• Journal of Chest Surgery
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• v.31 no.3
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• pp.336-338
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• 1998

Facial hyperhidrosis has a symptom of excessive sweating on the face with or without underlying disease. It can be surgically treated by video-assisted thoracic surgery(VATS). We encountered three cases of facial hyperhidrosis which we treated by VATS, which was performed by resection of the lower third of stellate ganglion and T2-T3 sympathetic ganglia with chains. Postoperative symptom was improved in all cases. There were no postoperative complications such as Horner's syndrome or postsympathectomy neuralgia.

• 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.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.29 no.10
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• pp.1129-1132
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• 1996

Excessive sweating of the face has a strong negative impact on the quality of life for many persons. We have experienced 10 patients with facial hyperhidrosis among the 150 essential hyperhidrosis patients They were 9 male and 1 fatale patients and their age range was 20 to 47 years(mean age 33.8 years). All patients, except one, received bilateral thoracic sympathectomy via VATS. One patient was done via minithoracotomy due to severe pleural adhesion. During the followup period, there was no recurence of facial sweating. Hone of the patients showed Horne 's syndrome.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1089-1093
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• 1998

Background: In 1992, we first developed the technique for video-assisted thoracoscopic sympathectomy to treat palmar hyperhidrosis. It was soon proven to be a simple and effective therapy for essential hyperhidrosis. Clinically, patients suffereing from distressing hyperhidrosis in their heads and faces were observed. Materials and methods: From March 1997 to March 1998, the vidio-assisted thoracoscopic sympathectomy and sympathicotomy were performed in 60 patients suffering from craniofacial hyperhidrosis in the Department of Thoracic and Cardiovascular Surgery in the Respiratory Center of Yongdong Severance Hospital Seoul, Korea. Thirty-nine patients underwent a conventional sympathectomy(T1 sympathectomy group), and twenty-one patients underwent division of the sympathetic nerve trunk above the T2 sympathetic ganglion(T2 sympathicotomy). The median follow up was 9 months. Results: All of the treated patients obtained satisfactory alleviation of craniofacial hyperhidrosis. No recurrence was observed in group T1 sympathectomy whereas one occurred in sympathicotomy. The global rate of compensatory sweating was about the same in both groups ; 76.9% in T1 sympathectomy and 76.2% in T2 sympathicotomy. The rate of embarrassing and disabling compensatory sweating was 38.5% in T1 sympathectomy and 38.1% in T2 sympathicotomy with no significant in the statistic analysis(p> 0.05). No transient Horner's syndrome was observed in group T2 sympathicotomy whereas seven occurred in T1 sympathectomy with improvement in follow-up. Only an overnight hospital stay was required in both group. Conclusions: The video-assist thoracoscopic sympathicotomy is minimally invasive and effective. Video-assisted thoracoscopic T2 sympathicotomy has proven to be effective method and less complicated in treating patients with distressing craniofacial hyperhidrosis and consistent in obtaining the same results as T1 sympathectomy.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.807-810
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• 2008

From October 2005 to August 2006, sympathetic nerve reconstruction with using the intercostal nerve was performed in 4 patients with severe compensatory hyperhidrosis following thoracoscopic sympathetic surgery for facial hyperhidrosis. The interval between the initial sympathetic clipping and the sympathetic nerve reconstruction was a median of 23.1 months. The compensatory sweating after sympathetic nerve reconstruction was improved for 2 patients, but it was not improved for 2 patients. Thoracoscopic sympathetic nerve reconstruction may be one of the useful treatment methods for the patients with severe compensatory hyperhidrosis after they under go sympathetic nerve surgery for hyperhidrosis.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.818-822
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• 1999

Background: Thoracoscopic T2 sympathicotomy had been performed as a simple and effective method in treating palmar hyperhidrosis, however, this method had the complications of compensatory hyperhidrosis and facial anhidrosis. Therefore, a more limited and modified methods for T2 sympathicotomies were introduced and comparative analysis of the modified upper and lower T2 sympathicotomy were made in the treatment of palmar hyperhidrosis. Material and Method: From January 1997 to December 1998, 41 patients with palmar hyperhidrosis had been treated by modified T2 sympathicotomy at the Kon-Kuk University Seoul Hospital. Twenty-four patients underwent a modified upper T2 sympathicotomy(Group A), and seventeen patients underwent a modified lower sympathicotomy(Group B). A comparison between groups A and B were made according to the medical records and interview results. Result: All patients showed symptomatic improvements after the operation. The anisocoria, facial anhidrosis and dissatisfaction for compensatory hyperhidrosis were more common in Group A and the individual satisfaction for the operations were higher in Group B. Conclusion: The modified lower T2 sympathicotomy might be a more effective and less complicated method than the modified upper T2 sympathicotomy.

• Journal of Chest Surgery
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• v.37 no.3
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• pp.267-271
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• 2004

Compensatory sweating is the main cause of patient dissatisfaction after sympathetic surgery for craniofacial hyperhidrosis. Surgery that sympathetic nerve trunk preserved and extent of resection limited was introduced to decrease compensatory sweating. From Jan 2000 to July 2002, the vidio-assisted thoracoscopic T2 sympathetic clipping and rami comunicantes selective division were performed in 36 patients suffering from craniofacial hyperhidrosis. Twenty two patients underwent a T2 sympathetic nerve clipping (Group 1), and fourteen patients underwent division of the T2 ramicommunicates (Group 2). We retrospectively analysed the rate of satisfaction, dryness of face, the rate of compensatory sweating, grade of compensatory sweating. The dryness of face was that no statistical difference between group 1 and group 2 (p=0.387); group1: dry 22.7% (5/22), humid 77.3% (17/22) group 2: dry 14.3% (2/14), humid 78.5% (11/14), persist 7.2% (1/14). The rate of satisfaction was 77.3% in T2 clipping and 64.2% in T2 sympathicotomy with no significant in the statistic analysis (p=0.396). The rate of compensatory sweating on group 2 was lower than group 1 (p=0.042); 95.4% (21/22) in T1 sympathetic clipping and 71.4% in T2 ramicotomy. The rate of embarrassing and disabling compensatory sweating was 70.5% (embarassing 8 patients, disabling 9 patients) in T2 clipping and 42.9% (embarassing 8 patients, disabling 9 patients)in T2 ramicotomy with statistically significant difference (p=0.036). The sympathetic trunk preservation surgery for craniofacial hyperhidrosis (T2 ramicotomy) redueced the rate of compensatory sweating when compared to the blocking surgery of sypathetic trunk (T2 clipping).

• 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.30 no.11
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• pp.1105-1110
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• 1997

Essential hyperhidrosis is a condition with excessive sweating, which may be localized in any part of the body Excessive sweating has a strong negative impact on the qual ty of life for many persons. From June 1992 to May 1996, 211 cases of thoracoscopic thoracic sympathectomy were performed in the Department of Thoracic Surgery, Yongdong Severance Hospital, Seoul, Korea. Among the 211 cases, 192 patients had palmar hyperhidrosis, and 19 cases had facial hyperhidrosis. There were 121 males and 90 (tamales, and the ages ranged from 10 to 67 years(average: 24.82 years old). The average operation time and the average postoperative hospital stay were 91.94 minutes and 4.31 days, respectively. Perioperative courses were uneventful, and all the patients had immediate and complete relief of symptoms with mild compensatory sweating on the chest wall and the back. Even though a thoracoscopy has the possibility of emergency conversion to a thoracotomy and technical difficulties still exist, especially in patients with facial hyperhidrosis, our experience indicates that video-assisted thoracoscopic thoracic sympathectomy is a very safe and useful procedure for h perhidrosis.