Users Online : 611 About us |  Subscribe |  e-Alerts  | Feedback | Login   
Journal of Minimal Access Surgery Current Issue | Archives | Ahead Of Print Journal of Minimal Access Surgery
           Print this page Email this page   Small font sizeDefault font sizeIncrease font size 
  Search
 
 ¤  Next article
 ¤  Previous article 
 ¤  Table of Contents
  
 ¤   Similar in PUBMED
 ¤  Search Pubmed for
 ¤  Search in Google Scholar for
 ¤Related articles
 ¤   Article in PDF (244 KB)
 ¤   Citation Manager
 ¤   Access Statistics
 ¤   Reader Comments
 ¤   Email Alert *
 ¤   Add to My List *
* Registration required (free)  


 ¤  Abstract
 ¤  Introduction
 ¤  Treatments
 ¤  Endoscopic Sympa...
 ¤  Quality of Life ...
 ¤  Impact of ETS on...
 ¤  Complications of ETS
 ¤  Selection of Pat...
 ¤  Future Directions
 ¤  Summary and Conc...
 ¤  Acknowledgements
 ¤  References
 ¤  Article Figures
 ¤  Article Tables

 Article Access Statistics
    Viewed9096    
    Printed214    
    Emailed4    
    PDF Downloaded325    
    Comments [Add]    
    Cited by others 3    

Recommend this journal

 


 
CME ARTICLE
Year : 2007  |  Volume : 3  |  Issue : 4  |  Page : 132-140
 

Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results


1 Division of Vascular Surgery, Department of Surgery, University of Toronto and Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
2 Student Toronto French School, Canada
3 Division of Nephrology, Department of Medicine and Epidemiology and Biostatistics, McMaster University, Hamilton, Canada

Date of Submission17-Jan-2007
Date of Acceptance31-Jan-2007

Correspondence Address:
C S Cina
Victoria Medical Centre, 304 Victoria Avenue North, Suite 305, Hamilton, ON, L8L 5G4
Canada
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9941.38907

Rights and Permissions

 ¤ Abstract 

Outline: We review the clinical features of hyperhidrosis and the range of treatments used for this condition. We describe in detail the technique of endoscopic sympathectomy. We summarize studies that have reported results of endoscopic sympathectomy. We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls.


Keywords: Endoscopic sympathectomy, hyperhidrosis, quality of life


How to cite this article:
Cina C S, Cina M M, Clase C M. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results. J Min Access Surg 2007;3:132-40

How to cite this URL:
Cina C S, Cina M M, Clase C M. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results. J Min Access Surg [serial online] 2007 [cited 2018 Sep 20];3:132-40. Available from: http://www.journalofmas.com/text.asp?2007/3/4/132/38907



 ¤ Introduction Top


Hyperhidrosis is a dysregulation of the neural sympathetic control of the eccrine sweat glands, which leads to excessive and unpleasant sweating. The thoracic sympathetic chain is involved in the neural control of sweating in hyperhidrosis of the upper limbs. It lies in front of the neck of the thoracic ribs and under the parietal pleura. Preganglionic sympathetic fibers (white rami) synapse with ganglionic cells of the sympathetic chain, usually at the same level of the lateral horn of the spinal cord where they originate. Occasionally, these preganglionic fibers travel along the sympathetic chain downward or more commonly upward before joining a ganglionic cell at a different level. The postganglionic fibres (gray rami) join a peripheral nerve or distribute around a segmental artery to reach the effector cell. The nerve endings, which control the function of the glands involved in hyperhidrosis, differ from other sympathetic fibers in that they use acetylcholine as the neurotransmitter, which is why anticholinergic drugs are sometimes used in the treatment of this condition. Symptoms affect important aspects of quality of life including physical, psychological and social dimensions.

