title: Transareolar Single-Port Needlescopic Thoracic Sympathectomy Under Intravenous Anesthesia Without Intubation: A Randomized Controlled Trial.
abstract: OBJECTIVE
  Transareolar single-port needlescopic thoracic sympathectomy under intravenous anesthesia without intubation has rarely been attempted in managing primary palmar hyperhidrosis (PPH). The objective of this study is to evaluate the feasibility and safety of this minimally invasive technique.
  
  
  METHODS
  From May 2012 to May 2015, 168 male patients with severe PPH underwent single-port endoscopic thoracic sympathectomy (ETS) and were randomly allocated to groups A or B. Patients in group A underwent nonintubated transareolar ETS with a 2-mm needle endoscope, while those in group B underwent intubated transaxillary ETS with a 5-mm thoracoscope.
  
  
  RESULTS
  All procedures were performed successfully. 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. Postoperative sore throat occurred in 4 patients in group A and in 32 patients in group B (P < .01). The mean incision length was significantly shorter in group A than in group B. The mean postoperative pain scores were markedly higher in group B than in group A. The mean cost of anesthesia was considerably lower in nonintubated patients than in intubated patients. The mean cosmetic scores were higher in group A than in group B (P < .01).
  
  
  CONCLUSIONS
  Nonintubated transareolar single-port ETS with a needle endoscope is a safe, effective, and minimally invasive therapeutic procedure, which allows a smaller incision with less pain and excellent cosmetic results. This novel procedure can be performed in a routine clinical practice for male patients with severe PPH.
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China .
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China .
authors.forename: Quan
authors.initials: Q
authors.lastname: Du
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China .
authors.forename: Min
authors.initials: M
authors.lastname: Lin
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China .
authors.forename: Jianbo
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China .
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China .
authors.forename: Fancai
authors.initials: F
authors.lastname: Lai
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital of Fujian Medical University , Fuzhou, China .
authors.forename: Yuanrong
authors.initials: Y
authors.lastname: Tu
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000771:Anesthesia, Intravenous / Q000379:methods*; D001365:Axilla; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D017214:Laryngeal Masks; D008297:Male; D009339:Needles; D009558:Nipples; D063087:Noninvasive Ventilation / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012121:Respiration, Artificial; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: needlescopic surgery; primary palmar hyperhidrosis; thoracic sympathectomy; tracheal intubation