Category: Sympathectomy

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Ultrasound-guided percutaneous puncturing technique: novel radiofrequency ablation technique for thoracic sympathectomy in treatment of palmar hyperhidrosis

Eur J Cardiothorac Surg. 2023 Nov 8:ezad372. doi: 10.1093/ejcts/ezad372. Online ahead of print.

ABSTRACT

Radiofrequency thoracic sympathectomy is routinely conducted under computed tomography or fluoroscopy in treatment of palmar hyperhidrosis. However, it remains a great challenge to perform thoracic paravertebral puncture precisely and safely, that is associated with repeated exposure of radiation and risk of pneumothorax. Alternatively, ultrasound-guided technique can provide high-resolution and real-time needle tracking during percutaneous procedure. Here, we provided our experience of ultrasonic guidance in radiofrequency sympathectomy for treatment of primary palmar hyperhidrosis.

PMID:37947326 | DOI:10.1093/ejcts/ezad372

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The success rate and associated risk factors of CT-guided percutaneous radiofrequency sympathectomy in the treatment of primary hyperhidrosis: A retrospective observational trial

J Clin Neurosci. 2023 Oct 25;118:81-89. doi: 10.1016/j.jocn.2023.10.010. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to investigate the success rate of surgical technique and associated risk factors based on the follow-up of patients who underwent CT-guided percutaneous radiofrequency sympathectomy (RFS) to treat primary hyperhidrosis (PH).

METHODS: 370 patients who underwent RFS for PH treatment between January 2018 and April 2022 were enrolled. Patients responded to a questionnaire and telephone follow-up on the effects of treatment and their electronic medical records and imaging findings were reviewed. Logistic regression was performed to identify risk factors related to the success rate of surgical technique.

RESULTS: A temperature difference ≥2 °C before and after procedure was defined as a successful surgical technique. Among the 370 patients (740 sides), 637 sides had successful RFS, and the technical success rate was 86.1 %. Immediately after procedure, 636 sides (85.9 %) were completely dry, 64 (8.7 %) were partially dry, and 40 (5.4 %) were still wet. During the longest follow-up period (54 months), 103 patients relapsed. The median hyperhidrosis disease severity scale score on both sides decreased from 4 to 1 after RFS. According to logistic regression analysis, only the pre-post pulse index was associated with the success rate of surgical technique (odds ratio, 1.14; 95 % confidence interval, 1.06-1.23; p = 0.0004).

CONCLUSIONS: We observed that the immediate efficiency and success rate of surgical technique after RFS for PH treatment were relatively high, although there is a possibility of recurrence in the long term. In general, RFS is a safe and effective procedure for alleviating the symptoms of patients with hyperhidrosis.

PMID:37890198 | DOI:10.1016/j.jocn.2023.10.010

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Machine learning analysis of primary hyperhidrosis for classification of hyperhidrosis type and prediction of compensatory hyperhidrosis

J Thorac Dis. 2023 Sep 28;15(9):4808-4817. doi: 10.21037/jtd-23-471. Epub 2023 Aug 23.

ABSTRACT

BACKGROUND: Although sympathectomy is highly effective for improving symptom, compensatory hyperhidrosis (CH) is a major issue. In this study, characteristics of primary hyperhidrosis were investigated in terms of the heart rate variability (HRV) parameters. Classification of hyperhidrosis type and prediction of CH after sympathicotomy were also determined using machine learning analysis.

METHODS: From March 2017 to December 2021, 128 subjects who underwent HRV tests before sympathicotomy were analyzed. T2 and T3 bilateral endoscopic sympathicotomy were routinely performed in patients with craniofacial and palmar hyperhidrosis, respectively. Data collected age, sex, body mass index (BMI), hyperhidrosis type, symptom improvement after sympathicotomy, the degrees of CH after sympathicotomy, and preoperative HRV findings. The independent risk factors associated with the degree of CH after sympathicotomy were investigated. Machine learning analysis was used to determine classification of hyperhidrosis type and prediction of the degree of CH.

RESULTS: Preoperatively, patients with palmar hyperhidrosis presented with significantly larger standard deviation of normal-to-normal (SDNN), root mean square of successive differences (RMSSD), total power (TP), and low frequency (LF) than patients with craniofacial hyperhidrosis after controlling for age and sex (P=0.030, P=0.004, P=0.041, and P=0.022, respectively). More sympathetic nervous predominance was found in craniofacial type (P=0.019). Low degree of CH had significantly greater RMSSD (P=0.047), and high degree of CH showed more sympathetic nervous predominance (P=0.006). Multivariate analysis showed the type and expansion of sympathicotomy were significant factors for CH (P=0.001 and P=0.028, respectively). The neural network (NN) algorithm outperformed and showed a 0.961 accuracy, 0.961 F1 score, 0.961 precision, 0.961 recall, and 0.972 area under the curve (AUC) for classification of hyperhidrosis type. The random forest (RF) model outperformed showed a 0.852 accuracy, 0.853 F1 score, 0.856 precision, 0.852 recall, and 0.914 AUC for prediction of the degree of CH.

