• Journal of Chest Surgery
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• v.31 no.3
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• pp.226-232
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• 1998

With recent advancements in the instrumentation and technique of VATS, it has become the method of choice to cure facial hyperhidrosis. From July 1996 to April 1997, we performed 43 thoracic lower stellate ganglionectomy with VATS for facial hyperhidrosis. There were 33 men and 10 women whose ages ranged from 17 to 63 years(mean age, 37 years). Of those patients, 23 complained only of facial hyperhidrosis, and 20 complained of facial hyperhidrosis along with excessive sweating of the palm or foot. Thoracoscopic sympathetic ganglionectomy procedures included lower stellate ganglionectomy in 12 patients; lower stellate ganglionectomy and T2-sympathetic ganglionectomy in 28 patients; and lower stellate, T2 and T3 sympathetic ganglionectomy in 3 patients. Common complications were compensatory hyperhidrosis(36 patients) and causalgia(8 patients). At the end of the follow-up period(minimum, 3 months) ninety-five percent of the patients reported satisfactory results. Thoracic lower stellate ganglionectomy with VATS is an efficient, safe and minimally invasive surgical procedure for facial hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.519-524
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• 1998

From January 1996 to December 1996, we performed 137 thoracic sympathetic ganglionectomies with VATs for primary hyperhidrosis in the department of thoracic and cardiovascular surgery at Anam hospital, Korea university medical center. There were 83 men and 54 women whose ages ranged from 13 to 63 years old(mean age: 25years). Of these patients, 128 patients had complained of palmar hyperhidrosis and 26 of facial hyperhidrosis. Thoracoscopic sympathetic ganglionectomies procedures included lower 1/3 Stellate ganglionectomies in 4 patients; lower 1/3 Stellate ganglionectomies and T2-sympathetic ganglionectomies in 18 patients; T2-sympathetic ganglionectomies in 86 patients; T2 and T3 sympathetic ganglionectomies in 10 patients; and T2, T3 and T4 sympathetic ganglionectomies in 19 patients. The mean operating time was 59 minutes(range: 25 to 162 minutes), and the mean hospital stay was 3.8 days(range: 2 to 8 days). Common complications were compensatory hyperhidrosis(109 patients) and causalgia(18 patients). At the end of the follow-up period(mean: 8 months) ninety-seven percent of the patients reported satisfactory results. Thoracic sympathetic ganglionectomy with VATs is an efficient, safe, and minimally invasive surgical procedure for primary hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.388-392
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• 1998

Hyperhidrosis is one of abnormalities in autonomic nervous system, it has been treated with dermatologic principles or thoracic sympathectomy via thoracotomy. But these techniques were rather ineffective or invasive. Recently, Video Assisted Thoracoscopic Surgery(VATS) is widely applided in thoracic surgical area, and palmar & axillary hyperhidrosis is not the exception. From August 1995 to February 1997, 52 patients with bilateral palmar hyperhidrosis underwent bilateral thoracic sympathectomy with VATS in the department of thoracic & cardiovascular surgery, Inje university, Pusan Paik Hospital. There were 27 men and 25 women and the mean age was 22 years. Mean operating time was 172 min and unilateral sympathectomy via minithoracotomy was applied in one patient due to severe pleural adhesion. Mean postoperative hospital stay was 2.6 days. During mean 12.5 months follow-up, there was no recurrence of sweating in the both hands. Thirty patients(57.7%) complained moderate degree of compensatory sweating, but the discomfort was decreased in severity. 83.8% of all patients were satisfied with the result of operation.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.724-729
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• 2002

Although variable surgical methods of sympathetic nerve for palmar hyperhidrosis are curative and safe therapeutic options, they have some limitations such as compensatory sweating and anhidrosis of hand in long term satisfaction rate. Material and Method: Therefore, we tried to decrease severity of compensatory sweating and prevent excessive dryness of hand through selective division of rami communicantes of thoracic sympathetic ganglia distributed to the hands(ramicotomy). Result: In postoperative results, about half of the patients maintained humidity of hands and most of them showed no more than mild degree of compensatory sweating. Conclusion: Therefore, ramicotomy of thoracic sympathetic ganglia can be recommended as selective and physiologic surgical method for palmar hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.203-207
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• 1998

We have experienced 2 patients who underwent retroperitoneal endoscopic lumbar sympathectomy(RELS) for bilateral plantar hyperhidrosis. They had underwent thoracic sympathectomy by thoracoscopy 20 months and 1 month ago, respectively. The first patient had to be converted to the open procedure due to pneumoperitonium and she was reoperated due to continous sweating by the incomplete sympathectomy on right side. At follow-up after 70 and 30 days postoperatively, RELS results were graded as excellent, good, fair, or poor. The first patient was very satisfied as "Excellent" and the second was slightly less satisfied as "Good" with compensatory hyperhidrosis at perianal area. This RELS is a feasible procedure to plantar hyperhydrosis patients with less pain, minimal scar, short period of convalescence, and short hospital stay.short hospital stay.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.766-769
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• 2000

