• Journal of Chest Surgery
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• v.36 no.4
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• pp.297-299
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• 2003

Thoracoscopic syrnpathicotomy is effective in treating not only palmar hyperhidrosis, but, also in treating axillary hyperhidrosis. In previous studies in Korea, sympathicotomy was focused on combinations including the End to 4th sympathetic chains (R2, 3, 4). Using a minimally invasive technique, the results of sympathicotomy of the 4th and 5th chains (R4, 5) of five patients, from February to August, 2002, for axillary hyperhidrosis without osmidrosis, were reviewed. All patients had a successful operation, their profuse sweating ceased. Three patients suffered from some degree of compensatory sweating. Among the three patients, only one patient suffered from moderate compensatory sweating over his back and thighs. Thoracoscopic R4, 5 sympathicotomy offers a very appealing method in the treatment for axillary hyperhidrosis in patients who have profuse axillary sweating.

• Journal of Chest Surgery
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• v.32 no.12
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• pp.1106-1110
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• 1999

배경: 다한증의 치료에 있어서 흉강경을 이용한 교감신경절제술의 시술 빈도가 급증하고 있다. 그러나 액와부 다한증의 경우 수장부나 안면 두부다한증에 비하여 절제범위가 광범위하여 이에 따른 보상성 다한증 및 기타 합병증의 발생의 높고 액취증이 동반되어있는 경우 장기적인 만족도가 낮아서 크게 각광 받지 못해왔다. 대상 및 방법: 본 교실에서는 1997년 3월부터 1999년 4월까지 45례의 액와부 다한증 환자에서 2 mm 흉강내시경을 이용하여 흉부교감신경절제술 또는 잘단술을 시행하였다. 남자 28례 여자 17례로 평균연령은 28(13-46세) 였고 평균추적기간은 10개월(1-24)이었다. 24례가 액와부에만 국한된 과도발한을 호소 하였고 2례에서 수술 전 심한 액취증이 동반되어있었다. 21례의 T3,4 교감신경절제술, 20례의 T2,4 교감신경단술 그리고 4례의 T4 교감신경절제수을 시행하여 즉각적인 증상치유효과 보상성 다한증 및 장기적 만족도를 비교 분석하였다. 중등도 이상의 흉막유착으로 5mm 내시경이 필요했던 2례을 제외한 전 환자에서 2mm 트로카 2개를 사용하여 수술을 하였다 결과: 평균수술시간은 T3,4 교감신경절제술이 46.2$\pm$11분 T2, 4 교감신경절단술이 32.5$\pm$23분 T4 교감신경절제술이 53.8$\pm$18분이 소요되었고 수술직후의 효과는 T3,4 교감신경절제술과 T2,4 교감신경절단술에서 '전혀땀이 나지 않는다'가 17례(81%) 와 12례(60%) '수술전보다 감소했으나 약간땀이 난다'가 4례(19%) 와 8례(40%) 로 모든 환자에서 효과가 있었으나 T4 교감신경절제술은 4례중3례(75%)에서 전혀 효과가 없었다. 보상성 다한증은 T3,4교감신경절제술과 T2,4 교감신경절단술에서 각각 67%, 60%로 나타났고 생활에 불편을 줄 정도의 심한경우는 10% 5%에 불과했으며 장기적인 만족도는 T3,4 교감신경절제술이 86% T2,4 교감신경절단술이 89%로 나타나 높은 성공률을 보았다 결론 : 액와부다한증의 치료에 있어서 T3,4 교감신경절제술과 T2,4교감신경절단술은 증상치유효과가 높고 절제범위의 제한에 따른 보상성 다한증의 감소로 장기적 만족도가 우수한 효과적인 방법이다. 액취증이 동반된 경우 이에대한 충분한사전 설명과 원인 감별후 적절한 보조요법을 병행함으로써 환자의 만족도를 높힐수 있다고 본다.

