title: Incidence of chest wall paresthesia after needlescopic video-assisted thoracic surgery for palmar hyperhidrosis.
abstract: OBJECTIVE
  Chest wall paresthesia is a reported sequela of thoracotomy and Video-Assisted Thoracic Surgery (VATS) which is distinct from wound pain. Although needlescopic VATS confers less post-operative pain and better cosmesis, the incidence of paresthesia after needlescopic VATS has not been quantified.
  
  
  METHODS
  For homogeneity of the patient cohort, we studied 50 patients who received bilateral needlescopic VATS sympathectomy (T2-T4 excision) for palmar hyperhidrosis using 2 or 3 mm instruments during a 36-month period at a single institute. A standard questionnaire was administered by telephone interview, with 34 patents responding (68.0%). The median post-operative observation time was 16.5 months (range: 10-40 months). Collected data were compared with a historical group who received conventional VATS using 10 mm ports.
  
  
  RESULTS
  Paresthetic discomfort distinguishable from wound pain was described by 17 patients (50.0%). The most common descriptions were of 'bloating' (41.2%), 'pins and needles' (35.3%), or 'numbness' (23.5%) in the chest wall. The paresthesia resolved in less than two months in 12 patients (70.6%), but was still felt for over 12 months in three patients (17.6%). Post-operative paresthesia and pain did not impact on patient satisfaction with the surgery, whereas compensatory hyperhidrosis in 24 patients (70.6%) did (P=0.001). The rates and characteristics of the paresthesia following needlescopic VATS are similar to those observed after conventional VATS.
  
  
  CONCLUSIONS
  Chest wall paresthesia affects a significant but previously overlooked proportion of patients following needlescopic VATS, but has minimal impact on post-operative satisfaction. Needlescopic VATS offers no apparent advantage over conventional VATS with regard to paresthesia.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
authors.forename: Alan D L
authors.initials: AD
authors.lastname: Sihoe
authors.forename: Clement S K
authors.initials: CS
authors.lastname: Cheung
authors.forename: Ho-Kei
authors.initials: HK
authors.lastname: Lai
authors.forename: Tak-Wai
authors.initials: TW
authors.lastname: Lee
authors.forename: Kin-Hoi
authors.initials: KH
authors.lastname: Thung
authors.forename: Anthony P C
authors.initials: AP
authors.lastname: Yim
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010292:Paresthesia / Q000209:etiology*; D017060:Patient Satisfaction; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000379:methods; D035441:Thoracic Wall