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).
(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