Temporary thoracoscopic sympathetic block for hyperhidrosis
- PMID: 18355498
- DOI: 10.1016/j.athoracsur.2007.11.020
Temporary thoracoscopic sympathetic block for hyperhidrosis
Abstract
Background: Compensatory hyperhidrosis (CH) is the most common side effect after a thoracoscopic sympathectomy. The fear of CH is the most common reason why patients do not undergo a sympathectomy, because it is an irreversible procedure unless removal clips are used. Unfortunately, clip removal for reversal of postsympathectomy CH has not been reliable. To address this issue, we developed a new technique of a temporary thoracoscopic sympathetic block that can hopefully predict if postsympathectomy CH is going to occur after sympathectomy for medical refractory primary hyperhidrosis (PH).
Methods: We reviewed all patients who underwent a temporary thoracoscopic sympathetic block and subsequent thoracoscopic sympathectomy for medical refractory PH. All patients were concerned about the development of CH and requested the possibility of a reversible procedure.
Results: Twenty-five patients underwent a temporary thoracoscopic sympathetic block; 18 suffered from palmar, axillary, and plantar hyperhidrosis, 4 had axillary and plantar hyperhidrosis; and 3 had palmar and plantar hyperhidrosis. The sympathetic block and subsequent sympathectomy were performed as outpatient bilateral thoracoscopic procedures. Sympathetic blockade was performed at each level of the planned sympathectomy (T2, T3, and accessory nerves) with 2.5 cc 0.25% marcaine with epinephrine per level without complications. All patients had temporary relief of hyperhidrosis ranging from 1 to 10 days with a median of 4 days after the block. Three patients (12%) had temporary CH after the thoracoscopic block, 2 mild and 1 severe. All but 1 (4%), the severe CH patient, elected to proceed with the planned sympathectomy; all sympathectomy patients (100%) were cured of their excessive sweating. The 2 patients who experienced mild CH after the thoracoscopic block also had it after the sympathectomy. All patients were completely satisfied with the final results, even the 2 patients in whom mild CH developed.
Conclusions: Temporary thoracoscopic sympathetic block is a reversible and accurate procedure for the determination of postsympathectomy CH. A temporary thoracoscopic sympathetic block followed by sympathectomy may be the best approach for the treatment of medically refractory PH in patients who are concerned about the development of postsympathectomy CH.
Similar articles
-
Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility.J Thorac Cardiovasc Surg. 2009 Jun;137(6):1370-6; discussion 1376-7. doi: 10.1016/j.jtcvs.2009.01.008. J Thorac Cardiovasc Surg. 2009. PMID: 19464450
-
T3T4 endoscopic sympathetic blockade versus T3T4 video thoracoscopic sympathectomy in the treatment of axillary hyperhidrosis.Ann Thorac Surg. 2009 Dec;88(6):1780-5. doi: 10.1016/j.athoracsur.2009.08.007. Ann Thorac Surg. 2009. PMID: 19932234
-
Endoscopic thoracic sympathetic block by clipping for recurrent palmar hyperhidrosis.Int Surg. 2005 Nov-Dec;90(5):284-8. Int Surg. 2005. PMID: 16625948
-
Long-term results of thoracoscopic sympathectomy for hyperhidrosis.Ann Thorac Surg. 2004 Nov;78(5):1801-7. doi: 10.1016/j.athoracsur.2004.03.012. Ann Thorac Surg. 2004. PMID: 15511477 Review.
-
Thoracoscopic sympathectomy: a standardized approach to therapy for hyperhidrosis.Ann Thorac Surg. 2008 Feb;85(2):S764-7. doi: 10.1016/j.athoracsur.2007.12.005. Ann Thorac Surg. 2008. PMID: 18222213 Review.
Cited by
-
Thoracic sympathectomy: a review of current indications.Surg Endosc. 2016 Apr;30(4):1255-69. doi: 10.1007/s00464-015-4353-0. Epub 2015 Jun 27. Surg Endosc. 2016. PMID: 26123342 Review.
-
Achieving high patient satisfaction after sympathectomy through preoperative thoracoscopic sympathetic nerve block in primary hyperhidrosis.J Thorac Dis. 2025 Apr 30;17(4):2050-2055. doi: 10.21037/jtd-2024-2145. Epub 2025 Apr 21. J Thorac Dis. 2025. PMID: 40400983 Free PMC article.
-
Novel Treatment of Palmar Hyperhidrosis With Robotic Hybrid Cryoablation Sympathectomy.Innovations (Phila). 2025 Jan-Feb;20(1):106-108. doi: 10.1177/15569845241298256. Epub 2024 Dec 30. Innovations (Phila). 2025. PMID: 40071566 Free PMC article. No abstract available.
-
Prediction of compensatory hyperhidrosis with botulinum toxin A and local anesthetic.Clin Auton Res. 2015 Aug;25(4):201-5. doi: 10.1007/s10286-015-0288-8. Epub 2015 May 8. Clin Auton Res. 2015. PMID: 25952006
-
Thoracoscopic sympathetic block to predict compensatory hyperhidrosis in primary hyperhidrosis.J Thorac Dis. 2021 Jun;13(6):3509-3517. doi: 10.21037/jtd-21-229. J Thorac Dis. 2021. PMID: 34277046 Free PMC article.
MeSH terms
LinkOut - more resources
Full Text Sources