The long QT syndromes have been classified into acquired or inheritary forms, both of which are associated with a characteristic type of life-threatening polymorphic ventricular tachycardia called torsade de points. Beta-adrenergic blocker is the first cholic treatment, but in those whom cardiac events are not prevented by $\beta$-blockade, left thoracic sympathetic ganglionectomy may be useful in selected cases. A 50-year-old woman had an recurrent syncopal attack in which she was unconscious for 1-2 min and 1-2 times a month for 10 years. The EKG revealed that QT & QTc intervals were 744 and 632 msec respectively. Treatment with Beta-adrenergic blocker and calcium channel blocker was ineffective in preventing recurrence of syncopal spell. Therefore, she underwent left thoracic sympathetic ganglionectomy with thoracoscope. During the 9 months after operation, she was free of syncopal episodes and is doing well.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.697-702
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• 1998

Hyperhidrosis of the palms, axillae, and the face has a strong negative impact on the quality of life for many people. Existing nonsurgical therapeutic options are far from ideal. A definitive cure can be obtained by upper thoracic sympathectomy. The traditional open surgical technique is a major procedure; few patients and doctors have found that risk-benefit considerations favor surgery. Endoscopic minimal invasive surgical techniques are now available. We investigated whether endoscopic ablation of upper thoracic sympathetic chain(T2-4) is an efficient and safe treatment of hyperhidrosis. We treated 40 patients with bilateral endoscopic transthoracic sympathectomy. There were no mortalities, life-threatening complication, no treatment failures occurred in 40 patients. After a short-term follow-up, 100% of the patients reported satisfactory results. Endoscopic transthoracic sympathectomy is an efficient, safe, and minimally invasive surgical method for the treatment of palmar, axillary hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.999-1003
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• 1998

Background: Thoracoscopic sympathetic block in palmar hyperhidrosis has merits in its immediate responsiveness and recovery. In palmar hyperhidrosis, the level of sympathetic chain to be blocked has been somewhat obscure. Materials and methods: To compare the results of T2 with T2,3 sympathetic block, we retrospectively studied 192 patients (T2 group: 84, T23 group: 108) operated on at SNUH with palmar hyperhidrosis between April 1994 and July 1997. We reviewed medical records and recently interviewed the patients by telephone call. Sex and age distribution between two groups showed no significant differences. We performed sympathectomy at the early phase of the syudy until April 1997, and after then, we adopted sympathicotomy rather than sympathectomy. Results: All patients showed symptomatic improvement after the operation. Mean operation times of T2, T23 groups were 61.3$\pm$22.5min, 82.7$\pm$24.8min, respectively(p<0.01). Early postoperative complications, such as Horner's syndrome or chest tube insertion, were not different in two groups. There were no statistical differences of late complications such as compensatory truncal hyperhidrosis, gustatory sweating, and phantom sweating. No patient experienced recurrence of palmar hyperhidrosis during the study period. The only difference was the extent of compensatory truncal hyperhidrosis. The compensatory sweating occurred from axilla to suprapatella in T2 group whereas its extent was from nipple to suprapatella in T23 group. Conclusions: We concluded that T2 thoracic sympathetic block is mandatory for the treatment of primary palmar hyperhidrosis.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.525-530
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• 1998

Thoracoscopic thoracic sympathectomy for primary palmar hyperhidrosis has been known to be effective and to have cosmetic merits compared to conventional open sympathectomy. In spite of its cosmetic advantages over thoracotomy, VATS using 5 mm or 10 mm instruments still has the problem of operative wound as well as pain on trocar sites. Recently, 2 mm thoracoscopic instruments have been used. The purpose of this study was to examine the results of thoracoscopic sympathectomy for palmar hyperhidrosis with 2 mm thoracoscopic instruments. From January 1997 to April 1997, 46 patients underwent bilateral thoracoscopic sympathectomy with 2mm instruments at Seoul National University Hospital. T-2 ganglion was carefully dissected and resected out in all patients. In one patient, the lower third of T-1 ganglion was inadvertently resected together with T-2 ganglion due to poor anatomical localization. In 4 patients who also complained of excessive axillary sweating, T-3 ganglion was resected as well. The instruments were removed without leaving any chest drain after reexpansion of the lung. Trocar sites were approximated with sterile tapes. All patients were relieved of excessive sweating in their upper extremities immediately after the operation. Nine patients(19.6%) showed incomplete reexpansion of the lung, and two of them required needle aspiration. Complications related to the surgical procedures, such as Horner's syndrome, hemothorax, and brachial plexus injury, were not detected in any cases. Most patientsdid not complaine of pain. All patients were discharged from the hospital on the day of operation. Despite a narrow operative viewfield, thoracic sympathectomy with 2 mm thoracoscopic instruments can be performed without increasing any severe complications. We recommend 2 mm instruments for thoracoscopic sympathectomy because they make as the more cosmetic, less painful, and equally effective compared to thoracoscopic sympathectomy using 5 mm or greater instruments.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.703-710
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• 1998

We treated 654 patients with simultaneous bilateral sympathectomy for essential hyperhidrosis from March 1989 to September 1997(354 males and 300 females). The exposure afforded by thoracoscopy is actually superior to that seen at the time of either thoracotomy or axillary thoracotomy. The use of single-lumen intubation with alternating partially collapsed lung by CO2 inflation resulted in shorter anesthesia, shorter operative time, and shorter hospitalization. 2-mm extended thoracoscopic T2-sympathectomy is not only a time-saving method but also a very simple and effective one in the treatment of hyperhidrosis by experienced surgeons. The modification on our technique of thoracoscopic sympathectomy as described allowed us to significantly improve our previous results. A majority of the patients were relieved, and over 95% were satisfied initially.