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Endoscopic clipping in video-assisted thoracoscopic sympathetic blockade for axillary hyperhidrosis

An analysis of 26 cases

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Abstract

Background

Endoscopic thoracic sympathectomy or sympathicotomy is the standard method for the treatment of axillary hyperhidrosis. But postoperative compensatory sweating may be troublesome in some patients. Therefore, we use endoclips to perform the T3 and T4 sympathetic blockade instead of permanently interrupting the transmission of nerve impulses from the sympathetic trunk.

Methods

Between May 1997 and June 1998, a total of 26 patients with axillary hyperhidrosis underwent videoassisted thoracoscopic sympathetic blocking of the T3 and T4 ganglia at our hospital. There were 10 men and 16 women with a mean age of 31.7 years (range, 16–47). All patients were placed in a semi-sitting position under singlelumen intubated anesthesia. We performed the sympathetic blockade by clipping the T3 and T4 ganglia at the level of the third, fourth, and fifth rib beds using an 8-mm 0° thoracoscope.

Results

Bilateral T3 and T4 sympathetic blockade was achieved in all 26 patients. The operation was usually completed within 30 min (range, 20–42). Most patients were discharged within 4 h after the operation. Surgical complications were minimal, with only one case of segmental atelectasis (3.8%). There were no deaths. The mean postoperative follow-up period was 31.3 months (range, 24–37). Twenty-three patients (88.5%) developed compensatory sweating of the trunk and lower limbs. Twenty-four patients (92.3%) were satisfied with the results of the operation. Improvement of axillary hyperhidrosis was obtained in all patients. One patient underwent a reverse operation to remove the endoclips due to intolerable compensatory sweating; improvement was seen 25 days after removal of the clips.

Conclusion

Video-assisted thoracoscopic T3 and T4 sympathetic blockade by clipping is a safe and effective method for the treatment of patients with axillary hyperhidrosis. Patients who experience excessive compensatory sweating may require a reverse operation for endoclip removal.

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References

  1. Beltra KA, Foreman PA, Rodeheaver GT (1994) Quantitation of force to dislodge endoscopic ligation clips: Endoclip II vs. Ligaclip ERCA. J Laparoendosc Surg 4: 253–6

    Article  Google Scholar 

  2. Byrne J, Walsh TN, Hederman WP (1990) Endoscopic transthoracic electocautery of the sympathetic chain for palmar and axillary hyperhidrosis. Br J Surg 77: 1040–9

    Google Scholar 

  3. Denny-Brown D, Brenner C (1944) Lesion in peripheral nerve resulting from compression by spring clip. Arch Neurol Psychiatr 52: 1–19

    Article  Google Scholar 

  4. Drott C, Gothberg G, Claes G (1995) Endoscopic thansthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol 33: 78–81

    Article  CAS  PubMed  Google Scholar 

  5. Herbst F, Plas EG, Függer R (1994) Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs: a critical analysis and long-term results of 480 operations. Ann Surg 220: 86–90

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Kao MC, Lin JY, Chen YL, Hsieh CH, Cheng LC, Huang SJ (1996) Minimal invasive surgery: video endoscopic thoracic sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore 25: 673–8

    CAS  PubMed  Google Scholar 

  7. Kux M (1978) Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 113: 264–6

    Article  CAS  PubMed  Google Scholar 

  8. Lee LS, Ng SM, Lin CC (1994) Single-lumen endotracheal intubated anesthesia for thoracoscopic sympathectomy—experiences of 719 cases. Eur J Surg 572: 27–31

    Google Scholar 

  9. Lin CC, Mo LR, Hwang MH (1994) Intraoperative cardiac arrest: a rare complication of T2,3-sympathectomy for treatment of hyperhidrosis plamaris. Eur J Surg 572 (Suppl): 43–5

    Google Scholar 

  10. Lin CC, Mo LR, Lee LS, Ng SM, Hwang MH (1998) Thoracoscopic T2-sympathetic block by clipping—a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases. Eur J Surg 164: 13–6

    Article  Google Scholar 

  11. Lin TS, Fang HY (1999) Transthoracic endoscopic sympathectomy in the treatment of palmar hyperhidrosis-with emphasis on perioperative management (1360 case analysis). Surg Neurol 52: 453–7

    Article  CAS  PubMed  Google Scholar 

  12. Lin TS, Fang CY, Wu CY (2000) Repeat transthoracic endoscopic sympathectomy for palmar and axillary hyperhidrosis. Surg Endosc 14: 134–6 DOI: 10.1007/s004649900084

    Article  CAS  PubMed  Google Scholar 

  13. Mares AJ, Steiner Z, Cohen Z (1994) Transaxillary upper thoracic sympathectomy for primary hyperhidrosis in children and adolescents. J Pediatr Surg 29: 382–6

    Article  CAS  PubMed  Google Scholar 

  14. Yilmaz EN, Dur AHM, Cuesta MA, Rauwerda JA (1996) Endoscopic versus transaxillary thoracic sympathectomy for primary axillary and palmar hyperhidrosis and/or facial blushing: 5-year experience. Eur J Cardio-thorac Surg 10: 168–72

    Article  CAS  Google Scholar 

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Online publication: 21 December 2000

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Lin, T.S. Endoscopic clipping in video-assisted thoracoscopic sympathetic blockade for axillary hyperhidrosis. Surg Endosc 15, 126–128 (2001). https://doi.org/10.1007/s004640080107

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  • DOI: https://doi.org/10.1007/s004640080107

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