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Ann Thorac Surg 2001;72:1801
© 2001 The Society of Thoracic Surgeons

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Correspondence

Video thoracoscopic sympathectomy with intraoperative monitoring of Palmar skin temperature for Palmar hyperhidrosis

^a Division of Neurosurgery, National Taiwan University Hospital, No. 7, Chung-Shan S. Rd,, Taipei, Taiwan 100, ROC

e-mail: neurokao{at}ha.mc.ntu.edu.tw

To the Editor

We read with interest the article by Goh and associates [1]. We congratulate them on their excellent results. However, they did not mention our first application of "video" endoscopic technique to treat palmar hyperhidrosis (PH) in 1990. This novel technique has dramatically revolutionalized the primitive keyhole vision technique reported by Kux in 1978 [2]. Subsequently, the technique has became widely accepted as the standard treatment for PH [3].

Furthermore, we appreciate that they monitored palmar skin temperature (PST) during sympathectomy, which we first advocated in 1990 to aid the confirmation of adequate sympathectomy for PH. Unfortunately, our report was also not mentioned in the article [4]. We have published several papers describing how to correctly explain the monitoring data to confirm correct sympathectomy. A rise of palmar skin temperature of approximately 2°C indicates accomplishment of adequate sympathectomy leading a definite and long-lasting relief of PH [5, 6].

Based on our extensive experience, we preferred single-lumen endotracheal general anesthesia rather than a double-lumen tube for alternating ventilation. Routinely, we used a 10-mm operating thoracoscope with one-port axillary approach. We put the patient in semi-Fowler’s (15-degree) position and ask the anesthesiologist to temporarily disconnect the ventilation before insertion of the trocar (the tip of trocar is polished blunt). Using these precautions, the risk of injury to the lung is minimal and the upper lung will collapse spontaneously once the trocar is inserted, without the need of CO₂ insufflation [6].

Thus, we believe that a 10-mm operating thoracoscope with one-port approach is eariser and simpler than a needlescope with two-port approach. Our average time of bilateral sympathectomy is less than 30 minutes. After undergoing our technique, patients experienced no wound pain and had good cosmetic results.

References

1. Goh P.M.Y., Cheah W.K., Costa M.D., Siro E.K.W. Needlescopic thoracic sympathectomy: treatment for palmar hyperhidrosis. Ann Thorac Surg 2000;70:240-242.[Abstract/Free Full Text]
2. Kux M. Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis. Arch Surg 1978;113:264-266.[Abstract/Free Full Text]
3. Kao M.C. Vedio endoscopic sympathectomy using a fiberoptic CO2 laser to treat palmar hyperhidrosis. Neurosurgery 1992;30:131-135.[Medline]
4. Kao M.C., Tsai J.C., Lai D.M., Hsiao Y.Y., Chiu M.J. Autonomic activities in hyperhidrosis patients before, during, and after endoscopic laser sympathectomy. Neurosurgery 1994;34:262-268.[Medline]
5. Kao M.C. Endoscopic sympathectomy. J Neurosurg: Spine 2000;93:342-343.
6. Kao M.C. Endoscopic thoracic sympathectomy for treatment of essential hyperhidrosis syndrome: experience with 650 patients by Reisfeld R. et al. Surg Laparosc Endosc 2000;10:338-339.

This article has been cited by other articles:

				X. Li, Y.-R. Tu, M. Lin, F.-C. Lai, J.-F. Chen, and H.-W. Miao Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow. Ann. Thorac. Surg., February 1, 2009; 87(2): 427 - 431. [Abstract] [Full Text] [PDF]

				C. T. Klodell, E. B. Lobato, J. L. Willert, and N. Gravenstein Oximetry-Derived Perfusion Index for Intraoperative Identification of Successful Thoracic Sympathectomy Ann. Thorac. Surg., August 1, 2005; 80(2): 467 - 470. [Abstract] [Full Text] [PDF]

				S. Elia, G. Guggino, D. Mineo, G. Vanni, A. Gatti, and T. C. Mineo Awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis: a safe outpatient procedure Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 312 - 317. [Abstract] [Full Text] [PDF]

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