LETTERS TO THE EDITOR"Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients"
Resource
SURGICAL LAPAROSCOPY & ENDOSCOPY v.10 n.5 pp.338
Journal
SURGICAL LAPAROSCOPY & ENDOSCOPY
Journal Volume
v.10
Journal Issue
n.5
Pages
33-8
Date Issued
2000
Date
2000
Author(s)
KAO, MING-CHIEN
Abstract
Dear Editor: I read with interest the article by Reisfeld et al. (1) in the February issue and congratulate them on their excellent results. This paper confirms that endoscopic thoracic sympathectomy (ETS), developed by our service in 1990, is a simple, safe, and effective method for treating palmar hyperhidrosis (2,3). We would like to comment on several important points. Although endoscopic sympathectomy was described early by Hughes and later by Kux, as mentioned in the paper, their procedure was a keyhole vision technique in which the operative field was small and poorly illuminated because at that time they did not have a charge- coupled device to display on a TV monitor. Therefore, their primitive keyhole endoscopic technique was not popular until 1990, when we developed the video-endoscopic technique for ETS. The procedure then became so easy and minimally invasive that it was soon well accepted as a standard therapy for palmar hyperhidrosis (1–6). Further, we first advocated the importance of intraoperative monitoring of palmar skin temperature and proved that monitoring is a simple, cost-effective, and essential technique to confirm an adequate sympathectomy leading to a definite therapeutic result for palmar hyperhidrosis. Meanwhile, we first claimed that ablation of the T2 segment (containing a major part of the T2 ganglion and the adjacent fibers overlying the second rib neck) was an adequate and standard extent of sympathectomy for palmar hyperhidrosis (2, 3,5). As for the surgical treatment of craniofacial hyperhidrosis, to the best of our knowledge, we were the first to report the concept of using endoscopic transthoracic ablation of the sympathetic T2 segment to treat this entity with satisfactory results in 1991. Based on our experience, the incidence of craniofacial hyperhidrosis is much lower than that of palmar hyperhidrosis—approximately 2.5% of palmar hyperhidrosis, in contrast to the extraordinarily high incidence in Reisfeld et al.'s series (11%). In particular, most patients with craniofacial hyperhidrosis have a sweaty but relatively cold face instead of a blushing face, as described by Reisfeld et al. (1–3). Regarding the surgical technique, we believe it is unnecessary to insufflate the pleural space with a surgical CO2 insufflator (1). With our routine technique, we first temporarily disconnect the ventilator from the patient just before the insertion of the trocar. Because of the difference in atmospheric pressure between the extrathoracic and intrathoracic spaces, the lung partially collapses spontaneously once the trocar is inserted into the pleural space, especially when the patient is in a back-elevated position. This practical procedure has been adopted in all hospitals in Taiwan, and this experience has confirmed that almost no insufflation of CO2 is needed for ETS (2,4,5,6). These points are based on our extensive experience. We believe this information will be useful for those performing ETS for palmar hyperhidrosis. Ming-Chien Kao MD, DMSc
Type
journal article