title: Nonintubated Needlescopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis: A Randomized Controlled Trial.
abstract: BACKGROUND
  Conventional endoscopic thoracic sympathectomy (ETS) is usually performed with 5-mm thoracoscope under general anesthesia with endotracheal intubation. Needlescopic thoracic sympathectomy under total intravenous anesthesia without intubation has rarely been attempted. This randomized controlled trial assesses the feasibility and safety of this minimally invasive therapeutic procedure in managing primary palmar hyperhidrosis.
  
  
  METHODS
  From July 2012 to July 2014, 221 patients with severe primary palmar hyperhidrosis underwent bilateral ETS and were randomly allocated to group A or group B. Patients in group A (n=108) underwent nonintubated ETS using a needle endoscope, whereas those in group B (n=113) underwent traditional transaxillary single-port ETS using a 5-mm thoracoscope.
  
  
  RESULTS
  ETS was successfully performed in all patients. The palms of all patients became dry and warm immediately after surgery. The mean resuscitation time was significantly shorter in nonintubated patients than in intubated patients (P<0.01). Postoperative sore throat occurred in 37 patients in group B, whereas none of the patients in group A complained about sore throat after surgery (P<0.01). The mean incision length was 5.1±0.1 mm with needle endoscope and 11.0±0.8 mm with traditional thoracoscope (P<0.01). The mean postoperative pain score was 1.1±0.8 in group A and 3.2±0.8 in group B (P<0.01). The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients (P<0.01). Follow-up was 100% completed. The mean cosmetic scores were higher in group A than in group B (P<0.01). Residual pain occurred in 2 patients in group A and in 18 patients in group B (P<0.01).
  
  
  CONCLUSIONS
  Nonintubated needlescopic thoracic sympathectomy is a safe, effective, and minimally invasive therapeutic procedure, which has the advantages of a smaller incision with less pain, shorter resuscitation time, and better cosmetic results.
authors.affiliation: Departments of *Thoracic Surgery †Anesthesia, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China.
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Chen
authors.forename: Min
authors.initials: M
authors.lastname: Lin
authors.forename: Ping
authors.initials: P
authors.lastname: Chen
authors.forename: Du
authors.initials: D
authors.lastname: Quan
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.forename: Fan-Cai
authors.initials: FC
authors.lastname: Lai
authors.forename: Yuan-Rong
authors.initials: YR
authors.lastname: Tu
mesh_terms: D000293:Adolescent; D000328:Adult; D000762:Anesthesia Recovery Period; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult