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'Needlescopic' video-assisted thoracic surgery for palmar hyperhidrosis.
1Division of Cardio-thoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., People's Republic of, Hong Kong, China. yimap@cuhk.edu.hk
Summary
Ultra-fine thoracoscopic instruments enable feasible thoracodorsal sympathectomy for hyperhidrosis with excellent outcomes. This minimally invasive approach offers rapid recovery and no symptom recurrence, though equipment limitations exist.
Area of Science:
- Thoracic Surgery
- Minimally Invasive Procedures
- Surgical Instrumentation
Background:
- Video-assisted thoracic surgery (VATS) is a standard approach for thoracodorsal sympathectomy.
- Ultra-fine thoracoscopic equipment offers potential for enhanced minimally invasive surgery.
Purpose of the Study:
- To evaluate the feasibility and outcomes of thoracodorsal sympathectomy using 2-mm instruments.
- To assess the safety and efficacy of this ultra-fine equipment in treating palmar hyperhidrosis.
Main Methods:
- Thirty-eight patients with palmar hyperhidrosis underwent bilateral VATS thoracodorsal sympathectomy using exclusively 2-mm instruments.
- Procedures involved either excision or cauterization of the sympathetic chain (T2-T3/T4).
- Patients received general anesthesia with one-lung ventilation; no chest drains or wound stitching were required.
Main Results:
- No mortality or major complications were observed; three patients had minor pneumothorax that resolved spontaneously.
- High discharge rates: 27 patients same-day, 11 on postoperative day one.
- Excellent long-term results with no recurrence after an average 16-month follow-up; mild compensatory hyperhidrosis in two patients.
Conclusions:
- Thoracodorsal sympathectomy with 2-mm instruments is technically feasible and yields excellent clinical outcomes for hyperhidrosis.
- The ultra-fine equipment facilitates minimally invasive surgery with rapid patient recovery.
- Limitations include a narrow field of vision and reduced control, currently restricting use to simpler procedures.