• The Korean Journal of Pain
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• v.18 no.1
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• pp.92-95
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• 2005

Primary hyperhidrosis, a disorder of unknown etiology, is characterized by excessive uncontrollable sweating, most often of the palm surface of the hands, armpits, groin and feet. To decrease the symptoms of hyperhidrosis, drug therapy, iontophoresis, excision of axillary sweat glands and thoracoscopic sympathectomy have been attempted. A lumbar sympathectomy is one of the available choices for the treatment hyperhidrosis of the lower extremities. A 28-year old female patient presented with excessive sweating of her hands and feet. For the treatment of her foot hyperhidrosis, a bipolar radiofrequency ablation system was used to ablate the lumbar sympathetic ganglion, with a successful result. This modality will receive greater attention as an available alternative to lumbar sympathetic neurolysis.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.279-285
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• 1998

Exessive sweating of the palms and soles, is a psychologically and occupationally distressing and sometimes disabling condition. Hyperhidrosis is one of the common abnormalities in autonomic nervous system. There were no specific treatment on hyperhidrosis, so invasive thoracic sympathectomy via axillary thoracotomy or cervical approach had been used. Video-assisted thoracic surgery(VATS) is now mostly performed for treating of the palmar and axillary hyperhidrosis. From March 1996 to March 1997, 15 patients with bilateral palmar hyperhidrosis had been treated by the bilateral thoracic sympathectomy(T2, T3, T4) with thoracoscopic resection. The patient were evaluated preoperative and postoperative Digital Infrared Thermographic Imaging (DITI) at Kyung-Hee University Hospital. There were no case of the thoracotomy conversion. There were 3 complications ; pulmonary edema in 1 case, Horner's syndrome in 1 case, and gustatory hyperhidrosis in 1 case. More than half of the patients also had compensatory sweating in the lower abdomen, the buttocks, the back and the thighs. In conclusion, most of the patients were satisfied with the postoperative results of the thoracoscopic sympathectomy, including no more palmar and axillary sweating, less pain, better cosmetic appearances, decreased sweating of the face and soles. In addition, intraoperative temperature monitoring of the hands could estimate the successful thoracoscopic sympathectomy and the preoperative and postoperative Digital infrared thermographic imaging(DITI) could especially be the technique for the objective manifestation of the successful results of the thoracoscopic sympathectomy.

• Archives of Plastic Surgery
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• v.37 no.3
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• pp.301-303
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• 2010

Purpose: The axillary web syndrome (AWS) is a selflimiting cause of morbidity in the early postoperative period after axillary surgery. This article presents a rare complication developed after surgical treatment for axillary osmidrosis. Methods: A 55-year-old male patient underwent surgical excision of skin and glandular tissue for axillary osmidrosis. Three weeks after the surgery, he visited our department due to a visible web of left axillary skin overlying palpable cord extends into the medial ipsilateral arm. There was a taut and tender cord of tissue under the skin and shoulder abduction was limited to less than 90 degrees. He was diagnosed with AWS and treated with conservative management. Results: Four months later, AWS resolved completely without any treatment and patient was free of pain or motion restriction. Conculsion: Axillary web syndrome has been described as frequent complication after axillary lymph node dissection or sentinel node biopsy, but not after surgical treatment of axillary osmidrosis. Surgeons must be aware of the risk of axillary web syndrome after treatment of axillary osmidrosis.

• 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.28 no.7
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• pp.684-688
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• 1995

Hyperhidrosis, one of the abnormalities in autonomic nervous system, has been treated with dermatologic principles or thoracic sympathectomy via conventional axillary thoracotomy or dorsal spinal approach. But these techniques were rather ineffective or invasive. Recently, VATS is widely applied in thoracic surgical area, and hyperhidrosis is not the exception of these cases.From May 1993 to August 1994, 30 patients with bilateral palmar hyperhidrosis underwent bilateral thoracic [T2, T3 sympathectomy with thoracoscopic surgery at Seoul National University Hospital. There were 20 men and 10 women and the mean age was 23.0 years.Mean operating time was 115 min and there was no thoracotomy conversion. Operative complications were anesthetic overdose in 1, Horner`s syndrome in 1, and small amount of residual pneumothorax in 6. Mean postoperative hospital stay was 2.3 days [range from 1 to 4 days and postoperative analgesics were required in 17 cases with a single dose.Sweating amount was measured in 12 patients, showing significantly decreased amount from 284.5 mg preoperatively to 18.9 mg postoperatively in 5 minutes [p=0.004 . There was no recurrence during mean 6 months follow up. Twenty two patients [73.3 % complained moderate compensatory hyperhidrosis on the trunk.In conclusion, all patients were greatly satisfied with those results including no more palmar sweating, less pain, better cosmetics, short hospital stay. In addition, recent use of sweating amount measurement and intraoperative temperature monitoring could make this technique more accurate, so we easily applied thoracoscopic sympathectomy with minimal risk.

• 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.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.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.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.235-238
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• 1996

Hyperhidrosis is the distressing condition of abnormal sweating which affects the palm, sole and axillary region. Transthoracic endoscopic sympathectomy is recommended as the treatment of choice for hyperhidrosis, especially when the upper limbs are affected. We experienced a case of accidental cauterization of right azygos vein in a healthy 23 year old male during endoscopic transthoracic sympathectomy. We changed the single lumen endotracheal tube to a double lumen tube which made it easier to perform the explo-thoracotomy and bleeder ligation under one lung ventilation. Crystalloid and colloid solutions, and packed RBC were loaded during explo-thoracotomy. Monitoring showed the signs indicating pulmonary edema. Pulmonary arterial catheterization revealed global heart failure. The patient was transfered to ICU for intensive management for heart failure. On the 4th postoperative day, pulmonary edema and heart failure were cured; and the patient was extubated. But in the evening of the same day ST-segment elevation and Q-wave were noted on ECG monitoring. On the 13th postoperative day coronary angiography was performed. This revealed left apex focal hypokinesia, patent coronary artery and accidental right coronary spasm, treated by vasodilator. On the 14 day, after surgery, he was discharged to return to work.

• The Korean Journal of Pain
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• v.11 no.2
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• pp.220-225
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• 1998

Background: The patients of facial hyperhidrosis have been known that they had much difficulties in interpersonal relationships and social activities due to excessive hidrosis when they were in stress, hot weather, or having meals. Previous drug therapy and stellate ganglion block have only temporary effects. The surgical method, $T_1$ sympathetomy has the risk of Hornor's syndrome. For that reasons, the sympathicotomy of proximal and distal portions of $T_2$ sympathetic ganglion with electroresectoscope used in transurethral resection seemed to be appropriate procedure, and we would like to report the results of our procedure. Method: Under the general anesthesia with semi-sitting position, and the portal was made through the small incision along the upper border of the 4th rib at the crossing point of mid-axillary line. After the partial collapse of lung by insufflation of 300 to 500 ml of $CO_2$, $T_2$ sympathetic ganglion was identified and resected proximally and distally with electro-cauterization. Finally the lung was expanded by limiting flow until the airway pressure reached 30 to 40 cm$H_2O$, and the wound was closed after removal of electroresectoscope. Result: There was no postoperative complication requiring surgical interventions. The facial sweating was stopped immediately after the operation and all the patients appeared to be satisfied. Conclusion: $T_2$ sympathicotomy with TUR electroresectoscope is thought be the minimal invasive and highly successful method in the treatment of facial hyperhidrosis. But longer terms follow-up will be needed to prove this result.