• Journal of Korean Neurosurgical Society
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• v.30 no.10
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• pp.1177-1181
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• 2001

Objective : Thoracoscopic T2 sympathicotomy had been performed as a simple and effective method in treating palmar hyperhidrosis, but some patients are not satisfied with the result of sympathicotomy due to compensatory hyperhidrosis. Therefore, a more limited T2 sympathicotomy using 2mm endoscope was introduced. We made a comparison between conventional T2 sympathicotomy and limited T2 sympathicotomy on operative results and compensatory hyperhidrosis. Material and Method : From January 1998 to April 2000, 56 patients were treated by video assisted endoscopic thoracic sympathicotomy. Thirty patients of these underwent T2 sympathicotomy(Group A), and the remainders underwent limited T2 sympathicotomy(Group B). The limited T2 sympathicotomy is coagulation of the interganglionic fibers of T2 sympathetic ganglion on T2 rib head. The comparative analysis between two groups was based on the medical records and telephone interview results. Result : All patients were treated for excessive sweating on palms with 2mm endoscopic sympathicotmy. There were no mortalities, life-threatening complications except one recurrent patient who was treated successfully with reoperation( endoscopic sympathicotomy). Compensatory hyperhidrosis was common in group A. An individual satisfactory rate for the operations was higher in group B than in group A. Conclusion : The limited T2 sympathicotomy considered to be a more effective and less complicated method than the T2 sympathicotomy for the treatment of palmar 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 Korean Neurosurgical Society
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• v.37 no.5
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• pp.354-356
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• 2005

Objective: Thoracoscopic sympathicotomy is effective in treating not only palmar hyperhidrosis, but also axillary hyperhidrosis. But studies for axillary hyperhidrosis accompanying osmidrosis are few. We report the outcome of six axillary hyperhidrosis with osmidrosis with literatures review. Methods: Using a minimally invasive technique, thoracoscopic T3-4 sympathicotomy was performed. The results of sympathicotomy of third and fourth sympathetic chains of six patients from January 1999 to August 2003 for axillary hyperhidrosis with osmidrosis were reviewed. Results: All patients had a successful outcomes, their profuse sweating ceased. Two patients suffered from compensatory hyperhidrosis. Three patients disappeared or diminished foul odor but three patients complained remained osmidrosis. Conclusion: In the treatment of axillary hyperhidrosis, the sympathicotomy of T3 and T4 chain is an effective method but osmidrosis must be treated according to its cause.

• 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.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.56-60
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• 2001

Background: Conventional thoracoscopic sympathectomy or sympathicotomy is an effective method in treating localized hyperhidrosis; however, this may result in a postoperatively compensatory hyperhidrosis or facial anhidrosis in the treatment of palmar hyperhidrosis. We modified the conventional sympathicotomy by limiting the extent of nerve transection (limited T3 sympathicotomy) since May 1998. However, there are many reports of a good short-term outcome of limited T3 sympathicotomy. Therefore, we reviewed long-term follow-up of limited T3 sympathicotomy based on outcomes analysis using a questionnaire. Methods: Fifty four patients with palmar hyperhidrosis underwent a limited T3 sympathicotomy between May 1998 and March 1999 and had a complete follow-up over two years using a questionnaire (the mean follow-up was 2.6 years). The patients' postoperative satisfaction was determined by their subjective responses to the questionnaires; the degree of compensatory hyperhidrosis, the effects on foot hyperhidrosis, gustatory hyperhidrosis and facial dryness, and recurrence, and patient's satisfaction. Results: Of the total, 87% of patients had a compensatory hyperhidrosis and 3.7% of them were disabled. 31.5% of patients showed improvement in foot hyperhidrosis, while 68.5% of patients demonstrated no change or got worse. 31.5% of patients had gustatory hyperhidrosis and facial dryness and 22.2% of patients showed a mild palmar hyperhidrosis. The postoperative patients' satisfaction was significantly in 96.3% of patients. Conclusions: The limited T3 sympathicotomy is a highly effective treatment of palmar hyperhidrosis and has a low rate of postoperative compensatory hyperhidrosis, gustatory hyperhidrosis, and facial dryness.

