title: Embryonic NOTES thoracic sympathectomy for palmar hyperhidrosis: results of a novel technique and comparison with the conventional VATS procedure.
abstract: BACKGROUND
  To avoid the disadvantages of chronic pain and chest wall paresthesia associated with video-assisted thoracic surgery (VATS) procedures, we developed a novel surgical technique for performing sympathectomy by embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) with a flexible endoscope. In this study, we compared the outcomes of E-NOTES with conventional VATS thoracic sympathectomy on palmar hyperhidrosis.
  
  
  METHODS
  From January 2010 to April 2011, a total of 66 patients with severe palmar hyperhidrosis were treated with thoracic sympathectomy in our department. Thirty-four transumbilical thoracic sympathectomies were performed via a 5-mm umbilicus incision with ultrathin gastroscope, then compared with 32 conventional needlescopic thoracic sympathectomies. Retrospective statistical analysis of a prospectively collected group of patients was performed.
  
  
  RESULTS
  There was no significant difference with regard to gender, mean age, body mass index, and length of hospital stay between the two groups. The operative time for E-NOTES thoracic sympathectomy was longer than that of VATS thoracic sympathectomy (56.4 ± 10.8 vs. 40.3 ± 6.5 min, p < 0.01). No mortality, diaphragmatic hernia, or Horner syndrome was observed in either group. Postoperative questionnaires were returned by all treated patients with a mean time from operation to follow-up of 1.4 ± 0.3 years. All 66 patients receiving sympathectomy reported successful treatment of their palmar hyperhidrosis. Compensatory hyperhidrosis was noticed in 7 (20.1 %) and 6 (18.8 %) patients in the E-NOTES and VATS groups, respectively (p > 0.05). Postoperative pain and paresthesia were significantly reduced in the E-NOTES group at each time interval, and the aesthetic effect of the incision was superior in the E-NOTES group.
  
  
  CONCLUSIONS
  Transumbilical-diaphragmatic thoracic sympathectomy is a safe and efficacious alternative to the conventional approach. This novel procedure can further reduce postoperative pain and chest wall paresthesia as well as afford maximum cosmetic benefits by hiding the surgical incision in the umbilicus.
authors.affiliation: Department of Cardiothoracic Surgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, China, lihuan.zhu@yahoo.cn.
authors.forename: Li-Huan
authors.initials: LH
authors.lastname: Zhu
authors.forename: Long
authors.initials: L
authors.lastname: Chen
authors.forename: Shengsheng
authors.initials: S
authors.lastname: Yang
authors.forename: Daoming
authors.initials: D
authors.lastname: Liu
authors.forename: Jixue
authors.initials: J
authors.lastname: Zhang
authors.forename: Xianjin
authors.initials: X
authors.lastname: Cheng
authors.forename: Weisheng
authors.initials: W
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D003964:Diaphragm / Q000601:surgery; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000601:surgery; D010292:Paresthesia / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D035441:Thoracic Wall / Q000601:surgery; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery; D055815:Young Adult