Embryonic-notes Thoracic Sympathectomy for Palmar Hyperhidrosis: Results of a Novel Technique and Comparison with the Conventional Vats Procedure

Weisheng Chen, MD, Lihuan Zhu, MD, Shengsheng Yang, MD, Dazhou Li, MD, Wen Wang, MD, Long Chen, MD, PhD

Department of Cardiothoracic Surgery, Fuzhou General Hospital

Introduction: Thoracic sympathectomy is considered as the most effective method to treat palmar hyperhidrosis. Although video-assisted thoracic surgery (VATS) confers better cosmesis, some patients are still concerned with the chest wall paresthesia and post-operative pain associated with the chest incision. In order to avoid these disadvantages, we developed a novel surgical technique for performance of sympathectomy by embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) with flexible endoscope. In this study, we compare the outcomes of E-NOTES with needlescopic VATS thoracic sympathectomy for palmar hyperhidrosis.

Methods and procedures: From January 2010 to April 2011, a total of 66 patients with severe palmar hyperhidrosis were treated with thoracic sympathectomy in our department. 34 transumbilical -diaphragmatic thoracic sympathectomy were performed via a 5mm umbilicus incision with ultrathin gastroscope, 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 (BMI), and length of hospital stay between these two groups. The operative time for E-NOTES thoracic sympathectomy was longer than that of VATS thoracic sympathectomy (56 vs 40 min p<0.01). There was no mortality, diaphragmatic hernia, and Horner’s syndrome in both groups. Postoperative questionnaires were returned by all of the treated patients, the mean time from operation to follow-up was 1.4 ± 0.3 years. All 66 patients receiving sympathectomy reported successful treatment of their palmar hyperhidrosis following surgery as de?ned by completely dry hands. Compensatory hyperhidrosis was noticed in 7 (20.1%) patients and 6 (18.8%) in the E-NOTES and VATS groups respectively (p>0.05). Post-operative pain and paresthesia was significant less for the E-NOTES group at each interval, and the aesthetic effect of the incision is superior to VATS groups (Table 1).

E-NOTES VATS P value
Pain score
(visual analogue scale)

4h after operation, (mean±SD) 1.4±0.5 3.3±0.7 <0.001
8h after operation, (mean±SD) 3.1±0.7 4.4±0.6 <0.001
12h after operation, (mean±SD) 2.1±0.8 4.1±0.6 <0.001

Paresthesia distinct from wound pain

1 day post-op, No. (%) 4 (11.8%) 12 (37.5%) 0.015
1 week post-op, No. (%) 0 (0.0%) 6 (18.8%) <0.001
1 month post-op, No. (%) 0 (0.0%) 2 (6.3%) <0.001
Satisfaction of aesthetic result, No. of patients (%) 32 (94.1%) 23 (71.9%) 0.036

Conclusions: Transumbilical-diaphragmatic thoracic sympathectomy is a safe and efficacious alternative to the conventional approach. It can further reduce post-operative pain and chest wall paresthesia. In addition, this novel procedure affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus.


Session: Podium Presentation

Program Number: S077

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