CONCLUSIONS: The present study showed the machine learning algorithm can classify types and predict CH after sympathicotomy for primary hyperhidrosis with considerable accuracy. Further large-scale studies are needed to validate the findings and provide management guidelines for primary hyperhidrosis.

PMID:37868857 | PMC:PMC10586983 | DOI:10.21037/jtd-23-471

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Development and Validation of a Nomogram to Predict Recurrence of Primary Hyperhidrosis after CT-guided Percutaneous Radiofrequency Sympathectomy

J Vasc Interv Radiol. 2023 Aug 5:S1051-0443(23)00568-7. doi: 10.1016/j.jvir.2023.07.030. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the recurrence rate of primary hyperhidrosis (PH) after computed tomography (CT)-guided radiofrequency sympathectomy (RFS) and to identify risk factors associated with recurrence.

MATERIALS AND METHODS: A total of 290 patients with PH who received CT-guided RFS were included in this retrospective cohort study. The electronic medical record was queried for patients’ information and surgical parameters. Follow-ups were conducted for recurrence rate, and Hyperhidrosis Disease Severity Scale was used to assess presence or absence of recurrence. Stepwise regression and the least absolute shrinkage and selection operator regression algorithms were used for feature selection.

RESULTS: The recurrence rate 1 year after procedure was 17.6%. Male (hazard ratio [HR]: 2.35, 95% confidence interval [CI]:1.08-5.15), low postoperative palm or foot temperature (HR: 0.77, 95% CI:0.60-0.98), high postoperative heart rate (HR: 1.06, 95% CI:1.02-1.10), low preoperative and postoperative hospital anxiety and depression score difference (HR: 0.59, 95% CI:0.43-0.80), and the absence of compensatory hyperhidrosis immediately after procedure (HR: 0.46, 95% CI:0.22-0.98) were established as independent factors affecting prognosis. A nomogram was built accordingly. The C-indices of the training and testing sets were 0.773 and 0.659, respectively.

CONCLUSION: Follow-up results showed that the recurrence rate of PH treated with CT-guided RFS was low. This study constructed and validated a nomogram to predict the recurrence of PH 1 year after CT-guided RFS, which is convenient for interventionalists to accurately evaluate the prognosis of postoperative patients, identify high-risk patients who need more active treatment.

PMID:37549843 | DOI:10.1016/j.jvir.2023.07.030

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Rhomboid intercostal block versus serratus block for postoperative analgesia after thoracoscopic sympathectomy for primary palmar hyperhidrosis: a randomized controlled trial

BMC Anesthesiol. 2023 Jul 19;23(1):241. doi: 10.1186/s12871-023-02203-z.

ABSTRACT

BACKGROUND: Although thoracoscopic sympathectomy is made via small incisions, it is associated with severe postoperative pain. Both Rhomboid intercostal block (RIB) and serratus anterior plane block (SABP) are recent techniques used for pain control after such procedures. Herein, we compared RIB and SAPB regarding pain control in patients undergoing thoracoscopic sympathectomy for palmar hyperhidrosis.

PATIENTS AND METHODS: Three groups were enrolled in this prospective randomized study (71 patients in each group); Group S received SAPB, Group R received RIB and Group C as controls. The block procedures were performed after general anesthesia and prior to the skin incision.

RESULTS: The three groups showed comparable demographics and operative time (P ˃ 0.05). Pain scores showed a significant decline with the two block procedures compared to controls during the first day following surgery (both P ˂ 0.05), but Group R had better scores compared to Group S. Both block techniques were associated with a significant prolongation of the time to first rescue analgesic and less fentanyl consumption compared to controls (both P ˂ 0.05). However, both parameters were improved with RIB rather than SAPB (both P ˂ 0.05). Both blocks led to a significant improvement in patient satisfaction than in the control group (both P ˂ 0.05), but it was comparable between the two approaches (P ˃ 0.05).

CONCLUSION: Both RIB and SAPB are safe and effective in pain reduction after thoracoscopic sympathectomy procedures in patients with hyperhidrosis. Moreover, RIB is superior to SAPB as it is associated with better analgesic outcomes.

TRIAL REGISTRATION: Pan African Trial Registry PACTR202203766891354. https://pactr.samrc.ac.za/Researcher/TrialRegister.aspx?TrialID=21522.

PMID:37468840 | DOI:10.1186/s12871-023-02203-z

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Evaluation of quality of life (QOL) of young patients with primary hyperhidrosis (PH) before and after endoscopic thoracic sympathectomy (ETS)

J Am Acad Dermatol. 2023 May;88(5):e197-e201. doi: 10.1016/j.jaad.2015.10.048.

ABSTRACT

BACKGROUND: Primary hyperhidrosis (PH) affects young patients and may cause emotional distress and a negative quality of life (QOL).

OBJECTIVE: We sought to evaluate the QOL of children and adolescents with PH treated by endoscopic thoracic sympathectomy.

