Bilateral Thoracic Sympathectomies for Hyperhidrosis: A novel minimal invasive approach
Angel Flores, MD1, Carlos E. Donayre, MD2, Antonio Ordaz, MD1.
1Hospital Virgen de la Salud, Toledo, Spain, 2University of California, Irvine, Orange, CA, USA.
Objectives Hyperhidrosis occurs due to a dysregulation of the neural sympathetic control of the eccrine sweat glands, which leads to excessive and unpleasant sweating. It's effects have negative psychological and social implications. In the past treatment consisted of open bilateral thoracotomies, which lead to patients seeking less invasive treatments. Endoscopic thoracic sympathectomy (ETS) offers a safe and durable alternative. We have developed a novel posterior ETS, which further shortens and minimizes the morbidity of an already minimally invasive technique and this experience will be presented.
Methods Thirteen patients with hyperhidrosis: palmar (n=13), palmar and axillary hyperhidrosis (n=1), and right digital ulceration due to Raynaud's and s/p unilateral open sympathectomy (n=1) underwent general anesthesia without selective lung ventilation. They were placed on a prone position and ETS was performed from T2 to T-3, through two 3 mm access ports. (A short Video will be shown). No chest tubes were inserted and patients were hospitalized overnight.
Results The fifteen patients (12 males and 3 females) averaged 28.2 years (range 19-32 years) were ASA I or II. No pneumothorax, subcutaneous emphysema, or Horner's syndrome developed post ETS. The most common post-operative complain was minimal pain/discomfort in the anterior pectoral area, which responded to oral analgesics and lasted less than one week. Follow-up of 13.7 months (range 1-18 months) revealed cessation of their symptomatic hyperhidrosis without development of compensatory increase in sweating in the lumbar area.
Conclusions Severe hyperhidrosis affects patient's social interactions. The use of durable, minimal invasive ETS through a novel posterior approach appears to be a safe and effective treatment with minimal complications. Longer follow-up needs to be pursued.
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