• 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 Pediatrics of Korean Medicine
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• v.16 no.1
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• pp.1-8
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• 2002

Back ground: The purpose of this study was to examine the patient's satisfaction of Sympathicotomy and clinical observation by Oriental medicine. Methods: We studied 93 hyperhidrosis patients after Sympathicotomy. They were treated on East-West Hyperhidrosis Clinic, Kyung Hee University Medical Center, from October 1999 to February 2002. Resurt and Conclusion: The most patients were satisfied with treatment effects of Sympathicotomy and there were few side effects. The only complain was compensatory sweating. Sympathicotomy can be recommended as a useful treatment for hyperhidrosis. Clinical study by Oriental medicine on hyperhidrosis patients was showed that hyperhidrosis could be observed at Taeeumin, Soyangin and Soeumin. We can find the new treatment of compensatory sweating, by Sasang Constitutional Medicine and Oriental diagnosis.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.486-492
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• 2001

Objective : Essential hyperhidrosis is a pathological condition of excessive sweating beyond that required to cool the body, though poorly understood, originating from a dysfunction of the sympathetic nervous system. Thoracoscopic sympathectomy is the most popular treatment for upper limb hyperhidrosis, because it is a safe, effective, minimally invasive, and time-saving method. However, the common complication is the compensatory hyperhidrosis in other areas of the body, notably on the back, chest, abdomen, and buttocks. Compensatory hyperhidrosis is severe enough for some people, especially those living in a warm climate or engaging in heavy physical activities, to regret ever having had operation. The pathophysiological mechanisms underlying compensatory hyperhidrosis are incompletely understood, even though it is thought to be a truly compensatory feature related to thermoregulation of the body. Materials and Methods : we studied the clinical features of total 233 patients who were diagnosed as essential hyperhidrosis and treated with thoracoscopic sympathectomy or sympathicotomy from March 1992 to July 2000. Results : The success rate of thoracoscopic sympathetic surgery(sympathectomy or sympathicotomy) was 98.7%. The global rate of compensatory hyperhidrosis was 77% ; 84% in group T2, 3 sympathectomy, 76% in group T2 sympathectomy, 43% in group T2, 3 sympathicotomy and 59% in group T2 sympathicotomy. The rate of embarrassing or disabling compensatory sweating was significantly higher in T2 sympathectomy and in T2, 3 sympathectomy than in T2 sympathicotomy and T2, 3 sympathicotomy with significancy in statistic analysis(p<0.01). The precipitating factors of compensatory hiperhidrosis, including heat(warm weather), anxiety, stress, and exertion were noted. The compensatory hyperhidrosis was the main cause of patient dissatisfaction after thoracoscopic sympathectomy. Conclusion : The degree of compensatory hyperhidrosis is closely related to the extent of thoracic sympathectomy.

• 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.

• The Korean Journal of Pain
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• v.14 no.2
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• pp.181-185
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• 2001

Background: Bradycardia frequently occurs in intravenous anesthesia with propofol. Additionally, the thoracic sympathetic nerves influence the heart so that the heart rate (HR) and blood pressure are expected to decrease due to this procedure. Therefore, we measured changes in HR, mean arterial pressure (MAP) and both thumb temperatures before and after thoracic sympathicotomy under total intravenous anesthesia with propofol. Methods: The subjects included 21 outpatients of ASA class I who received thoracoscopic thoracic sympathicotomy under total intravenous anesthesia. Anesthesia was induced with propofol (2 mg/kg) and vecuronium (0.1 mg/kg) and maintained with propofol-fentanyl-oxygen (100%). The surgical procedure was performed at the T3 level in the order of left sympathicotomy (LST) and right sympathicotomy (RST). Measurements of HR, MAP and both thumb temperatures were taken before induction of anesthesia, before and after LST and RST, and 1 hour after the completion of anesthesia. Additionally, the time to the beginning of a rise in temperature in both thumbs after sympathicotomy was recorded. Results: HR did not show any significant difference before or after sympathicotomy, however it decreased at 1 hour after the completion of anesthesia. MAP decreased after LST and decreased further after RST. Left thumb temperature began to increase at $45.8{\pm}10.7$ seconds after LST. Right thumb temperature initially decreased after LST and increased from $45.2{\pm}11.8$ seconds after RST. Subsequently, both increased temperatures were maintained at 1 hour after the completion of anesthesia. Conclusions: Although HR and MAP decreased, there were no severe hemodynamic changes. An increase in the thumb temperature was confirmed within 1 minute after sympathicotomy on the same side.