Skip to main content
Log in

Embryonic NOTES thoracic sympathectomy for palmar hyperhidrosis: results of a novel technique and comparison with the conventional VATS procedure

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

To avoid the disadvantages of chronic pain and chest wall paresthesia associated with video-assisted thoracic surgery (VATS) procedures, we developed a novel surgical technique for performing sympathectomy by embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) with a flexible endoscope. In this study, we compared the outcomes of E-NOTES with conventional VATS thoracic sympathectomy on palmar hyperhidrosis.

Methods

From January 2010 to April 2011, a total of 66 patients with severe palmar hyperhidrosis were treated with thoracic sympathectomy in our department. Thirty-four transumbilical thoracic sympathectomies were performed via a 5-mm umbilicus incision with ultrathin gastroscope, then compared with 32 conventional needlescopic thoracic sympathectomies. Retrospective statistical analysis of a prospectively collected group of patients was performed.

Results

There was no significant difference with regard to gender, mean age, body mass index, and length of hospital stay between the two groups. The operative time for E-NOTES thoracic sympathectomy was longer than that of VATS thoracic sympathectomy (56.4 ± 10.8 vs. 40.3 ± 6.5 min, p < 0.01). No mortality, diaphragmatic hernia, or Horner syndrome was observed in either group. Postoperative questionnaires were returned by all treated patients with a mean time from operation to follow-up of 1.4 ± 0.3 years. All 66 patients receiving sympathectomy reported successful treatment of their palmar hyperhidrosis. Compensatory hyperhidrosis was noticed in 7 (20.1 %) and 6 (18.8 %) patients in the E-NOTES and VATS groups, respectively (p > 0.05). Postoperative pain and paresthesia were significantly reduced in the E-NOTES group at each time interval, and the aesthetic effect of the incision was superior in the E-NOTES group.

Conclusions

Transumbilical-diaphragmatic thoracic sympathectomy is a safe and efficacious alternative to the conventional approach. This novel procedure can further reduce postoperative pain and chest wall paresthesia as well as afford maximum cosmetic benefits by hiding the surgical incision in the umbilicus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Wong RH, Ng CS, Wong JK, Tsang S (2012) Needlescopic video-assisted thoracic surgery for reversal of thoracic sympathectomy. Interact Cardiovasc Thorac Surg 14:350–352

    Article  PubMed  Google Scholar 

  2. Sihoe AD, Manlulu AV, Lee TW, Thung KH, Yim AP (2007) Pre-emptive local anesthesia for needlescopic video-assisted thoracic surgery: a randomized controlled trial. Eur J Cardiothorac Surg 31:103–108

    Article  PubMed  Google Scholar 

  3. 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 27:313–319

    Article  PubMed  Google Scholar 

  4. Dewey TM, Herbert MA, Hill SL, Prince SL, Mack MJ (2006) One-year follow-up after thoracoscopic sympathectomy for hyperhidrosis: outcomes and consequences. Ann Thorac Surg 81:1227–1232

    Article  PubMed  Google Scholar 

  5. 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 27:2149–2155

    Article  PubMed  Google Scholar 

  6. Yang C, Chu Y, Wu YC, Hsieh MJ, Lu MS, Liu CY, Yuan HC, Liu YH, Ko PJ, Liu HP (2012) The lateral decubitus position improves transoral endoscopic access to the posterior aspects of the thorax. Surg Endosc 26:2988–2992

    Article  PubMed  Google Scholar 

  7. 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 34:514–519

    Article  PubMed  Google Scholar 

  8. Liu CY, Chu Y, Wu YC, Yuan HC, Ko PJ, Liu YH, Liu HP (2013) Transoral endoscopic surgery versus conventional thoracoscopic surgery for thoracic intervention: safety and efficacy in a canine survival model. Surg Endosc 27:2428–2435

    Article  PubMed  Google Scholar 

  9. Turner BG, Gee DW, Cizginer S, Konuk Y, Karaca C, Willingham F, Mino-Kenudson M, Morse C, Rattner DW, Brugge WR (2010) Feasibility of endoscopic transesophageal thoracic sympathectomy (with video). Gastrointest Endosc 71:171–175

    Article  PubMed  Google Scholar 

  10. Horgan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P (2009) Natural orifice surgery: initial clinical experience. Surg Endosc 23:1512–1518

    Article  PubMed  Google Scholar 

  11. Raznatović ZJ, Zarić ND, Djurasić LM, Lekić NS, Djordjević VR, Radojković ZZ, Veselinović MD, Duka SV, Kerkez MD (2012) Single-incision laparoscopic cholecystectomy—initial experience with different multichannel ports. Acta Chir Iugosl 59:67–70

    Article  PubMed  Google Scholar 

  12. Goh PM, Cheah WK, De Costa M, Sim EK (2000) Needlescopic thoracic sympathectomy: treatment for palmar hyperhidrosis. Ann Thorac Surg 70:240–242

    Article  PubMed  CAS  Google Scholar 

  13. 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 35:398–402

    Article  PubMed  Google Scholar 

  14. Lyra Rde M, Campos JR, Kang DW, Loureiro Mde P, Furian MB, Costa MG, Coelho Mde S (2008) Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis. J Bras Pneumol 34:967–977

    PubMed  Google Scholar 

  15. Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y (2009) Thoracoscopic sympathetic clipping for hyperhidrosis: longterm results and reversibility. J Thorac Cardiovasc Surg 137:1376–1377

    Article  Google Scholar 

  16. Baumgartner FJ (2008) Surgical approaches and techniques in the management of severe hyperhidrosis. Thorac Surg Clin 18:167–181

    Article  PubMed  Google Scholar 

  17. Miller DL, Bryant AS, Force SD, Miller JI Jr (2009) Effect of sympathectomy level on the incidence of compensatory hyperhidrosis after sympathectomy for palmar hyperhidrosis. J Thorac Cardiovasc Surg 138:581–585

    Article  PubMed  Google Scholar 

  18. Weksler B, Blaine G, Souza ZB, Gavina R (2009) Transection of more than one sympathetic chain ganglion for hyperhidrosis increases the severity of compensatory hyperhidrosis and decreases patient satisfaction. J Surg Res 156:110–115

    Article  PubMed  Google Scholar 

  19. Atkinson JL, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ (2011) Endoscopic transthoracic limited sympathotomy for palmar–plantar hyperhidrosis: outcomes and complications during a 10-year period. Mayo Clin Proc 86:721–729

    Article  PubMed  Google Scholar 

  20. de Campos JR, Wolosker N, Yazbek G, Munia MA, Kauffman P, Puech-Leao P, Jatene FB (2010) Comparison of pain severity following video-assisted thoracoscopic sympathectomy: electric versus harmonic scalpels. Interact Cardiovasc Thorac Surg 10:919–922

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Key Project of Science and Technology of Fujian Province (Grant 2010I0011). We thank Lily Chen for her revision.

Disclosures

Li-Huan Zhu, Long Chen, Shengsheng Yang, Daoming Liu, Jixue Zhang, Xianjin Cheng, and Weisheng Chen have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Weisheng Chen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhu, LH., Chen, L., Yang, S. et al. Embryonic NOTES thoracic sympathectomy for palmar hyperhidrosis: results of a novel technique and comparison with the conventional VATS procedure. Surg Endosc 27, 4124–4129 (2013). https://doi.org/10.1007/s00464-013-3079-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-3079-0

Keywords

Navigation