• Journal of Chest Surgery
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• v.33 no.12
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• pp.995-997
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• 2000

내장의 통증은 교감신경을 통하여 척수로 전달된다고 알려져있다. 특히 췌장염이나 췌장암의 통증에 관해서 Mallet-Guy 등이 1943년 큰내장신경 및 요교감신경절 절제술을 시행한 이래로 상기 방법이 이용되어 왔다. 내장신경 절제술은 효과에 비해 수술이 커지고, 긴 바늘을 이용한 복강신경총 차단술이 발달하면서 사장된 방법으로 여겨졌다. 그러나, 최근에 흉강경을 이용한 수술방법이 발달하면서 간단히 큰내장신경 절제술이 가능해져 흉강경을 이용한 큰내장신경 절단술은 난치성 복통치료의 좋은 방법으로 받아 들여지고 있다.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.813-817
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• 1999

Background: Conventional thoracoscopic thoracic sympathectomy or sympathicotomy is an effective method in treating localized hyperhidrosis; however, this may result in a postoperatively embarrassing compensatory hyperhidrosis or facial anhidrosis in the treatment of palmar hyperhidrosis. We modified the conventional sympathicotomy by limiting the extent of nerve transection. The purpose of this study was to assess the result of the limited thoracoscopic sympathetic nerve transection in hyperhidrosis. Material and Method: From May to August 1998, 17 patients underwent limited transection of the sympathetic nerve. For 9 patients with facial hyperhidrosis, we transected only the interganglionic fiber between the first and the second ganglion, whereas the conventional method cuts two interganglionic fibers. Eight patients with palmar hyperhidrosis underwent limited transection of the interganglionic fiber between the second and third ganglion. Result: Sixteen patients had improved symptom postoperatively. There was a recurred facial sweating in 1 patient 1 month after the operation. Among the 9 facial hyperhidrosis patients, postoperative compensatory hyperhidrosis was severe in 4, moderate in 4 and minimal in 1. But in 8 cases of palmar hyperhidrosis compensatory hyperhidrosis was moderate in 3, and minimal in 1, none in 4. Facial sweating was not disturbed postoperatively in all of the palmar hyperhidrosis patients. Conclusion: Limited sympathetic nerve transection is a practical and less invasive method for the treatment of localized hyperhidrosis and may reduce the incidence of compensatory truncal hyperhidrosis and facial anhidrosis in case of palmar hyperhidrosis.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.465-470
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• 1999

Background: Facial hyperhidrosis patients have as much difficulty in personal relationships as the palmar and axillary hyperhidrosis patients. There have been no appropriate treatment, but recently, satisfactory results have been obtained through sympathetic blockade. Thoracoscopic thoracic sympathectomy for facial hyperhidrosis has been known to resect cervicothoracic (stellate) ganglion, but its inherent complications such as Horner syndrome have made the surgeons hesitant to use this method. We, through our experiences in treating palmar and axillary hyperhidrosis for the past 6 years, believed that T2 sympathicotomy would be enough for facial hyperhidrosis and have experimented and obtained satisfactory results. Material and Method: From June 1997 to May 1998, 38 consecutive patients underwent bilateral thoracoscopic T2 sympathicotomy with 2mm instruments at Seoul National University Hospital. Result: All patients were relieved of excessive sweating in their faces immediately after the operation. Postoperatively, 5 patients (13.2%) required insertion of chest tubes because 3 had incomplete reexpansion of the lung, and 2 had hemothorax from severe adhesion. Other complications related to the surgical procedures, such as Horner's syndrome, and brachial plexus injury, were not detected in any cases. The mean hospital stay was mean 1.7$\pm$0.9 days after surgery. Conclusion: T2 sympathetic ganglion is the appropriate resection site for facial hyperhidrosis, and complications such as Horner syndrome can be prevented by not cutting the stellate ganglion. In addition, it is possible to perform the operation by using a 2 mm thoracoscopic instrument, and may obtain much better results.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.223-226
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• 2002

Background: Thoracoscopic sympathicotomy is an effective treatment in essential hyperhidrosis. However, many patients suffer from compensatory hyperhidrosis. Compensatory hyperhidrosis is a very uncomfortable problem, but the mechanisms underlying compensatory hyperhidrosis are not completely understood. Material and Method: From May 1999 to June 2001, 25 cases of thoracoscopic sympathicotomy at the 2nd rib for facial hyperhidrosis and 116 cases of thoracoscopic sympathicotomy at the 3rd rib for palmar hyperhidrosis were performed in 141 patients. All of the patients were divided into noncompensatory sweating(NCS) and compensatory sweating(CS) group. Each group was investigated according to age, sex, body surface area(BSA), level of sympathicotomy and occupation. Result: The global rate of compensatory hyperhidorsis were 64.5%(91/141). There was no difference between the two groups for BSA, level of sympathicotomy and occupation. Mean age showed 23.2 years old in NCS group and 26.4 years old in CS group(p=0.09). In CS group, 46 cases were male(50.5%) and 45 cases were female(49.5%) and in NCS group, 19 cases were male(38.0%) and 31 cases were female(62.0%) (p=0.16). Conclusion: There were no available statistical data, but there was the fact that old age and male patients had the tendency for compensatory hyperhidrosis. If we have more patient group and consider the patient's family history or psychiatric problems, we will have more valuable data for compensatory hyperhidrosis.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.579-583
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• 1999

Background: Thoracic sympathicotomy has been used safely and successfully to manage palmar hyperhidrosis. The preoperative and postoperative recording of Sympathetic Skin Responses(SSR) was performed for objective evaluation and follow-up of thoracic sympathicotomy in hyperhidrosis patients, and also for ascertaining the clinical usefullness of SSR. Material and Method: The recording of SSR was performed on 15 patients suffering from palmar hyperhidrosis with Medelec Sapphire Plus electromyogragh before and after thoracic sympathicotomy. Eletrical stimuli on the right median nerve was made in patients in supine position and results were recorded on right and left palms with soles at the same time by 4 channels. Skin temperatures were also monitored simultaneously. T2,3 sympathicotomy was performed with VATS in every patients. SSR was done in 2 patients one month later. Result: Clinically, all patients had symptomatic improvement with satisfaction. Postoperative complication was small amount of residual pneumothorax in 5 patients but it was absorbed sponteneously. There was no recurrence during follow-up period and ten patients(66%) complained compensatory hyperhidrosis. After operation, SSR change was shown in every 15 patients. Abolition of SSR on both palms was achieved in 12 patients(80%) and on both soles in 6 patients. In the other 3 patients, the latencies were significantly delayed and the amplitudes were significantly reduced at both palms and soles. In two patients who were examined at one month later after operation, similar results with postoperative SSRs were shown. The skin temperature on preoperative both palm and sole were lower than normal temperature, and those on postoperative both palm and sole were increased. Those had statistical significance(p<0.05), and the temperature on the palm was increased higher that than on the sole. Conclusion: After thoracic sympathicotomy was performed on palmar hyperhidrosis patients, an increment of skin temperatures and SSR changes were achieved at both palms and soles of all patients. Palmar SSRs were completely abolished in 12 patients(80%), and similar results of postoperative SSRs were achieved. The recording of SSR may be useful to easily and objectively assess the completeness of sympathicotomy and the follow-up of recurrence in hyperhidrosis patients.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.461-464
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• 1999

