gms | German Medical Science

Objective: The classic indication for endoscopic transthoracic sympathectomy (ETS) is primary focal axillar and/ or palmar hyperhidrosis (HH) in which patients suffer considerably in their working and social environment. Weaim to show the benefit of this minimally invasive methodin terms of patient's satisfaction and possible undue effects.

Methods: ETS is a video-assisted endoscopic keyhole procedure under general anesthesia using a biluminal intubation tube for separate ventilation of the lungs. The endoscope is inserted via a single skin-incision in the arm pit and once the lung is deflated, the local anatomy can be overviewed excellently. Through the working channel, a cautery probe is inserted to place two to three thermo-lesions on the sympathetic trunk between ganglia 2, 3, and 4. We also coagulate aberrant, mostly invisible connections up to 3 cm laterally as prevention against recurrences. These alternative neuronal pathways are commonly also called nerve of Kuntz. After the procedure of about 10 to 15 minutes, the lung is inflated again, the endoscope is withdrawn and the wound is closed in the usual surgical fashion. As a rule, a chest tube for residual pneumothorax is not mandatory.

Results: We reviewed a total of 44 patients over a period of 60 months. The mean success rate by increased quality of life was 92% ( 96% for palmar HH and 85% for axillary HH). The recurrence rate was 14%, whereas only two patients required a reoperation. There was no serious complication.

Fifty-five percent of the patients reported signs of compensatory HH, however 18% denoted it onerous and only one patient (2%) would not have the same procedure again. Compensatory hyperhidrosis was habitually noted temporarily or was accepted in a lesser stage by most of the patients.

Conclusion: ETS is an effective and safe method to treat patients with focal HH. However, these results motivate us to refine the technique in order to reduce recurrences and to minimize compensatory hiperhydrosis.