Clinical Outcomes of Uniportal Versus Multiportal Endoscopic Thoracic Sympathectomy in Patients With Severe Palmar and Axillary Hyperhidrosis

Year 2022, Volume: 6 Issue: 2, 151 - 158, 20.08.2022

Oktay Aslaner

https://doi.org/10.30565/medalanya.1106046

Cited By: 1

Abstract

Aim: Palmar and axillary hyperhidrosis is caused by overstimulation of the sympathetic nervous system that control the sweat glands. This study compares the clinical consequences of uniportal and multiportal thoracic endoscopic thoracic sympathectomy (ETS), in cases of severe palmar and axillary hyperhidrosis.

Methods: In this retrospective study, forty-one patients who were diagnosed as severe palmar and axillary primary hyperhidrosis were analyzed. These underwent multiportal ETS between 2015 and 2020 at our thoracic surgery clinic. They were divided into two groups, 24 as uniportal (58.5%) and 17 as multiportal (41.5%). They were compared in terms of the length of hospital stay, the initial complications and possible recurrences after three months. Descriptive statistics were used to evaluate stratified and continuous variables.

Results: There was no significant difference in moderate pain between the two groups. There was a significant difference between the two groups in terms of 3 days or more hospitalization. There were no significant difference related to the rate of complications such as ptosis, Horner syndrome, increased duration of surgery and recurrence rate of hyperhidrosis 3 months after surgery. Some mild to moderate side effects disappeared spontaneously at 6-month follow-up.

Conclusion: The results showed that uniportal and multiportal endoscopic thoracoscopic sympathectomy (EST) are very effective, safe and minimally invasive methods for the treatment of palmar and axillary hyperhidrosis. Compared to the multiportal approach, uniportal EST causes less postoperative pain and less surgical duration.

Keywords

uniportal, multiportal, hiperhydrosis, ETS

Şiddetli Palmar ve Aksiller Hiperhidrozu Olan Hastalarda Uniportal ve Multiportal Endoskopik Torasik Sempatektomi’nin Klinik Sonuçları

Abstract

Amaç: Palmar ve aksiller hiperhidroz, ter bezlerini kontrol eden sempatik sinir sisteminin aşırı uyarılmasından kaynaklanır. Bu çalışma, şiddetli palmar ve aksiller hiperhidroz vakalarında uniportal ve multiportal torasik endoskopik torasik sempatektominin (ETS) klinik sonuçlarını karşılaştırmaktadır.

Yöntemler: Bu retrospektif çalışmada şiddetli palmar ve aksiller primer hiperhidroz tanısı konulan 41 hasta incelendi. 2015-2020 yılları arasında göğüs cerrahisi kliniğimizde tüm vakalarımıza ETS uygulandı. Uniportal 24 (%58,5) ve 17 Multiportal (%41,5) olmak üzere iki gruba ayrıldılar. Hastanede kalış süreleri, ilk komplikasyonlar ve üç ay sonra olası nüksler açısından karşılaştırıldılar. Tabakalı ve sürekli değişkenleri değerlendirmek için tanımlayıcı istatistikler kullanıldı.

Bulgular: İki grup arasında orta derecede ağrı açısından anlamlı bir fark yoktu. Hastanede 3 gün ve üzeri yatış açısından iki grup arasında anlamlı fark vardı. Ameliyattan 3 ay sonra pitozis, Horner sendromu, ameliyat süresinin uzaması ve hiperhidrozun tekrarlama oranı gibi komplikasyon oranları arasında anlamlı fark yoktu. Bazı hafif ila orta dereceli yan etkiler 6 aylık takipte kendiliğinden kayboldu.

Sonuç: Sonuçlar, palmar ve aksiller hiperhidroz tedavisinde uniportal ve multiportal endoskopik torakoskopik sempatektominin (EST) çok etkili, güvenli ve minimal invaziv yöntemler olduğunu göstermiştir. Multiportal yaklaşımla karşılaştırıldığında, uniportal ETS daha az postoperatif ağrıya ve daha az cerrahi süreye neden olur.

Keywords

uniportal, multiportal, hiperhidrozis, ETS

References

• 1. Cerfolio RJ, De Campos JRM, Bryant AS, Connery CP, Miller DL, DeCamp MM, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. The Annals of thoracic surgery. 2011;91(5):1642-8. doi: 10.1016/j.athoracsur.2011.01.105.
• 2. Mohebbi HA, Mehrvarz S, Manoochehry S. Thoracoscopic sympathectomy vs sympathectomy in primary hyperhidrosis. Trauma monthly. 2012;17(2):291. doi: 10.5812/traumamon.6335.
• 3. Alar T, Gedik İE. The Results of a Long-Term Follow-up of Bilateral Single Port Sympathectomy in Primary Hyperhidrosis: Should We Perform This Surgery? Clinical Surgery Research Communications. 2019;3(4):26-30. doi: 10.31491/CSRC.2019.12.041.
• 4. Pashaei-Marandi A, Assam JH, Arnold A, Lee AG, Bonelli L. Reversible anisocoria due to inadvertent ocular exposure to topical anticholinergic treatment for primary axillary hyperhidrosis. Canadian Journal of Ophthalmology. 2019;54 (6):e300-e2. doi: 10.1016/j.jcjo.2019.04.009.
• 5. Heidemann E, Licht PB. A comparative study of thoracoscopic sympathectomy versus local surgical treatment for axillary hyperhidrosis. The Annals of thoracic surgery. 2013;95(1):264-8. doi: 10.1016/j.athoracsur.2012.08.103.
• 6. Abouarab AA, Rahouma M, Kamel M, Ghaly G, Mohamed A. Single versus multi-incisional video-assisted thoracic surgery: a systematic review and meta-analysis. Journal of Laparoendoscopic & Advanced Surgical Techniques. 2018;28(2):174-85. doi: 10.1089/lap.2017.0446.
• 7. Cerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011;91(5):1642-8. doi: 10.1016/j.athoracsur.2011.01.105.
• 8. Cinà CS, Cinà MM, Clase CM. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results. J Minim Access Surg. 2007;3(4):132-40. doi: 10.4103/0972-9941.38907.
• 9. Musa AF, Gandhi VP, Dillon J, Nordin RB. A retrospective review on minimally invasive technique via endoscopic thoracic sympathectomy (ETS) in the treatment of severe primary hyperhidrosis: Experiences from the National Heart Institute, Malaysia. F1000Res. 2018;7:670. doi: 10.12688/f1000research.14777.1.
• 10. Walling HW, Swick BL. Treatment options for hyperhidrosis. Am J Clin Dermatol. 2011;12(5):285-95. doi: 10.2165/11587870-000000000-00000.
• 11. Horslen LC, Wilshire CL, Louie BE, Vallières E. Long-term impact of endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. The Annals of thoracic surgery. 2018;106(4):1008-12. doi: 10.1016/j.athoracsur.2018.04.063.
• 12. Wait SD, Killory BD, Lekovic GP, Dickman CA. Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents. Journal of Neurosurgery: Pediatrics. 2010;6(2):183-7. doi: 10.3171/2010.5.PEDS09225.
• 13. Ozdemir S. Comparison of Treatment Results and Satisfaction Levels of Endoscopic Thoracic Sympathectomy Techniques Performed in Primary Focal Hyperhidrosis. Medical Bulletin of Haseki/ Haseki Tip Bulteni. 2021;59:172-7. doi: 10.4274/haseki.galenos.2021.6713
• 14. Aboollo MF, Hafez BA, Shaker AA, Ghoneim B. Prospective randomized study comparing Video assisted thoracoscopic surgery (VATS) resection versus cautery for treatment of primary hyperhidrosis. Journal of the Egyptian Society of Cardio-Thoracic Surgery. 2018;26(4):318-23. doi: 10.1016/j.jescts.2018.11.005.
• 15. Wait SD, Killory BD, Lekovic GP, Ponce FA, Kenny KJ, Dickman CA. Thoracoscopic sympathectomy for hyperhidrosis: analysis of 642 procedures with special attention to Horner's syndrome and compensatory hyperhidrosis. Neurosurgery. 2010;67(3):652-7 PMID: 20647968. doi: 10.1227/01.NEU.0000374719.32137.BB.
• 16. Raposi, E., Caruana G. Video-Assisted Thoracoscopic Sympathicotomies for the Treatment of Palmar and Axillary Hyperhidrosis. In: Raposio E, editör. Atlas of Endoscopic Plastic Surgery. 1st ed. Switzerland: Springer; 2016. p. 81-89
• 17. Kazemzadeh GH, Modaghegh MHS, Ravari H, Mannani R, Salehian M, Yarigholi F. Comparison of single port thoracoscopic sympathectomy and multiport thoracoscopy in patients with hyperhidrosis. Journal of Advances in Medical and Biomedical Research. 2018; 26(116):1-8.
• 18. Zhang M. P-256. Uniportal video-assisted thoracoscopic surgery without one-lung ventilation for sympathectomy for palmar hyperhidrosis. Interactive Cardiovascular and Thoracic Surgery. 2017;25(suppl_1) doi: 10.1093/icvts/ivx280.256.
• 19. de Andrade Filho LO, Kuzniec S, Wolosker N, Yazbek G, Kauffman P, de Campos JRM. Technical difficulties and complications of sympathectomy in the treatment of hyperhidrosis: an analysis of 1731 cases. Ann Vasc Surg. 2013;27(4):447-53. doi: 10.1016/j.avsg.2012.05.026.
• 20. Sang H-W, Li G-L, Xiong P, Zhu M-C, Zhu M. Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review. Surgical endoscopy. 2017;31(11):4357-69. doi: 10.1007/s00464-017-5508-y.
• 21. Jung HS, Lee DY, Park JS. Alternative surgical methods in patients with recurrent palmar hyperhidrosis and compensatory hyperhidrosis. Yonsei medical journal. 2018; 59(2):345-8. doi: 10.3349/ymj.2018.59.2.345.
• 22. Chen YB, Ye W, Yang WT, Shi L, Guo XF, Xu ZH, et.al.. Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Chin Med J (Engl). 2009;122(13):1525-8. PMID: 19719942. https://doi.org/10.3760/cma.j.issn.0366-6999.2009.13.010
• 23. Georghiou GP, Berman M, Bobovnikov V, Vidne BA, Saute M. Minimally invasive thoracoscopic sympathectomy for palmar hyperhidrosis via a transaxillary single-port approach. Interact Cardiovasc Thorac Surg. 2004;3(3):437-41. doi: 10.1016/j.icvts.2004.03.003.
• 24. Murphy MO, Jonathan G, Nadeem K, David M, Anastassi TH, Andrew C, et.al. Upper dorsal endoscopic thoracic sympathectomy: a comparison of one- and two-port ablation techniques, Eur J Cardiothorac Surg. 2006;30(2)223-7. doi: 10.1016/j.ejcts.2006.04.016.
• 25. Drott C. Results of endoscopic thoracic sympathectomy (ETS) on hyperhidrosis, facial blushing, angina pectoris, vascular disorders and pain syndromes of the hand and arm. Clin Auton Res. 2003;13 Suppl 1:I26-30. doi: 10.1007/s10286-003-1109-z.