Background: Thoracoscopic T2 sympathicotomy is an effective method for the treatment of palmar hyperhidrosis. Not only are the symptoms of hyperhidrosis abolished but also the temperature of the ipsilateral palm is elevated due to the sympatholytic vasodilation after the completion of the sympathicotomy on the first side. However little is known about the temperature changes in the contralateral palm. This study was performed to evaluate the changes in both palmar temperatures during the thoracoscopic T2 sympathicotomy for palmar hyperhidrosis. Material and Method: Thoracoscopic T2 sympathicotomy was performed in 15 patients with primary palmar hyperhidrosis. Surface temperatures of both palms were monitored continuously and were recorded simultaneously during the 7 different stages of the operation. Result: When T2 sympathicotomy was performed on the first(left) side, an ipsilateral increase with a contralateral decrease of temperature was observed. The difference in the temperature of both palms was greatest just before the sympathicotomy on the contralateral(right) side(Lt. 34.6$\pm$0.9$^{\circ}C$ vs. Rt. 31.6$\pm$1.3$^{\circ}C$, P<0.0001). After the sympathicotomy on the second(right) side, temperature of the right palm was elevated. The difference in the temperature of both palms was abolished at the end of the operation(Lt.34.7$\pm$0.9$^{\circ}C$ vs. Rt.34.4$\pm$1.$0^{\circ}C$, P=0.415). Conclusion: When T2 sympathicotomy was performed on the first side, an ipsilateral palmar temperature increased due to the sympatholytic vasodilation. However contralateral palmar temperature decreased due to a vasoconstriction. Although the mechanism of vasoconstriction is still unknown, it is postulated that there may be a cross- inhibitory effect by the post-ganglionic neurons innervating blood vessels of the palm.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.530-535
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• 2004

Background: Thoracoscopic R3 (above the third rib)sympathicotomy has been performed as an effective method in treating palmar hyperhidrosis because it is effective in eliminating the symptoms of hyperhidrosis and has lower degree of compensatory hyperhidrosis than that of sympathectomy. Most of the results published were based on the short-term follow up. So we evaluated the intermediate term follow up results of the R3 sympathicotomy. Material and Method: From April 1999 to August 2001, ninety-four patients with palmar hyperhidrosis had been treated by R3 sympathicotomy at the Inha University Hospital. Follow-up study was completed for 76 patients (male 38, female 38) and average follow-up period were 25$\pm$9.1 (15∼50) months. The sympathetic trunk passing above the upper border of third rib was divided by electric cautery. The patient's satisfaction after surgery was estimated using the analogue scale from score 0 to 100 (100 means perfect satisfaction). Result. The scale of patient's satisfaction immediately after operation was 92.36$\pm$9.93. After 15 months, the scale of satisfaction was decreased to average 71.80$\pm$20.24 and it is statiscally significant. The cause of dissatisfaction were compensatory hyper-hidrosis and recurrence of symptom. The degree of sweating immediately after operation was mean 0 and after 15 months it increased to mean 1.5. The degree of the compensatory hyperhidrosis immediately after operation was mean 1 and it increased to mean 5 after 15 months. Conclusion: R3 sympathicotomy has excellent therapeutic results immediately after operation but therapeutic effectiveness is becoming to decrease 15 months after operation. The common causes of dissatisfaction are compensatory hyperhidrosis and recurrence of hyperhidrosis.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.343-346
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• 2008

Background: Thoracoscpic sympathicotomy is an effective treatment for essential hyperhidrosis. Patients are generally satisfied with the surgery at the early post operative period, but they suffer from recurrence and compensatory sweating at the late post operative period. There are many sympathicotomy methods for minimizing recurrence and the compensatory sweating. We compared the outcome from between the R3 and R4 sympathicotomy methods for the symptoms, atisfaction, recurrence and compensatory sweating. Material and Method: From January 1999 to July 2007, 39 cases of thoracoscopic sympathicotomy at the 3rd rib (R3) and 72 cases of thoracoscopic sympathicotomy at the 4th rib (R4) for treating palmar hyperhidrosis were compared for the early and late satisfaction, the compensatory sweating and recurrence. Result: There is no difference of gender and age for the 2 groups. Early satisfaction was reported by 94.9% of the R3 patients and by 98.7% of the R4 patients. 84.6% of the R3 patients reported late satisfaction and 87.5% of the R4 patients reported late satisfaction. There were no significant differences between the groups for the early and late satisfaction. But there was a difference between the groups for compensatory sweating (23.1% in the R3 group and 9.7% in the R4 group (p=0.020)). The reoperation rate due to recurrence was 5.1% in the R3 group and 4.2% in the R4 group. There was no significant difference between the groups for recurrence. Conclusion: R4 sympathicotomy has excellent therapeutic results for compensatory sweating as compared to R3 sympathicotomy for treating palmar hyperhidrosis.