Video-assisted thoracoscopic "resympathicotomy" for palmar hyperhidrosis: analysis of 42 cases.
BACKGROUND
There are rare reports of video-assisted thoracoscopic resympathicotomy for patients with palmar hyperhidrosis. I present our experience in treating a persistent or recurrent palmar hyperhidrosis after primary endoscopic sympathectomy or sympathicotomy and discuss the perioperative management.


METHODS
We reoperated on 42 patients using a technique of video-assisted thoracoscopic resympathicotomy. All patients were placed in a semi-sitting position under single- or double-lumen intubated anesthesia. An 8-mm, 0 degrees thoracoscope was used to interrupt the nerve conduction to the palms from the T2 and T3 ganglia, through one or two 0.8-cm subaxillary incisions.


RESULTS
The reasons for failure of endoscopic sympathectomy or sympathicotomy in 26 patients included pleural adhesion (15 of 26, 57.7%), incorrect identification of T2 ganglion (3 of 26, 11.5%), vessel overriding or close to sympathetic nerve (3 of 26, 11.5%), incomplete interruption of sympathetic nerve (2 of 26, 7.7%), medially located sympathetic nerve (2 of 26, 7.7%), and aberrant venous arch (1 of 26, 3.8%). The causes of recurrent palmar hyperhidrosis after primary transthoracic endoscopic sympathicotomy or sympathectomy (TES) in 16 patients included a possible effect of T3 ganglion (8 of 16, 50%), Kuntz fiber (3 of 16, 18.8%), nerve regeneration (3 of 16, 18.8%), and incomplete interruption of T2 ganglion (2 of 16, 12.5%). Surgical complications included pneumothorax (1 patient, 2.4%), hemothorax (1 patient, 2.4%), and compensatory sweating (36 patients, 86%). All patients had obtained successful bilateral sympathectomies and had satisfactory results after a mean of 32.1 months of follow-up.


CONCLUSIONS
Video-assisted thoracoscopic resympathicotomy is an effective and safe method for a previously unsuccessful sympathectomy or recurrent palmar hyperhidrosis if the surgeon acknowledges possible anatomic variations and can overcome the problems related to pleural adhesions.
Lin
T S
TS
Division of General Thoracic Surgery, Changhua Christian Hospital, Chung Shan Medical and Dental College, Taichung, Taiwan, Republic of China. lin8065@ms14.hinet.net
D000293:Adolescent; D000328:Adult; D004724:Endoscopy; D005260:Female; D005728:Ganglia, Sympathetic / Q000601:surgery; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013562:Sympathectomy / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted; D017211:Treatment Failure