Early results of new endoscopic thoracic sympathectomy for craniofacial hyperhidrosis

Abstract

Background: Endoscopic thoracic sympathectomy (ETS) has been considered as a definitive treatment for hyperhidrosis. However, despite its well-established success rate, surgical treatment for craniofacial hyperhidrosis (CFH) is rarely performed due to the possibility of fatal complications and compensatory sweating. The aim of this study was to evaluate the safety and efficacy of our newly developed method of ETS for CFH, based on early results.

Methods: Between June 2016 and October 2017, a total of 70 patients underwent ETS with our new technique for CFH. All patients were placed under double-lumen intubation anesthesia with CO2 gas installation. We utilized two ports, one for 2-mm endoscope and another for 3-mm instrument. Our technique involved R2 and R4-R7 sympathectomy with R4-R7 truncal ablation.

Results: There were 55 males and 15 females, with a mean age of 48 years (range, 22-75 years). The median operation time was 38 minutes (range, 28-75 minutes). There was no operative mortality and morbidity. During the short follow-up period (average 7 months; range, 1-17 months), symptoms were improved in all patients and compensatory hyperhidrosis was observed 68 patients: mild in 50 patients (71.4%), moderate in 13 patients (18.6%), and severe in 5 patients (7.1%).

Conclusions: In select patients, our technique of ETS appears to be a safe and effective treatment method for treating CFH. However, a study with long-term follow-up is still necessary to confirm our findings.

Keywords: Craniofacial hyperhidrosis (CFH); compensatory hyperhidrosis; endoscopic thoracic sympathectomy (ETS).

Figure 1

New endoscopic thoracic sympathectomy technique for craniofacial hyperhidrosis: R2 and R4–R7 sympathectomy with R4–R7 truncal ablation.

Figure 2

Frequency of compensatory hyperhidrosis sites.