ABSTRACT
OBJECTIVE: A retrospective study presenting our experience with upper thoracic endoscopic sympathectomy in patients with primary palmar hyperhidrosis. METHODS: One hundred patients (46 women and 54 men) underwent bilateral uniportal endoscopic thoracic sympathectomy since January 1, 1995. Age distribution ranged from 12 to 54 years (mean, 23.4 yr). RESULTS: Sympathectomy on both sides was accomplished within 30 minutes in a single stage. Ninety-six patients (96%) had an uneventful postoperative course and were discharged the following day. Four patients with residual hemothorax required intercostal drainage and were discharged on the third postoperative day. Ninety-six patients were completely satisfied with immediate and permanent relief of palmar perspiration. Compensatory hyperhidrosis was the major complication, which was usually mild and tolerable after reassurance. In only eight patients (8%) was the compensatory hyperhidrosis considered bothersome, requiring treatment with aluminum chloride in ethanol solution at 25%. There was no mortality. Recurrence of palmar hyperhidrosis has been noticed in five patients (5%) during the follow-up period (range, 2-56 mo; mean, 12 mo). At the time of reoperation, a remaining branch of the sympathetic chain could be observed and coagulated. CONCLUSION: We consider thoracoscopic sympathectomy to be a simple, safe, and effective method for treating palmar hyperhidrosis. It is an effective method for treating patients with palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches.
Subject(s)
Endoscopy/methods , Sympathectomy/methods , Thoracic Surgical Procedures/methods , Thorax/innervation , Adaptation, Physiological/drug effects , Adolescent , Adult , Aluminum Chloride , Aluminum Compounds/therapeutic use , Child , Chlorides/therapeutic use , Endoscopes , Equipment Design , Female , Hand , Humans , Hyperhidrosis/physiopathology , Hyperhidrosis/surgery , Male , Middle Aged , Postoperative Complications , Recurrence , Reoperation , Retrospective Studies , Surgical Instruments , Sympathectomy/instrumentation , Thoracic Surgical Procedures/instrumentationABSTRACT
OBJECTIVE: To find out how much the temperature in the palm rises after upper thoracic sympathectomy for palmar hyperhidrosis, and correlate the temperature with the outcome. DESIGN: Retrospective study. SETTING: University hospital, Spain. SUBJECTS: 73 patients (34 women and 39 men, age range 16-42 years, mean 26) who were operated for palmar hyperhidrosis between 1 January 1995 and 31 December 1997. INTERVENTIONS: Bilateral thoracic endoscopic sympathectomy during which the temperature was monitored on the skin of both axillae and thenar eminences, and in the oesophagus. MAIN OUTCOME MEASURES: Morbidity, alleviation of hyperhidrosis, recurrence rate, and differences in temperature postoperatively. RESULTS: There was minor bleeding during operation in 25 cases (34%), but in only 4 was it sufficient to require insertion of a drain; 2 patients developed transient Homer's syndrome; but the most common complication was compensatory hyperhidrosis (n = 52, 71%). In only 5 was this other than mild and required treatment with aluminium chloride in ethanol 25%. Palmar hyperhidrosis was alleviated in all cases, axillary sweating was considerably improved, and there was improvement in the feet in 56 (77%). There were 5 recurrences, all on the right side, during a mean follow up of 9 months (range 2-36), but in no case was the sweating severe. In almost all cases the temperature of the palm was less than that of the axilla before operation by a mean (SD) of 0.9 (0.3) degrees C. The rise in temperature varied from 1.7 (0.4) degrees C to 2.6 (0.4) degrees C. In the 5 patients who developed recurrences the increase was less (0.5 (0.4) degrees C). CONCLUSION: Thoracic endoscopic sympathectomy is safe, simple, and effective in treating palmar hyperhidrosis that has not responded to conservative treatment. Intradermal monitoring is an accurate and cost-effective way of monitoring temperature during operation. Although it is essential to achieve a rise in temperature of 1 degrees C, our most important finding was that the final temperature in both hands and axillae should be above 35 degrees C and as near as possible to 36 degrees C.
Subject(s)
Endoscopy , Hyperhidrosis/surgery , Monitoring, Intraoperative , Skin Temperature , Sympathectomy/methods , Adolescent , Adult , Axilla/physiology , Female , Ganglia, Sympathetic/surgery , Hand/physiology , Humans , Hyperhidrosis/physiopathology , Male , Retrospective Studies , Thoracic Nerves/surgery , Thoracoscopy , Treatment OutcomeABSTRACT
Dural tears located at the base of the skull are difficult to repair due to the difficulties in the appropriate access and the fragility of the dura in such areas. In our experience the biggest problem when attempting to perform a dural repair in a deep narrow field is not to place the stitches, but rather to set the knots. A newly designed, easy-to-learn technique has been developed for dural closure in these situations. We present here a new technique for dural suturing of special interest when the space available is limited. In our hands it is possible to obtain a watertight dural closure in most microsurgical operations performed through a small hole and/or into a narrow, deep surgical field. These techniques can also be applied during a secondary procedure following development of a postoperative CSF leak. While simple and easy to learn, these techniques require practice in the laboratory setting before clinical application.