METHODS: A study of 220 patients was performed, based on submitted QOL questionnaires from their first consultation. Patients were evaluated within 1 week and 24 months after surgery.

RESULTS: Before endoscopic thoracic sympathectomy, the QOL in relation to PH was declared very poor by 141 patients, and poor by the remaining 79 (P = .552). Postoperative cure was reported in 100% of palmar and axillary PH cases, and in 91.7% of facial PH. After 24 months, the QOL was described as much better by 212 patients, a little better by 6 patients, and 2 patients reported no change.

LIMITATIONS: Convenience sampling was used and patients were taken from private practice only, raising the possibility of bias in gathering the data.

CONCLUSION: Onset of PH symptoms was mainly before the age of 10 years and substantially affected daily activities. Endoscopic thoracic sympathectomy cured PH and promoted significant improvement in the QOL of these young patients.

PMID:37069802 | DOI:10.1016/j.jaad.2015.10.048

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Comparison of the efficacy of ETS with different segments for palmar, axillary and plantar hyperhidrosis

BMC Surg. 2023 Apr 11;23(1):82. doi: 10.1186/s12893-023-01976-x.

ABSTRACT

BACKGROUND: To compare the near and long-term outcomes of endoscopic thoracic sympathectomy (ETS) for palmar, axillary and plantar hyperhidrosis.

METHODS: We retrospectively analyzed the clinical data of 218 patients with hyperhidrosis who were admitted to the Department of Thoracic Surgery of Gansu Provincial People’s Hospital for surgical treatment from April 2014 to August 2021. The patients were divided into three groups according to the method of ETS and the perioperative clinical data and postoperative follow-up data were collected to compare the near and long term outcomes of the three groups.

RESULTS: There were 197 eligible patients at follow-up, 60 patients in the R4 cut-off group, 95 patients in the R3 + R4 cut-off group and 42 patients in the R4 + R5 cut-off group. There were no statistically significant differences in baseline indicators such as sex, age and positive family history among the three groups (P > 0.05). There was no statistically significant difference between the three groups in terms of operative time (P = 0.148), intraoperative bleeding (P = 0.308) and postoperative hospital stay (P = 0.407). Postoperatively, all three groups showed significant relief of palmar hyperhidrosis symptoms, with the R3 + R4 group having an advantage in terms of relief of axillary hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively and the R4 + R5 group having an advantage in terms of relief of plantar hyperhidrosis symptoms. The difference in compensatory hyperhidrosis at 12 months postoperatively was not statistically significant among the three groups (P = 0.867), but the incidence was higher in the R3 + R4 and R4 + R5 groups than that in the R4 group.

CONCLUSION: Patients with simple palmar hyperhidrosis can first consider R4 cut-off treatment; R3 + R4 cut-off is more effective in treating palmar hyperhidrosis combined with axillary hyperhidrosis; R4 + R5 cut-off is more effective in treating palmar hyperhidrosis combined with plantar hyperhidrosis. However, patients need to be informed that R3 + R4 and R4 + R5 dissection may increase the risk of severe compensatory hyperhidrosis after surgery.

PMID:37041509 | DOI:10.1186/s12893-023-01976-x

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Impact of endoscopic thoracic R4 sympathicotomy combined with R3 ramicotomy for primary palmar hyperhidrosis

Front Surg. 2023 Feb 24;10:1144299. doi: 10.3389/fsurg.2023.1144299. eCollection 2023.

ABSTRACT

BACKGROUND: Endoscopic thoracoscopic sympathectomy (ETS) is the preferred method for treating primary palmar hyperhidrosis (PPH) that bears the risk of compensatory hyperhidrosis (CH) following surgery. The current study aims to evaluate the effectiveness and safety of an innovative surgical procedure of ETS.

METHODS: A survey of the clinical data of 109 patients with PPH who underwent ETS in our department from May 2018 to August 2021 was retrospectively conducted. The patients were organized into two groups. Group A underwent R4 sympathicotomy combined with R3 ramicotomy. Group B underwent R3 sympathicotomy. Patients were followed up to evaluate the safety, effectiveness and the incidence of postoperative CH of the modified surgical approach.

RESULTS: A total of 102 patients completed follow-up, and seven of the total enrolled patients were lost to follow-up, with a loss rate of 6% (7/109). Among these, Group A constitutes 54 cases, group B constitutes 48 cases, and the mean follow-up was 14 months (interquartile range 12-23 months). There was no statistically difference in surgical safety, postoperative efficacy, and postoperative quality of life (QoL) score between group A and group B (p > 0.05). The score of the psychological assessment was higher (p = 0.004) in group A (14.15 ± 2.06) compared to group B (13.30 ± 1.86). The incidence of CH in group A was lower than in group B (p = 0.019).

CONCLUSION: R4 sympathicotomy combined with R3 ramicotomy is safe and effective for PPH treatment, along with a reduced incidence of postoperative CH rate and improved postoperative psychological satisfaction.

PMID:36911618 | PMC:PMC9998541 | DOI:10.3389/fsurg.2023.1144299