• 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 Korean Neurosurgical Society
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• v.29 no.11
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• pp.1499-1504
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• 2000

Objectives : In general, conventional T2, T3 thoracoscopic sympathicotomy must be one of the most effective treatments for the essential palmar hyperhidrosis. However, this is offset by the occurrence of a high rate of side effects, such as embarrassing compensatory sweating and Hornor's syndrome. The authors have performed a selective T3 thoracoscopic sympathicotomy to our patients to see whether it provides successful results with less side effects. Its preliminary results were compared with those of conventional T2, T3 thoracoscopic sympathicotomy. Methods : The thoracoscopic sympathicotomy was performed in 54 patients suffering from essential palmar hyperhidrosis. Twenty-four patients underwent a conventional sympathicotmy(group A) from Jan 1997 to Dec 1997 and 30 patients a selective T3 sympathicotmy(group B) from Jan 1998 to Dec 1999. For assessment of postoperative success and of complications all patients charts were reviewed. Patients further received a postal questionnaire regarding long-term effect, satisfaction, and side-effects. Results : No recurrence was observed in both groups. The global rate of compensatory sweating was significantly(p ＝0.020) different in both groups : 11 patients(45.8%) in group A and 5 patients(16.73%) in group B. The Hornor's syndrome was observed only in 4 patients in group A. The preliminary results of the procedure in group A were considered fully-satisfying by 16 patients(66.6%), 6 patients(25%) were satisfied partially, and only 2 patients(8.3%) were dissatisfied, and those of the procedure in group B satisfying by 26 patients(86.6%), 4 patients(13.3.% ) were satisfied partially, and none dissatisfied. Conclusion : The selective T3 sympathicotomy results in a significant decrease in the rate of disturbing side effects comparing to conventional T2, T3 sympathicotomy and it dose not lead to recurrence. Our results contribute to recommendations of a selective T3 thoracoscopic sympathicotomy as treatment of choice in essential palmar hyperhidrosis.

• Journal of Korean Neurosurgical Society
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• v.30 no.8
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• pp.992-997
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• 2001

Objectives : Essential hyperhidrosis is a common condition characterized by excessive body sweating. Excessive sweating beyond what is necessary to maintain normal body temperature need not be considered pathological unless it interferes with one's occupation and/or life-style. The existing non-operative therapeutic options seldom give sufficient relief or show a transient effect. In this regard, the thoracic sympathectomy may provide a definitive cure. In the past, surgical procedures were highly invasive and caused significant morbidity, but the minimally invasive thoracoscopic procedure provided detailed visualization of sympathetic ganglia and is associated with minimally postoperative morbidity. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential hyperhidrosis. In palmar hyperhidrosis, however, the level of sympathetic chain to be blocked has been somewhat obscure. It is assumed that the incidence of compensatory hyperhidrosis may closely related to the extent of thoracic sympathectomy. Material & Methods : To compare the results of posterior midline approach with endoscopic sympathectomy, and the results of T2 with T2, 3 sympathectomy or sympathicotomy, we retrospectively studied 62 patients treated for palmar hyperhidrosis between September 1993 and May 2000. We reviewed medical records and recently interviewed the patients by telephone calls. Results : The treatment effect of T2 sympathectomy is no different from T2, 3 sympathectomy. But, the incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than the T2, 3 sympathectomy group. Conclusion : Thoracoscopic sympathectomy is considered a simple, safe, and effective method for treating palmar hyperhidrosis, with a shorter operation time, fewer hospital days, and a better cosmetic result, as compared with the open approaches. However, sympathicotomy seems to provide the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.154-158
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• 2011

Background: Video-assisted thoracic sympathicotomy plays an important for the treatment of essential hyperhidrosis. Patients are usually satisfied with the surgical outcome at the early post-operative period, but suffer recurrence and compensatory sweating in the late post-operative period. There are many sympathicotomy methods to minimize recurrence and compensatory sweating. We compared the outcome of sympathicotomy methods above the third rib (R3) and the fourth rib (R4) with regards to symptoms, satisfaction, recurrence, and compensatory palmar and axillary hyperhydrosis. Materials and Methods: From January 1999 to April 2009, 39 cases of thoracoscopic sympathicotomy at the third rib (R3), and 94 cases of thoracoscopic sympathicotomy at the fourth rib (R4) for palmar and axillary hyperhidrosis were compared for early and late post-operative satisfaction, compensatory sweating and recurrence. Results: There was no sex or age difference between groups. Early satisfaction was 94.9% and 98.9% in the R3 group and R4 group, respectively. There was no difference in early satisfaction (94.9% in R3 and 98.9% in R4), late satisfaction (84.6% in R3 and 89.4% in R4), or recurrence (17.9% in R3 and 17.0% in R4) between groups. There was significant difference in compensatory sweating (71.8% in R3 and 33% in R4, p=0.002). Conclusion: R4 sympathicotomy demonstrated superior efficacy in the treatment of compensatory sweating compared to R3 in palmar and/or axillary hyperhidrosis.

• The Journal of Internal Korean Medicine
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• v.29 no.1
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• pp.1-11
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• 2008

Objectives : Essential hyperhidrosis is a socially and occupationally disabling disorder. There are many suggestions that hyperhidrosis is associated with the autonomic nervous system. This study was designed to investigate the autonomic nerve system the patients with hyperhidrosis. Methods : 348 palmar and plantar hyperhidrosis patients and 20 systemic hyperhidrosis patients in the ambulatory care were investigated. All patients were inspected at the first medical examination, using the PSA of HRV. HRV was measured for 5 minutes after 5 minutes' bed rest. We checked the frequency domain analysis of HRV (i.e. TP, VLF, LF, HF and LF/HF) which were transformed into natural logarithm of patients against the standard measures of the HRV components. Then, we compared the means of patients with means and highest values of in the normal range of Koreans 1) between the patients with palmar and plantar hyperhidrosis and the healthy controls and 2) between the patients with the systemic hyperhidrosis and healthy controls, by the frequency domain analysis of heart rate variability (HRV), respectively. We then compared the results between 1) and 2). Results : The values of natural logarithmic measures of LF/HF ratio in the patients with palmar and plantar hyperhidrosis we examined were significantly higher than the values of healthy controls, but those in the patients with systemic hyperhidrosis were not higher. Conclusion : This study suggests that the autonomic nervous function did not simply increase but that the balance between sympathetic and parasympathetic nervous function did matter in patients with palmar and plantar hyperhidrosis. This balance included that the sympathetic nervous function aggravated comparatively with parasympathetic nervous function. On the other hand, we couldn't find any significance of the patients with the systemic hyperhidrosis as for the autonomic nervous function.

• 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.

• Journal of Chest Surgery
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• v.32 no.2
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• pp.175-180
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• 1999

Background: Since 1992, we developed the technique for video endoscopic sympathectomy to treat palmar hyperhidrosis. It was soon proven to be a simple and effective therapy for essential hyperhidrosis. Compensatory hyperhidrosis, however, is the main cause of patient dissatisfaction after video-assisted thoracoscopic sympathectomy. According to many authors, initial satisfaction rate was high(94-98%), but it was declined with time (66%) due to mainly to embarrassing side effects. Material and Method: From January 1992 to February 1998, the thoracoscopic T2 sympathicotomy, T2 sympathectomy and T2-4 sympathectomy were performed in 315 patients suffering from Essential hyperhidrosis in the Department of Thoracic and Cardiovascular Surgery in the Respiratory Center of Yongdong Severance Hospital Seoul, Korea. Eighty-nine patients underwent T2 sympathicotomy, and Eighty-eight patients underwent division T2 sympathectomy. Result: All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis. The global rate of compensatory sweating were ; 64.0% in T2 sympathicotomy, 73.8% in T2 sympathectomy and 87.8% in T2-4 sympathectomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathicotomy 15.7%(14/89) and in T2 sympathectomy 32.8%(28/88) than in T2-4 sympathectomy 58.0%(80/138) with significancy in statistic analysis(p<0.05). Video- assisted thoracoscopic sympathectomy is an effective minimally invasive and effective procedure. Conclusion: We suggest that the incidence and degree of compensatory hyperhidrosis was closely related to the extent of thoracic sympathectomy.

• 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.36 no.3
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• pp.182-188
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• 2003

Background: Although ramicotomy (division of the rami communicantes of the thoracic sympathetic ganglia) is a selective and physiological surgical method for essential hyperhidrosis, it has some problems such as higher recurrence rates and the different surgical results among the patients and between left and right sides in the same individual. As one of the factors that are related to the differences in surgical result and recurrences, we investigated the anatomical variations of the rami communicantes. The purpose of this study is to help develop new surgical methods to decrease surgical differences among the patients or between the left and right sides of the same individual and recurrence rates in the clinical application of ramicotomy. Material and Method: We dissected 118 thoracic sympathetic chains in 59 adult Korean cadavers (male: 33, female: 26) to examine the anatomical variations of the rami communicantes from the second to the fourth thoracic sympathetic ganglia that have major components innervating to the hands. After the dissection of bilateral thoracic sympathetic chains, we compared the anatomy of left and right sides and examined the anatomical variations of rami communicantes. Result: The number and variation of communicating rami connecting the spinal nerves and the second sympathetic thoracic ganglion were much larger than lower levels. There was considerably less variability in the anatomy of the rami communicantes at successive levels. Among the 59 cadavers dissected, only 14.3% (9/59) had similar anatomy of thoracic sympathetic chains at both sides. As the components related to the essential palmar hyperhidrosis, intrathoracic nerve of Kuntz from the second thoracic sympathetic ganglion to the first intercostal nerve or brachial plexus were observed in 55.9% (66/118). The incidence of descending rami communicates from the second thoracic sympathetic ganglion to the third intercostal nerve and from the third thoracic sympathetic ganglion to the fourth intercostal nerve were 49.2% (58/118) and 28.0% (33/118). And the incidence of ascending rami communicates from the third thoracic sympathetic ganglion to the second intercostal nerve and from the fourth thoracic sympathetic ganglion to the third intercostal nerve were 6.8% (8/118) and 3.4% (4/118), respectively. Conclusion: Based on the various anatomical evidences of the rami communicantes from this study, only the ramicotomy at the third sympathetic ganglion level is insufficient for the treatment of the essential palmar hyperhidrosis to decrease the difference of surgical results and recurrences. When one is planning to perform the ramicotomy for the essential palmar hyperhidrosis, it is advantageous to divide the intrathoracic nerve of Kuntz on the second rib and the descending or ascending rami communicantes on the third and the fourth ribs as well as all the communicating rami from the third sympathetic ganglion.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.1001-1004
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• 1997

Thoracic sympathectomy is the radical and definite treatment of palmar hyperhidrosis. From January 1992 to March 1997, 4 patients with recurrent hyperhidrosis underwent resympathectomy via VATS at the Department of General Thoracic and Cardiovacular Surgery, Young Dong Severance Hospital. There were 2 men and 2 women and mean age was 20.0 years. There were moderate to severe adhesions at previous resection site but no thoracotomies were performed. There was no sweating on palms in all cases and all patients were greatly 5,Btisfied with those results postoperatively. In conclusion, recurrent hyperhidrosis was successfully treated with resympathectomy via VATS. In order to prevent recurrence and minimize the postoperative complication, the proper localization of the 2nd sympathetic ganglion and the radical excision of anatomical variation including Kuntz fiber are needed.