhidrosis have gradually decreased and thus the long-term satisfaction rate has been raised up to 98% for palmar hyperhidrosis, 92% for craniofacial hyperhidrosis and 89% for axillary hyperhidrosis. The recurrent cases (14/1167) were treated successfully with reoperations of thoracoscopic sympathetic surgery. The optimal goal of therapy could be achieved by complete elimination of the hyperhidrotic symptom, by decreasing the incidence and degree of compensatory hyperhidrosis through a selective and limited resection, and by adopting the least invasive procedures. Sympathicotomy has provided the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy. The reversible method of clipping may be an effective, provisionary means for cases of severe, intractable compensatory sweating. For craniofacial hyperhidrosis, T2 sympathicotomy or clipping has been proven to be superior to the T1 sympathectomy due to the decreased occurrence of Horner's syndrome and T3,4 sympathicotomy providing a satisfactory outcome with less compensatory hyperhidrosis for axillary hyperhidrosis.
Adolescence ; Adult ; Aged ; Child ; Female ; Human ; Hyperhidrosis/surgery* ; Male ; Middle Age ; Sympathectomy* ; Thoracoscopy*

Recurrent hyperhidrosis after thoracic sympathectomy is an uncomfortable condition, and compensatory hyperhidrosis (CH) is one of the most troublesome side effects. Here, we describe two patients with recurrent palmar hyperhidrosis (PH) and CH over the whole body simultaneously. They were treated with bilateral T4 sympathetic clipping and reconstruction of the sympathetic nerve from a T5 to T8 sympathetic nerve graft, which was transferred to the resected T3 sympathetic bed site. They reported improvements in sweating and were fully satisfied with the results. Our method can be considered as an alternative approach for patients with recurrent PH and CH.
Adult ; Female ; Humans ; Hyperhidrosis/*surgery ; Male ; Recurrence ; Thermography ; Thoracoscopy ; Treatment Outcome

OBJECTIVE: To evaluate the effect of video-assisted thoracoscopic sympathectomy at the T4 level on plantar hyperhidrosis in the treatment of palmoplantar hyperhidrosis.
 METHODS: The clinical data of 28 patients with primary palmoplantar hyperhidrosis, who were admited in our hospital from June 2009 to May 2014, was analyzed. All patients were qualified to bilateral thoracoscopic transaction of the sympathetic chain at the thoracic level T4. Patients completed a self-administered hyperhidrosis questionnaire and scoring before and after procedure. Follow-up data were obtained at 1 and 6 months after the surgery.
 RESULTS: Endoscopic thoracic sympathectomy at the thoracic level T4 was performed successfully for all cases. Palmar hyperhidrosis was completely alleviated after the operation and no recurrence was observed during follow-up. The ratio for initial improvement of plantar hyperhidrosis was 28.6% (8/28) at 1 month after the surgery followed by a recurrence of plantar hyperhidrosis. No case continued to show the improvement of palmoplantar hyperhidrosis at 6 months after the sympathectomy. Twenty-seven patients (96.4%) were very satisfied with the outcome of the operation, 1 patient (3.6%) satisfied and no patient regretted the surgical procedure.
 CONCLUSION T4 thoracoscopic sympathectomy could initialliy alleviate plantar hyperhidrosis in some patients with palmoplantar hyperhidrosis, but the improvement was not sustained over a long period. It could not be used to treat plantar hyperhidrosis.
Foot ; Humans ; Hyperhidrosis ; Recurrence ; Surveys and Questionnaires ; Sympathectomy ; Sympathetic Nervous System ; Thoracic Surgery, Video-Assisted

