Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow.
BACKGROUND
Limiting the extent of sympathectomy in palmar hyperhidrosis was recently recognized as an effective method to minimize the incidence and severity of troublesome compensatory sweating. However, the levels at which transection should be performed remain controversial. In this study, we proposed that the level of ablation varies and should be adjusted for each individual patient. Guided by palmar skin temperature and laser Doppler blood flow, we try to find the correct target level in each case.


METHODS
Fifty patients with severe primary palmar hyperhidrosis received bilateral endoscopic thoracic sympathectomy. Different levels of transection from T4 to T2 were performed step by step until the successful extirpation was implied by the intraoperative monitoring. The results of the operations were studied. All patients were followed up and evaluated for symptom resolution, postoperative complication, levels of satisfaction, and severity of compensatory sweating.


RESULTS
Of a total of 100 lateral procedures, 76 laterals (76%) ended the procedure at the T4 level, 23 laterals (23%) ended the procedure at the T3 level, and 1 lateral (1%) ended the procedure at the T2 level. The postoperative complication was minor, and no Horner's syndrome was detected. The rate of symptom resolution was 100% and no recurrence was found. The satisfaction rate was 92%, and the incidence of mild, moderate, and severe compensatory sweating were 12%, 8%, and 6%, respectively.


CONCLUSIONS
Concerning the sympathectomy for palmar hyperhidrosis, there is a possibility that the level of the transection varies and should be adjusted for each individual patient. Intraoperative monitoring of temperature and blood flow may be a useful tool in establishing a kind of standardized reference for finding the correct target level.
Li
Xu
X
Department of Thoracic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou City, People's Republic of China. lixu1967@hotmail.com
Tu
Yuan-Rong
YR
Lin
Min
M
Lai
Fan-Cai
FC
Chen
Jian-Feng
JF
Miao
Hui-Weng
HW
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis / Q000601:surgery*; D017078:Laser-Doppler Flowmetry; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012881:Skin Temperature / Q000502:physiology*; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013904:Thoracic Vertebrae; D013906:Thoracoscopy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult