Simultaneous bilateral transthoracic sympathectomy through posterior access in Lin-Telaranta modification for primary hyperhidrosis

Introduction: Primary hyperhidrosis (PHH) is a genetic disease resulting in excessive sweating of hands, armpits, feet and sometimes face under emotional and/or thermal stimulation. The disease most frequently starts in early childhood and poses a significant problem to the patients, mostly by causing social embarrassment with serious psychological consequences.
Aim: Thoracoscopic sympathectomy is one of the approved methods of treatment of PHH. The aim of this study is to make the first evaluation in Poland of results of simultaneous bilateral sympathectomy from a posterior approach with clipping as a method of sympathectomy.
Material and methods: There were 73 bilateral thoracoscopic sympathectomies of Th3, Th4 and Th5 ganglia performed between May 2006 and May 2008 in both participating centres. Data were collected prior to surgery, immediately after it and during a 3-month follow-up visit. The examination consisted of a questionnaire for subjective evaluation of symptoms and gravimetry for the measurement of sweat production over time. Fifty-seven patients (75%) were available for a follow-up visit.
Results: All procedures were completed with videoscopy. There was no mortality and no serious morbidity. Mean perspiration from the palmar region assessed gravimetrically reached 443.67 mg/min and dropped to 45.67 mg/min 3 months after the operation (p < 0.05). Mean intensity of disease-associated distress (measured on a visual scale from 1 to 10) was 9.46 prior to surgery and 1.03 during follow-up (p < 0.05).
Conclusions: Transthoracic, posterior access sympathectomy is a safe and effective procedure. The discussed technique allows for simultaneous bilateral surgery without the need for troublesome patient repositioning, while CO2 insufflation and careful, active pleural deflation need no post-operative pleural drainage, with very limited risk of pneumothorax.