Excessive sweating usually starts in childhood or adolescence and continues throughout life. Nervousness and anxiety can cause or aggravate sweating. Sweating can also be triggered by high environmental temperatures and emotional stress or it may appear without any obvious reasons. Usually, hyperhidrosis worsens during the warmer seasons and improves during the winter. People who suffer hyperhidrosis can experience excessive sweating on their hands (palmar), on their armpits (axillary), on their feet (plantar), on their face (facial) or on their trunk (truncal). Many individuals suffer from a combination of the above. The prevalence and incidence of the condition in North America are unknown. In a population-based study in Israel the prevalence in young adults was 0.6-1.0%. [1] Men and women appear to be equally likely to be affected. Although this condition appears to have a large impact on the quality of life, the true magnitude is difficult to quantify. Several scales have been designed or used: generic tools such as the SF36 [2],[3],[4] and specific measures such as the Dermatology Life Quality Index (DLQI) [5] and Keller [6] and Milanez de Campo [7] questionnaires. We have validated and used the Illness Intrusiveness Rating Scale and ten disease-specific severity questions in this setting. [3]


 ¤ Treatments Top


There are several ways to treat excessive sweating: Antiperspirants (e.g. Aluminium Zirconium, Tetrachlorohydrex Glycine), iontophoresis, anticholinergic medication, psychotherapy, botulinum toxin injections and surgery. Recently, there is increased awareness with the use of botulinum toxin injections as a non-surgical treatment of hyperhidrosis. Although indications have been made that botulinum toxin is effective in reducing sweating, the results are generally not durable beyond 14 months. [8] Also, the side effects of this treatment can involve temporary muscle weakness or partial paralysis [9],[10] and the injection procedure is technically demanding, involving up to 35 injection sites in each palm. [9] For patients whose disease is sufficiently severe that they would consider botulinum toxin injections, we believe that endoscopic thoracic sympathectomy (ETS) offers a safe and durable alternative. The latter requires excision, electrocoagulation of or application of surgical clips [11] on the thoracic sympathetic ganglia between T2 and T4 or T5. In the past, this surgery required bilateral thoracotomies and therefore it was rarely offered. ETS is a minimally invasive technique that has increased the interest in this modality of treatment.


 ¤ Endoscopic Sympathectomy: Surgical Technique Top


We perform bilateral ETS under general anesthesia using a single lumen endotracheal tube. Patients are positioned supine with both arms outstretched on arm boards and the trunk in a 30º Fowler position. The sterile field includes the neck, both axillae and upper arms down to the costal margin bilaterally [Figure - 1]. A specifically designed and custom made 5 mm rigid scope is used [Figure - 2]. This has a zero degree angle lens, an aspirating channel and an operating channel. The thoracoscope is introduced through a port placed in the mid-clavicular line in the second intercostal space. CO2 is insufflated to 8-10 cmH2O of pressure to collapse the dome of the lung. The thoracic chain is readily identified covered by the thin layer of the parietal pleura [Figure - 3],[Figure - 4]. A diathermy hook is inserted through the operating channel of the thoracoscope. The sympathetic chain is visualized behind the parietal pleura, which is then scored on either side using the cautery to delineate the position of the chain and the extent of the planned cauterization which corresponds to the extent of the chain destroyed [Figure - 5],[Figure - 6]. Using the ribs for reference, the sympathetic chain is then cauterized and divided from T2 to T3 for patients with predominantly palmar hyperhidrosis and from T2 to T4 for patients with predominantly axillary hyperhidrosis. The thoracoscope is then removed and replaced with a small red rubber catheter. With positive pressure ventilation, the catheter is then removed under suction to allow expansion of the lung. The skin incision is closed with a single absorbable 3-0 suture followed by placement of skin tapes. Contralateral sympathectomy is performed in a similar manner without changing the patient's position.


 ¤ Quality of Life in People with Hyperhidrosis Top


In clinical practice and for research, we found the Illness Intrusiveness Rating Scale [Table - 1] very useful in the assessment of the impact of hyperhidrosis on patients' lives and of the overall response to surgery in patients who undergo ETS. Respondents use a seven-point Likert scale to assess the impact of their disease on each of 13 domains: health, diet, work, active and passive recreation, financial situation, relationship with spouse, sex life, family and other social relations, self expression/self improvement, religious expression and community/civic involvement. The minimum score is 13 and the maximum 91. The scale has been validated and used in patients with a number of chronic diseases. [12],[13],[14],[15],[16] In patients with hyperhidrosis we have previously shown that the IIRS is valid by comparing responses on this scale with responses to a global severity item and ten additional severity questions, based on theoretical constructs, clinical observations and contributions from hyperhidrosis patients. [3] Internal consistency (Cronbach's α = 0.88) and test-retest reliability (intraclass correlation coefficient = 0.89) were shown to be very good in patients with hyperhidrosis. [3] We also use the ten severity questions described above [Table - 2]. [3]

In our study of 30 patients with primary, bilateral hyperhidrosis, the impact of hyperhidrosis on quality of life was demonstrated by the high preoperative IIRS score (57 ± 14) observed in this group of patients referred to vascular surgeons, similar to that seen in patients with severe debilitating chronic conditions, such as rheumatoid arthritis, end-stage renal disease and multiple sclerosis. [13],[17] The domains, which appeared most affected (median score 5 or greater) were work, active recreation, relation with spouse, sex life, other social relations, self-expression/self-improvement and community and civic involvement.

Ramos and colleagues have used the State-Trait Anxiety Inventory to document high levels of anxiety in 106 patients with hyperhidrosis. [18],[19] Many of these patients also reported symptoms more commonly associated with anxiety: palpitations, trembling, non-specific headache and gastrointestinal disturbance.

In addition, we have recently compared the preoperative quality of life in these patients with hyperhidrosis with that of controls. The control group was a random sample of eleven English and French speaking individuals older than 15 years of age not affected by hyperhidrosis identified among students and teachers in a Toronto French Schools, office assistants and physicians' offices [Table - 3]. Controls and people with hyperhidrosis provided significantly different answers to the questions addressing correlates of severity of disease [Table - 4]. Compared with controls, patients with hyperhidrosis more frequently used antiperspirants, took more showers or baths, changed their clothing more often, were limited in the type of wardrobe that they could use and their sweating was made worse by alcohol, spicy foods and caffeine containing drinks. On the IIRS, the control group, as expected, had a total score of 13.5 SD 0.7, while the group of individuals with hyperhidrosis scored 57 SD 14. This difference was highly statistically different ( P = 0.001). For all questions of the IIRS, the experimental group rated their health problems as more intrusive than the control group [Table - 5].


 ¤ Impact of ETS on Quality of Life in People with Hyperhidrosis Top


We have previously reported the results of our cohort study of quality of life in individuals with hyperhidrosis, using a pre-post design to study the change in quality of life before and after surgery. [4] Patients completed the questionnaires at two postoperative time points: early, defined as within two months after surgery and late, defined as four months or more after surgery. In addition, postoperative patients answered a single item question reflecting the magnitude of the change in their condition since surgery, rated on a seven-point scale (7 = greatest improvement; 1 = minimal or no improvement). Early postoperative data (1 to 2 months) were available in 12 patients and late postoperative data (4 to 34 months) in 19 patients. The median follow-up time for the early and late questionnaires was 30 days (14 to 64 days) and 370 days (118 to 1013 days), respectively.

Early after surgery (1 to 2 months) people with hyperhidrosis had a total score which was significantly lower than that before surgery ( P = < 0.0001) and more in keeping with that of people without hyperhidrosis [Figure - 7]. A similar pattern was identified for each of the individual questions of the IIRS. The difference is statistically significant for each of the questions and scale items, for the global severity score and for the total IIRS score at both early and late postoperative time points. For the global severity question, in the preoperative questionnaire the median global severity score was 7 and the lowest response was 5. In the early and late postoperative period the median score was 1, highest 7. For the question on magnitude of change in overall symptoms after ETS, the median score was 7 (lowest 5) at the early post-operative time point and 7 (lowest 2) for the late responses. The improvement in postoperative responses to the IIRS questionnaire was stable as manifested in the late follow up results [Table - 6]

The IIRS is an instrument known to be reliable and valid in other chronic conditions [12],[13],[14],[15],[16],[17],[20],[21] and we have previously demonstrated its measurement properties in hyperhidrosis, using a different group of patients. [3] Panhofer used two disease-specific questionnaires, devised by Keller et al. [6] and Milanez de Campos et al. [7] and showed improvement in ratings by both instruments following ETS, adding to the cumulative evidence of effectiveness of ETS and providing evidence for the construct validity of these two instruments. Other cohort studies, using different methods to assess patients' clinical status, support the effectiveness of ETS in patients with hyperhidrosis, though many of these used unvalidated clinical assessments or questionnaires. A number of retrospective cohort studies, [1],[22],[23],[24] reported that ETS is safe and effective using an assessment based on a non-quantitative clinical interview at the time of the office visit. Other studies have reported positive outcomes using questionnaires [25],[26],[27],[28] or visual analogue scales [29] which appear to have been developed for the purpose of the study and whose reliability and validity were not reported. In addition to using a newly-designed study-specific questionnaire, Sayeed et al , [28] reported the results of their prospective cohort study using the Medical Outcomes Study Short Form 36 (SF 36), which has not been validated in the context of hyperhidrosis and was not sensitive to change in their study. Amir validated a disease-specific questionnaire in young Jewish patients with hyperhidrosis. [30] This scale was developed in Hebrew and has not, to our knowledge, been used to measure changes after surgery.

In our study, multiple secondary outcome measures (a global severity item, ten severity questions and a single item rating of improvement with surgery), also gave results which were highly statistically and clinically significant and in keeping with the results of the IIRS. We have also reported statistical comparisons for both early and late postoperative outcomes and our reporting of all outcomes over medium-term follow-up shows that results of surgery were durable up to four years postoperatively. Employment, smoking and maintaining a stable relationship all showed changes in favorable directions after surgery, though these results were not statistically significant. In the study by Ramos and colleagues, anxiety, assessed by the State-Trait Anxiety Index, decreased from 2.08 SD 1.1 preoperatively to 0.39 SD 0.67 postoperatively ( P <0.001) and the frequency of palpitations, trembling, headache and gastrointestinal disturbance were all also decreased. [19]

A significant weakness of all the available evidence is the use of cohort design where a number of biases are possible: in this setting, patients at the start of a study may magnify the seriousness of their condition with the hope of being considered for treatment and at the end of the study may minimize residual difficulties in order to please the surgeon and staff, the 'hello-goodbye' effect. [31] This effect tends to magnify any differences in response to treatment. However, the effects observed in our study [4] were very large and are likely to represent true improvement. Jaeschke et al , [32] have suggested that for seven-point Likert scales, changes of 0.5, 1.0 and 1.5 usually correspond to small, medium and large clinical effects, respectively. The changes in the total IIRS score corresponded to a mean decrease of 2 to 3 points in each individual item, which exceeds the differences discussed by Jaeschke by a comfortable margin.


 ¤ Complications of ETS Top


In our own study, of the 22 patients who underwent surgery, one patient (5%) developed a postoperative pneumothorax requiring placement of a Heimlich valve. There were no other local or wound complications. No patient developed Horner's syndrome or any other neurologic complication. One patient (5%) reported compensatory increase in sweating in the lower lumbar area.

Our findings are in keeping with other studies, which have reported rates of perioperative complications between 4% and 21%. [19],[33],[34],[35],[36] In a cohort of 281 people undergoing ETS for hyperhidrosis, the rate of Horner's syndrome was 1% and no patient developed gustatory sweating. [37] In 458 patients undergoing ETS reported by Moya and colleagues, major perioperative complications with conversion to thoracotomy occurred in 0.4%, pneumothorax in 2%, subcutaneous emphysema in 1%, pleural bleeding in 0.2%, hemothorax in 0.1% and atelectasis in 0.1%. [38] In this study, excessive dryness of the hands occurred in 0.4%, Horner's syndrome in 0.3% and gustatory hyperhidrosis in 1.1% of patients.

Rates of compensatory hyperhidrosis in our study were low, occurring in one out of 22 patients (5%). This patient had noted increased sweating in the lumbar region since surgery, but her overall scores reflected marked improvement and the patient expressed satisfaction with the procedure. Other studies have reported higher rates of compensatory hyperhidrosis, between 17% and 100%. [34],[35],[36],[37],[39] Some authors suggest that a more extensive of sympathectomy (to the level of T4 or T5) is associated with increased compensatory hyperhidrosis. [40],[41] Leseche et al. [42] using multivariate analysis in a cohort of 134 patients undergoing ETS for hyperhidrosis reported an incidence of compensatory sweating of 71%. This was described as minor in 53% and severe in 19%. They found that the extent of sympathectomy was not associated with the occurrence of this complication. In their cohort, however, only 15% of patients had a sympathectomy extending to T3, 48% received a sympathectomy extending to T4 and 37% to T5. In 1,274 patients undergoing ETS reported by Reisfeld, some degree of compensatory sweating was reported in almost all patients, but was usually mild. [41] In this cohort, 2% of patients requested reversal of their procedure.

An advantage of using the IIRS, the Keller or the Milanez de Campos instruments in the study of response to surgery is that complications of surgery and adverse effects such as hyperhidrosis, if they are sufficiently severe that they impact upon the patient's life, will be reflected in a more severe total score. With respect to compensatory hyperhidrosis, we believe that the frequency and severity of this complication may be reduced by limiting the sympathectomy to T2-3 in most patients and reserving more extensive sympathectomy (T2-4 or T2-5) only to those with hyperhidrosis limited to the axillae or after failure of a previous sympathectomy. Our study suggests that whatever the true incidence of this complication is, patients feel that overall surgery improved their life in the large majority of cases. A thorough informed consent however is necessary to explain the nature and incidence of complications after ETS.


 ¤ Selection of Patients for ETS Top


As the high preoperative scores in our study show, patients referred to surgical practices suffered from severe manifestations of hyperhidrosis. [4] Given the possibility of complications from surgery, we believe that surgery should be reserved for those with the most severe manifestations and after other less invasive options have been exhausted.


 ¤ Future Directions Top


Surgeons should continue to report the results of cohort studies of ETS, including long-term results. A randomized controlled trial in people with severe hyperhidrosis, comparing ETS with continued best medical management or with repeated botulinum toxin injections, would be a valuable addition to the literature.


 ¤ Summary and Conclusions Top


Severe hyperhidrosis is severely intrusive and greatly affects people's lives. In cohort studies with medium-term follow-up, surgery appears to be safe and effective for the treatment of this condition. Given the possibility of complications, we believe that surgery should be reserved for patients with severe hyperhidrosis. In clinical practice, severity can be usefully defined by the use of a self-administered questionnaire containing the IIRS and the ten severity questions, the Keller questionnaire or the Milanez de Campos questionnaire and these same instruments can be used to monitor the response to treatment.


 ¤ Acknowledgements Top


We thank Dr G Devins for the use of the Illness Intrusiveness Rating Scale

 
 ¤ References Top

1.Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment: A report of 100 cases. Ann Surg 1977;186:34-41.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Young O, Neary P, Keaveny TV, Mehigan D, Sheehan S. Evaluation of the impact of transthoracic endoscopic sympathectomy on patients with palmar hyperhydrosis. Eur J Vasc Endovasc Surg 2003;26:673-6.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Cina CS, Clase CM. The Illness Intrusiveness Rating Scale: A measure of severity in individuals with hyperhidrosis. Qual Life Res 1999;8:693-8.  Back to cited text no. 3    
4.Cina CS, Robertson SG, Young EJ, Cartier B, Clase CM. Effect of endoscopic sympathectomy for hyperhidrosis on quality of life using the illness intrusiveness rating scale. Chirurgia 2006;19:23-9.  Back to cited text no. 4    
5.Swan MC, Paes T. Quality of life evaluation following endoscopic transthoracic sympathectomy for upper limb and facial hyperhydrosis. Ann Chir Gynaecol 2001;90:157-9.  Back to cited text no. 5  [PUBMED]  
6.Keller SM, Sekons D, Scher H, Homel P, Bookbinder MA. A novel scale for assessing quality of life following bilateral endoscopic thoracic sympathectomy for palmar and plantar hyperhidrosis. Fourth International Symposium on SympatheticSurgery, Tampere, Finland, 28-30 June 2001; Abstract O-22. 2001.   Back to cited text no. 6    
7.Milanez de Campos JR, Kauffman P, de Campos Webere E, Filho AF, Kusniek S, Wolosker N. Quality of life, before and after thoracic sympathectomy: Report on 378 operated patients. Ann Thorac Surg 2003;76:886-91.  Back to cited text no. 7    
8.Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: Randomized, parallel group, double blind, placebo controlled. BMJ 2001;323:596.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]
9.Glogau RG. Review of the use of botulinum toxin for hyperhidrosis and cosmetic purposes. Clin J Pain 2002;18:S191-7.  Back to cited text no. 9  [PUBMED]  [FULLTEXT]
10.Saadia D, Voustianouk A, Wang AK, Kaufmann H. Botulinum toxin type A in palmary hyperhidrosis: A randomized, single blind, two-dose study. Neurology 2001;57:2095-9.  Back to cited text no. 10    
11.Chou SH, Kao EL, Lin CC, Chang YT, Huang MF. The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: Experience with 464 cases. Surg Endoscop Other Interventional Tech 2006;20:1749-53.  Back to cited text no. 11    
12.Devins GM, Edworthy SM, Guthrie NG, Martin L. Illness intrusiveness in rheumatoid arthritis: Differential impact on depressive symptoms over the adult lifespan. J Rheumatol 1992;19:709-15.  Back to cited text no. 12  [PUBMED]  
13.Devins GM, Edworthy SM, Seland TP, Klein GM, Paul LC, Mandin H. Differences in illness intrusiveness across rheumatoid arthritis, end-stage renal disease and multiple sclerosis. J Nerv Mental Dis 1993;181:377-81.  Back to cited text no. 13    
14.Devins GM, Binik YM, Hutchinson TA, Hollomby DJ, Barre PE, Guttmann RD. The emotional impact of end-stage renal disease: Importance of patients' perception of intrusiveness and control. Int J Psychiatry Med 1983;13:327-43.  Back to cited text no. 14    
15.Devins GM, Binik YM, Hollomby DJ, Barre PE, Guttmann RD. Helplessness and depression in end-stage renal disease. J Abnormal Psychol 1981;90:531-45.  Back to cited text no. 15    
16.Devins GM, Mandin H, Hons RB, Burgess ED, Klassen J, Taub K, et al. Illness intrusiveness and quality of life in end-stage renal disease: Comparison and stability across treatment modalities. Health Psychol 1990;9:117-42.  Back to cited text no. 16  [PUBMED]  
17.Devins GM. Illness intrusiveness and the psychosocial impact of lifestyle disruptions in chronic life-threatening disease. Adv Renal Replace Ther 1994;1:251-63.  Back to cited text no. 17    
18.Ramos R, Moya J, Turon V, Perez J, Villalonga R, Morera R, et al. Primary hyperhidrosis and anxiety:a prospective preoperative survey of 158 patients. Arch Bronconeumol 2005;41:88-92.  Back to cited text no. 18    
19.Ramos R, Moya J, Morera R, Masuet C, Perna V, Macia I, et al. An assessment of anxiety in patients with primary hyperhidrosis before and after endoscopic thoracic sympathicolysis. Eur J Cardiothorac Surg 2006;30:228-31.  Back to cited text no. 19  [PUBMED]  [FULLTEXT]
20.Devins GM, Binik YM, Mandin H, Letourneau PK, Hollomby DJ, Barre PE, et al. The Kidney Disease Questionnaire: A test for measuring patient knowledge about end-stage renal disease. J Clin Epidemiol 1990;43:297-307.  Back to cited text no. 20  [PUBMED]  [FULLTEXT]
21.Devins GM, Armstrong SJ, Mandin H, Paul LC, Hons RB, Burgess ED, et al. Recurrent pain, illness intrusiveness and quality of life in end-stage renal disease. Pain 1990;42:279-85.  Back to cited text no. 21  [PUBMED]  
22.Mathews BD, Bui HT, Harold KL, Kercher KW, Cowan MA, Van der Veer CA. Thoracoscopic sympathectomy for palmar hyperhidrosis. South Med J 2003;96:254-8.  Back to cited text no. 22    
23.Salob SP, Atherton DJ, Kiely EM. Thoracic endoscopic symtathectomy for palmar hyperhidrosis in an adoloshent female. J R Soc Med 1991;84:114-5.  Back to cited text no. 23  [PUBMED]  [FULLTEXT]
24.Malone PS, Cameron AE, Rennie JA. Endoscopic thoracic sympathectomy in the treatment of upper limb hyperhidrosis. Ann R Coll Surg Engl 1986;68:93-4.  Back to cited text no. 24  [PUBMED]  
25.Lin TS, Kuo SJ, Chou MC. Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: Analysis of 2000 cases. Neurosurgery 2002;51:84-7.  Back to cited text no. 25    
26.Gossot D, Galetta D, Pascal A, Debrosse D, Caliandro R, Stern JB. Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis. Ann Thorac Surg 2003;75:1075-9.  Back to cited text no. 26    
27.Zacherl J, Huber ER, Imhof M, Plas EJ, Herbst F, Fugger R. Long-term results of 630 thoracoscopic sympathectomies for primary hyperhidrosis: The Vienna experience. Eur J Surg Suppl 1998;580:43-6.  Back to cited text no. 27    
28.Sayeed RA, Nyamekye I, Ghauri AS, Poskitt KR. Quality of life after transthoracic endoscopic sympathectomy for upper limb hyperhidrosis. Eur J Surg Suppl 1998;580:39-42.  Back to cited text no. 28  [PUBMED]  
29.Lardinois D, Ris HB. Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach. Eur J Cardio-Thorac Surg 2002;21:67-70.  Back to cited text no. 29    
30.Amir M, Arish A, Weinstein Y, Pfeffer M, Levy Y. Impairment in quality of life among patients seeking surgrey for hyperhidrosis (excessive sweating):preliminary results. Israel J Psychiatry Relat Sci 2000;37:25-31.  Back to cited text no. 30    
31.Streiner DL, Norman GR. Health measurement scale - A practical guide to their development and use. 2 nd ed. Oxford Medical Publications: New York; 1998.  Back to cited text no. 31    
32.Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimally clinically important difference. Controlled Clin Trials 1989;10:4115.  Back to cited text no. 32    
33.Sung SW, Kim YT, Kim JT. Ultra-thin needle thoracoscopic surgery for hyperhidrosis with excellent cosmetic effects. Eur J Cardiothorac Surg 2000;17:951-2.  Back to cited text no. 33    
34.Hederman WP. Present and future trends in thoracospcopic sympathectomy. Eur J Surg 1994;Supplement(572):17-19.  Back to cited text no. 34    
35.Fox AD, Hands L, Collin J. The reults of thoracoscopic sympathectomy for palmar hyperhidrosis and sympathetic ganglionectomy for axillary hyperhidrosis. European Journal of Vascular and Endovascular Surgery 1999;18:543-546.  Back to cited text no. 35    
36.Lai YT, Yang LH, Chio CC, Chen HH. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery 1997;41:110-113.  Back to cited text no. 36    
37.Sciuetti JF, Ballabio D, Corti F, Benenti C, Romano F, Costa Angeli M. Thoracic sympathetic block by clamping in the treatment of primary hyperhidrosis:indications and results in 281 patients. Minerva Chirurgica 2006;61:473-481.  Back to cited text no. 37    
38.Moya J, Ramos R, Morera R, Villalonga R, Perna V, Macia I et al. Thoracic sympathicolysis for primary hyperhidrosis:a review of 918 procedures. Surg Endosc 2006;20:598-602.  Back to cited text no. 38    
39.Panhofer P, Zacherl J, Jakesz R, Bischof G, Neumaver C. Improved quality of life after sympathetic block for upper limb hyperhidrosis. British Journal of Surgery 2006;93:582-586.  Back to cited text no. 39    
40.Licht PB, Pilegaard HK. Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg 2004;78:427-431.  Back to cited text no. 40    
41.Reisfeld R. One-year follow-up after thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg 2007;83:358-359.  Back to cited text no. 41    
42.Leseche G, Castier Y, Thabut G, Petit MD, Combes M, Cerceau O et al. Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis:limited sympathectomy does not reduce postoperative compensatory sweating. J Vasc Surg 2003;37:124-128.  Back to cited text no. 42    


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]

This article has been cited by
1 Predictors of outcome following endoscopic thoracic sympathectomy
David Bell,Justin Jedynak,Roger Bell
ANZ Journal of Surgery. 2013; : n/a
[Pubmed] | [DOI]
2 Minimal access mediastinal surgery: One or two lung ventilation
Toolabi, K., Aminian, A., Javid, M., Mirsharifi, R., Rabani, A.
Journal of Minimal Access Surgery. 2009; 5(4): 103-107
[Pubmed]
3 Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results
Prasad, A.
Journal of Minimal Access Surgery. 2008; 4(1): 23
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

© 2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04