Thoracic Sympathectomy By The Pleura Videoscope With A Single Skin Incision Through The Anterior Mediastinum For Palmar Hyperhidrosis

Objective:To develop a novel protocol for single-incision bilateral thoracic sympathectomy through the anterior mediastinum for the treatment of palmar hyperhidrosis, and compare with the typical2-port video-assisted thoracoscope approach or1-port mediastinoscopy approach.Method:Using the retrospective case-control method, between January2012and August2012,11patients received bilateral thoracic sympathectomy for palmar hyperhidrosis.6patients was performed bilateral thoracic sympathectomy by the LTF-240pleura videoscope and the other5patients were performed by VATS or mediastinoscopy. Compare the size of skin incision, clinical effect, complications etc between the two groups.Result:All the patients undergoing bilateral thoracic sympathectomy were performed successfully, without leading to hemorrhage, arrhythmia, cardiac arrest, Homer’s syndrome and other severe complications. No conversion to open technique was necessary.6patients were performed by the LTF-240pleura videoscope, one of six patients was performed by bilateral single-port method because of the flat chest and the blockage of the superior vena cava. The other five patients were performed with one single skin incision method (1/5by the left lateral method,4/5by the right lateral method). After the surgery, all the cases showed warm and dry palms without hyperhidrosis after the surgery. The meantime for bilateral operation was75.0±34.8min. The mean postoperative hospital stay was1.7±0.5days and operative bleeding was7.5±2.7ml. Follow-up was achieved in6patients, ranging from8-10months, during which all the cases showed warm and dry palms without hyperhidrosis (effective rate100%). Mild or moderate compensatory sweating occurred in2cases, which could be tolerable. The other complications, including Homer’s syndrome, severe compensatory hyperhidrosis and recurrence of palmar hyperhidrosis are not observed. All the patients were satisfied with the therapeutic effect. The incision was significantly smaller in the novel protocol group (9.0mm versus34mm, p<0.0001), with better cosmetic results, and the other parameters were not significantly different between the two groups.Conclusion:The new single-incision bilateral thoracic sympathectomy through the anterior mediastinum by the Olympus LTF-240pleura videoscope is an effective and reliable approach for the treatment of palmar hyperhidrosis with better cosmetic results, and promising approach for endoscopic thoracic sympathectomy.