OBJECTIVE: To assess the quality of life in patients with primary palmar hyperhidrosis before and after T4 endoscopic thoracic sympathicotomy (ETS) using the modified rating scales system for life quality.
 METHODS: Between June, 2009 and May, 2014, forty-eight patients with primary palmar hyperhidrosis received ETS at the thoracic level T4. Patients completed self assessment of life quality by the modified rating scales system before and after the surgery. Follow-up data including effectiveness of operation, patient satisfaction and life quality were obtained at 1 and 6 months after the surgery.
 RESULTS: ETS at the thoracic level T4 was performed successfully for all cases. No mortality or serious complications were observed. No one needed thoracotomy in the period of surgery. Mild or moderate compensatory sweating was appeared in 38 cases (79.1%) or 1 case (2.1%), respectively. None severe case was observed after T4 ETS. About 97.9% of the patients were very satisfied with the result of the operation and no patient regretted the surgical procedure. All patients answered the quality of life (QoL) questionnaire and showed the improvement of QoL after the procedure (F=763.67, P<0.001).
 CONCLUSION Primary palmar hyperhidrosis led to the reduction of life quality. ETS at T4 level could reduce sweating production and improve QoL in patients with primary palmar hyperhidrosis.
Endoscopy ; Humans ; Hyperhidrosis ; surgery ; Patient Satisfaction ; Quality of Life ; Surveys and Questionnaires ; Sweating ; Sympathectomy ; Thoracotomy ; Treatment Outcome

OBJECTIVETo compare the therapeutic effect of traditional and modified apocrine gland removal surgery with the combination of high radiofrequency knife for axillary osmidrosis.

METHODS105 cases (210 sides) were randomly divided into traditional group A (38 cases, 76 sides) and modified group B (67 cases, 134 sides). The wound healing and complications were recorded. The clinical effect was followed up for 6-12 months after operation.

RESULTSNo flap necrosis happened in both groups. The cure rate was 82.89% (63/76)) and 92.54% (124/134) in group A and B, respectively, which was significantly different (P < 0.05). The effective rate of hair removal in group A and B was 42. 1%, 59. 7% (P < 0. 05). There is no markedly difference between the two groups in postoperative hematoma( P >0.05). The recurrence rate in group A and B was 9.21% and 1.49% respectively, with a statistically difference between them (P < 0.05).

CONCLUSIONSModified apocrine gland removal surgery with the combination of high radiofrequency knife can expose the apocrine gland better and the gland, as well as hair, can be removed in the most. The residue hair and recurrency of osmidrosis are very lower.

Adolescent ; Adult ; Apocrine Glands ; surgery ; Catheter Ablation ; instrumentation ; methods ; Female ; Humans ; Hyperhidrosis ; surgery ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any part of the body. Excessive sweating has a strong negative impact on the quality of life for many persons. From June 1992 to May 1996, 211 cases of thoracoscopic thoracic sympathectomy were performed in the Department of Thoracic Surgery, Yongdong Severance Hospital, Seoul, Korea. Among the 211 cases, 192 patients had palmar hyperhidrosis, and 19 cases had facial hyperhidrosis. There were 121 males and 90 females, and the ages ranged from 10 to 67 years(average: 24.82 years old). The average operation time and the average postoperative hospital stay were 91.94 minutes and 4.31 days, respectively. Perioperative courses were uneventful, and all the patients had immediate and complete relief of symptoms with mild compensatory sweating on the chest wall and the back. Even though a thoracoscopy has the possibility of emergency conversion to a thoracotomy and technical difficulties still exist, especially in patients with facial hyperhidrosis, our experience indicates that video-assisted thoracoscopic thoracic sympathectomy is a very safe and useful procedure for hyperhidrosis.
Emergencies ; Female ; Humans ; Hyperhidrosis* ; Korea ; Length of Stay ; Male ; Quality of Life ; Seoul ; Sweat ; Sweating ; Sympathectomy* ; Thoracic Surgery ; Thoracic Wall ; Thoracoscopy ; Thoracotomy

Thoracic sympathectomy is the radical and definite treatment of palmar hyperhidrosis. From January 1992 to March 1997, 4 patients with recurrent hyperhidrosis underwent resympathectomy via VATS at the Department of General Thoracic and Cardiovacular Surgery, Young Dong Severance Hospital. There were 2 men and 2 women and mean age was 20.0 years. There were moderate to severe adhesions at previous resection site but no thoracotomies were performed. There was no sweating on palms in all cases and all patients were greatly satisfied with those results postoperatively. In conclusion, recurrent hyperhidrosis was successfully treated with resympathectomy via VATS. In order to prevent recurrence and minimize the postoperative complication, the proper localization of the 2nd sympathetic ganglion and the radical excision of anatomical variation including Kuntz fiber are needed.
Female ; Ganglia, Sympathetic ; Humans ; Hyperhidrosis* ; Male ; Postoperative Complications ; Recurrence ; Reoperation* ; Sweat ; Sweating ; Sympathectomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy