Skip to main content
Erschienen in: Surgical Endoscopy 8/2016

30.10.2015

Nonintubated transareolar single-port thoracic sympathicotomy with a needle scope in a series of 85 male patients

verfasst von: Jian-Feng Chen, Jian-Bo Lin, Yuan-Rong Tu, Min Lin, Xu Li, Fan-Cai Lai, Quan Du, Yuan-Da Dai

Erschienen in: Surgical Endoscopy | Ausgabe 8/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

Traditional endoscopic thoracic sympathicotomy is usually performed through an axillary incision with 5-mm thoracoscope under general anesthesia with endotrachea intubation. Nonintubated transareolar single-port thoracic sympathicotomy with a needle scope has rarely been attempted. The objective of this study is to evaluate the feasibility and safety of this minimally invasive technique in managing primary palmar hyperhidrosis (PPH).

Methods

From May 2012 to May 2014, a total of 85 male patients with severe PPH underwent transareolar single-port thoracic sympathicotomy by use of a 2-mm needle scope under total intravenous anesthesia without endotrachea intubation.

Results

All procedures were successfully performed with a mean operating time of 13.5 min. The palms of all patients became dry and warm as soon as the sympathetic chain was cut off. There were no sore throat, and all the patients regained consciousness rapidly after surgery. Eighty-two patients (96.5 %) were discharged from the hospital on the first postoperative day. The postoperative complications were minor, and no patients developed Horner’s syndrome. At 6 months postoperatively, there is no obvious surgical scar on the chest wall, and none of the patients complained about postoperative pain. Compensatory sweating appeared in 31 patients. No recurrent symptoms were observed in our study. One-year follow-up revealed an excellent cosmetic result and degree of satisfaction.

Conclusions

Nonintubated transareolar single-port needlescopic thoracic sympathicotomy is a safe, effective and minimally invasive therapeutic procedure, which can be performed in routine clinical practice for male PPH patients.
Literatur
1.
Zurück zum Zitat Sato K, Kang WH, Saga K, Sato KT (1989) Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol 20:713–726CrossRefPubMed Sato K, Kang WH, Saga K, Sato KT (1989) Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol 20:713–726CrossRefPubMed
2.
Zurück zum Zitat De Campos JR, Kauffman P, Werebe Ede C, Andrade Filho LO, Kusniek S, Wolosker N, Jatene FB (2003) Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg 76:886–891CrossRefPubMed De Campos JR, Kauffman P, Werebe Ede C, Andrade Filho LO, Kusniek S, Wolosker N, Jatene FB (2003) Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg 76:886–891CrossRefPubMed
4.
Zurück zum Zitat Friedel G, Linder A, Toomes H (1993) Selective video-assisted thoracoscopic sympathectomy. Thorac Cardiovasc Surg 41:245–248CrossRefPubMed Friedel G, Linder A, Toomes H (1993) Selective video-assisted thoracoscopic sympathectomy. Thorac Cardiovasc Surg 41:245–248CrossRefPubMed
5.
Zurück zum Zitat Malone PS, Cameron AE, Rennie JA (1986) Endoscopic thoracic sympathectomy in the treatment of upper limb hyperhidrosis. Ann R Coll Surg Engl 68:93–94PubMedPubMedCentral Malone PS, Cameron AE, Rennie JA (1986) Endoscopic thoracic sympathectomy in the treatment of upper limb hyperhidrosis. Ann R Coll Surg Engl 68:93–94PubMedPubMedCentral
6.
Zurück zum Zitat Heckmann M, Plewig G, Hyperhidrosis Study Group (2005) Low-dose efficacy of botulinum toxin a for axillary hyperhidrosis: a randomized, side-by-side, open-label study. Arch Dermatol 141:1255–1259CrossRefPubMed Heckmann M, Plewig G, Hyperhidrosis Study Group (2005) Low-dose efficacy of botulinum toxin a for axillary hyperhidrosis: a randomized, side-by-side, open-label study. Arch Dermatol 141:1255–1259CrossRefPubMed
7.
Zurück zum Zitat Lai FC, Tu YR, Li YP, Li X, Lin M, Chen JF, Lin JB (2015) Nation wide epidemiological survey of primary palmar hyperhidrosis in the People‘s Republic of China. Clin Auton Res 25:105–108CrossRefPubMed Lai FC, Tu YR, Li YP, Li X, Lin M, Chen JF, Lin JB (2015) Nation wide epidemiological survey of primary palmar hyperhidrosis in the People‘s Republic of China. Clin Auton Res 25:105–108CrossRefPubMed
8.
Zurück zum Zitat Ro KM, Cantor RM, Lange KL, Ahn SS (2002) Palmar hyperhidrosis: evidence of genetic transmission. J Vasc Surg 35:382–386CrossRefPubMed Ro KM, Cantor RM, Lange KL, Ahn SS (2002) Palmar hyperhidrosis: evidence of genetic transmission. J Vasc Surg 35:382–386CrossRefPubMed
9.
Zurück zum Zitat Kaufmann H, Saadia D, Polin C, Hague S, Singleton A, Singleton A (2003) Primary hyperhidrosis—evidence for autosomal dominant inheritance. Clin Auton Res 13:96–98CrossRefPubMed Kaufmann H, Saadia D, Polin C, Hague S, Singleton A, Singleton A (2003) Primary hyperhidrosis—evidence for autosomal dominant inheritance. Clin Auton Res 13:96–98CrossRefPubMed
10.
Zurück zum Zitat Chen J, Lin M, Chen X, Cao Z, Tan Z, Xiong W, Tu Y, Yang J (2015) A novel locus for primary focal hyperhidrosis mapped on chromosome 2q31.1. Br J Dermatol 172:1150–1153CrossRefPubMed Chen J, Lin M, Chen X, Cao Z, Tan Z, Xiong W, Tu Y, Yang J (2015) A novel locus for primary focal hyperhidrosis mapped on chromosome 2q31.1. Br J Dermatol 172:1150–1153CrossRefPubMed
11.
Zurück zum Zitat Krasna MJ (2008) Thoracoscopic sympathectomy: a standardized approach to therapy for hyperhidrosis. Ann Thorac Surg 85:S764–S767CrossRefPubMed Krasna MJ (2008) Thoracoscopic sympathectomy: a standardized approach to therapy for hyperhidrosis. Ann Thorac Surg 85:S764–S767CrossRefPubMed
12.
Zurück zum Zitat Cerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, McKenna RJ, Krasna MJ (2011) The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 91:1642–1648CrossRefPubMed Cerfolio RJ, De Campos JR, Bryant AS, Connery CP, Miller DL, DeCamp MM, McKenna RJ, Krasna MJ (2011) The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg 91:1642–1648CrossRefPubMed
13.
Zurück zum Zitat Tseng YD, Cheng YJ, Hung MH, Chen KC, Chen JS (2012) Nonintubated needlescopic video-assisted thoracic surgery for management of peripheral lung nodules. Ann Thorac Surg 93:1049–1054CrossRefPubMed Tseng YD, Cheng YJ, Hung MH, Chen KC, Chen JS (2012) Nonintubated needlescopic video-assisted thoracic surgery for management of peripheral lung nodules. Ann Thorac Surg 93:1049–1054CrossRefPubMed
14.
Zurück zum Zitat Mineo TC, Sellitri F, Tacconi F, Ambrogi V (2014) Quality of life and outcomes after nonintubated versus intubated video-thoracoscopic pleurodesis for malignant pleural effusion: comparison by a case-matched study. J Palliat Med 17:761–768CrossRefPubMed Mineo TC, Sellitri F, Tacconi F, Ambrogi V (2014) Quality of life and outcomes after nonintubated versus intubated video-thoracoscopic pleurodesis for malignant pleural effusion: comparison by a case-matched study. J Palliat Med 17:761–768CrossRefPubMed
15.
Zurück zum Zitat Li X, Tu YR, Lin M, Lai FC, Chen JF, Dai ZJ (2008) Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg 85:1747–1751CrossRefPubMed Li X, Tu YR, Lin M, Lai FC, Chen JF, Dai ZJ (2008) Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg 85:1747–1751CrossRefPubMed
16.
Zurück zum Zitat Sihoe AD, Cheung CS, Lai HK, Lee TW, Thung KH, Yim AP (2005) Incidence of chest wall paresthesia after needlescopic video-assisted thoracic surgery for palmar hyperhidrosis. Eur J Cardiothorac Surg 27:313–319CrossRefPubMed Sihoe AD, Cheung CS, Lai HK, Lee TW, Thung KH, Yim AP (2005) Incidence of chest wall paresthesia after needlescopic video-assisted thoracic surgery for palmar hyperhidrosis. Eur J Cardiothorac Surg 27:313–319CrossRefPubMed
17.
Zurück zum Zitat Dumont P, Denoyer A, Robin P (2004) Long-term results of thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg 78:1801–1807CrossRefPubMed Dumont P, Denoyer A, Robin P (2004) Long-term results of thoracoscopic sympathectomy for hyperhidrosis. Ann Thorac Surg 78:1801–1807CrossRefPubMed
18.
Zurück zum Zitat Lardinois D, Ris HB (2002) Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach. Eur J Cardiothorac Surg 21:67–70CrossRefPubMed Lardinois D, Ris HB (2002) Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach. Eur J Cardiothorac Surg 21:67–70CrossRefPubMed
19.
Zurück zum Zitat Zhu LH, Wang W, Yang S, Li D, Zhang Z, Chen S, Cheng X, Chen L, Chen W (2013) Transumbilical thoracic sympathectomy with an ultrathin flexible endoscope in a series of 38 patients. Surg Endosc 27:2149–2155CrossRefPubMed Zhu LH, Wang W, Yang S, Li D, Zhang Z, Chen S, Cheng X, Chen L, Chen W (2013) Transumbilical thoracic sympathectomy with an ultrathin flexible endoscope in a series of 38 patients. Surg Endosc 27:2149–2155CrossRefPubMed
20.
Zurück zum Zitat Doolabh N, Horswell S, Williams M, Huber L, Prince S, Meyer DM, Mack MJ (2004) Thoracoscopic sympathectomy for hyperhidrosis: indications and results. Ann Thorac Surg 77:410–414CrossRefPubMed Doolabh N, Horswell S, Williams M, Huber L, Prince S, Meyer DM, Mack MJ (2004) Thoracoscopic sympathectomy for hyperhidrosis: indications and results. Ann Thorac Surg 77:410–414CrossRefPubMed
21.
Zurück zum Zitat Jeganathan R, Jordan S, Jones M, Grant S, Diamond O, McManus K, Graham A, McGuigan J (2008) Bilateral thoracoscopic sympathectomy: results and long-term follow-up. Interact Cardiovasc Thorac Surg 7:67–70CrossRefPubMed Jeganathan R, Jordan S, Jones M, Grant S, Diamond O, McManus K, Graham A, McGuigan J (2008) Bilateral thoracoscopic sympathectomy: results and long-term follow-up. Interact Cardiovasc Thorac Surg 7:67–70CrossRefPubMed
22.
Zurück zum Zitat Liu Y, Yang J, Liu J, Yang F, Jiang G, Li J, Huang Y, Wang J (2009) Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg 35:398–402CrossRefPubMed Liu Y, Yang J, Liu J, Yang F, Jiang G, Li J, Huang Y, Wang J (2009) Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg 35:398–402CrossRefPubMed
23.
Zurück zum Zitat Fredman B, Olsfanger D, Jedeikin R (1997) Thorascopic sympathectomy in the treatment of palmar hyperhidrosis: anaesthetic implications. Br J Anaesth 79:113–119CrossRefPubMed Fredman B, Olsfanger D, Jedeikin R (1997) Thorascopic sympathectomy in the treatment of palmar hyperhidrosis: anaesthetic implications. Br J Anaesth 79:113–119CrossRefPubMed
24.
Zurück zum Zitat Conacher ID (2002) Anaesthesia for thoracoscopic surgery. Best Pract Res Clin Anaesthesiol 16:53–62CrossRefPubMed Conacher ID (2002) Anaesthesia for thoracoscopic surgery. Best Pract Res Clin Anaesthesiol 16:53–62CrossRefPubMed
25.
Zurück zum Zitat Kwong KF, Cooper LB, Bennett LA, Burrows W, Gamliel Z, Krasna MJ (2005) Clinical experience in 397 consecutive thoracoscopic sympathectomies. Ann Thorac Surg 80:1063–1066CrossRefPubMed Kwong KF, Cooper LB, Bennett LA, Burrows W, Gamliel Z, Krasna MJ (2005) Clinical experience in 397 consecutive thoracoscopic sympathectomies. Ann Thorac Surg 80:1063–1066CrossRefPubMed
26.
Zurück zum Zitat Singh B, Moodley J, Allopi L, Cassimjee HM (2006) Horner syndrome after sympathectomy in the thoracoscopic era. Surg Laparosc Endosc Percutan Tech 16:222–225CrossRefPubMed Singh B, Moodley J, Allopi L, Cassimjee HM (2006) Horner syndrome after sympathectomy in the thoracoscopic era. Surg Laparosc Endosc Percutan Tech 16:222–225CrossRefPubMed
27.
Zurück zum Zitat Rodríguez PM, Freixinet JL, Hussein M, Valencia JM, Gil RM, Herrero J, Caballero-Hidalgo A (2008) Side effects, complications and outcome of thoracoscopic sympathectomy for palmar and axillary hyperhidrosis in 406 patients. Eur J Cardiothorac Surg 34:514–519CrossRefPubMed Rodríguez PM, Freixinet JL, Hussein M, Valencia JM, Gil RM, Herrero J, Caballero-Hidalgo A (2008) Side effects, complications and outcome of thoracoscopic sympathectomy for palmar and axillary hyperhidrosis in 406 patients. Eur J Cardiothorac Surg 34:514–519CrossRefPubMed
28.
Zurück zum Zitat Kim DH, Paik HC, Lee DY (2005) Video assisted thoracoscopic re-sympathetic surgery in the treatment of re-sweating hyperhidrosis. Eur J Cardiothorac Surg 27:741–744CrossRefPubMed Kim DH, Paik HC, Lee DY (2005) Video assisted thoracoscopic re-sympathetic surgery in the treatment of re-sweating hyperhidrosis. Eur J Cardiothorac Surg 27:741–744CrossRefPubMed
29.
Zurück zum Zitat Schmidt J, Bechara FG, Altmeyer P, Zirngibl H (2006) Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating. Ann Thorac Surg 81:1048–1055CrossRefPubMed Schmidt J, Bechara FG, Altmeyer P, Zirngibl H (2006) Endoscopic thoracic sympathectomy for severe hyperhidrosis: impact of restrictive denervation on compensatory sweating. Ann Thorac Surg 81:1048–1055CrossRefPubMed
30.
Zurück zum Zitat Miller DL, Force SD (2007) Outpatient microthoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg 83:1850–1853CrossRefPubMed Miller DL, Force SD (2007) Outpatient microthoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg 83:1850–1853CrossRefPubMed
31.
Zurück zum Zitat Katara AN, Domino JP, Cheah WK, So JB, Ning C, Lomanto D (2007) Comparing T2 and T2–T3 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis: a randomized control trial. Surg Endosc 21:1768–1771CrossRefPubMed Katara AN, Domino JP, Cheah WK, So JB, Ning C, Lomanto D (2007) Comparing T2 and T2–T3 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis: a randomized control trial. Surg Endosc 21:1768–1771CrossRefPubMed
32.
Zurück zum Zitat Licht PB, Pilegaard HK (2004) Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg 78:427–431CrossRefPubMed Licht PB, Pilegaard HK (2004) Severity of compensatory sweating after thoracoscopic sympathectomy. Ann Thorac Surg 78:427–431CrossRefPubMed
33.
Zurück zum Zitat Yano M, Kiriyama M, Fukai I, Sasaki H, Kobayashi Y, Mizuno K, Haneda H, Suzuki E, Endo K, Fujii Y (2005) Endoscopic thoracic sympathectomy for palmar hyperhidrosis: efficacy of T2 and T3 ganglion resection. Surgery 138:40–45CrossRefPubMed Yano M, Kiriyama M, Fukai I, Sasaki H, Kobayashi Y, Mizuno K, Haneda H, Suzuki E, Endo K, Fujii Y (2005) Endoscopic thoracic sympathectomy for palmar hyperhidrosis: efficacy of T2 and T3 ganglion resection. Surgery 138:40–45CrossRefPubMed
34.
Zurück zum Zitat Liu YH, Liu HP, Wu YC, Ko PJ (2010) Feasibility of transtracheal thoracoscopy (natural orifice transluminal endoscopic surgery). J Thorac Cardiovasc Surg 139:1349–1350CrossRefPubMed Liu YH, Liu HP, Wu YC, Ko PJ (2010) Feasibility of transtracheal thoracoscopy (natural orifice transluminal endoscopic surgery). J Thorac Cardiovasc Surg 139:1349–1350CrossRefPubMed
35.
Zurück zum Zitat Rolanda C, Silva D, Branco C, Moreira I, Macedo G, Correia-Pinto J (2011) Peroral esophageal segmentectomy and anastomosis with single transthoracic trocar: a step forward in thoracic NOTES. Endoscopy 43:14–20CrossRefPubMed Rolanda C, Silva D, Branco C, Moreira I, Macedo G, Correia-Pinto J (2011) Peroral esophageal segmentectomy and anastomosis with single transthoracic trocar: a step forward in thoracic NOTES. Endoscopy 43:14–20CrossRefPubMed
36.
Zurück zum Zitat Ko PJ, Chu Y, Wu YC, Liu CY, Hsieh MJ, Chen TP, Chao YK, Wu CY, Yuan HC, Liu YH, Liu HP (2012) Feasibility of endoscopic transoral thoracic surgical lung biopsy and pericardial window creation. J Surg Res 175:207–214CrossRefPubMed Ko PJ, Chu Y, Wu YC, Liu CY, Hsieh MJ, Chen TP, Chao YK, Wu CY, Yuan HC, Liu YH, Liu HP (2012) Feasibility of endoscopic transoral thoracic surgical lung biopsy and pericardial window creation. J Surg Res 175:207–214CrossRefPubMed
Metadaten
Titel
Nonintubated transareolar single-port thoracic sympathicotomy with a needle scope in a series of 85 male patients
verfasst von
Jian-Feng Chen
Jian-Bo Lin
Yuan-Rong Tu
Min Lin
Xu Li
Fan-Cai Lai
Quan Du
Yuan-Da Dai
Publikationsdatum
30.10.2015
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 8/2016
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4628-5

Weitere Artikel der Ausgabe 8/2016

Surgical Endoscopy 8/2016 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.