Prospective randomized study comparing Video assisted thoracoscopic surgery (VATS) resection versus cautery for treatment of primary hyperhydrosis

Background

Endoscopic thoracic sympathectomy (ETS) can predictably eliminate the disabling symptoms of palmar and axillary hyperhidrosis. There is debate over different techniques, including excision, electro diathermy ablation or application of surgical clips on the thoracic sympathetic ganglia.

The present study was done to compare the results achieved by thoracoscopic resection and electro-cautery ablation.

Methods

This prospective randomized study was conducted in our centers along 3 years and included 40 patients with palmar and/or axillary hyperhidrosis who underwent a thoracoscopic sympathectomy. They were randomized into 2 groups; each of 20 patients. Group 1 (ABLATION GROUP); the sympathetic chains and ganglia were cauterized and group 2 (RESECTION GROUP); the sympathetic chains with T₂, T₃ and T₄ ganglia were resected.

Results

40 patients with palmar and/or axillary hyperhidrosis underwent thoracoscopic sympathectomy. The procedures were performed through two 5 mm ports in all patients of group1. In group 2 we used one 10 mm port with a single 5 mm port in 12 patients, and one 10 mm port with two 5 mm ports in 8 patients. Success rate (defined as dramatic disappearance of sweating) and patient satisfaction were 100% in both groups. Moderate to severe postoperative pain was observed more in Group 2 {with Two patients (10%) in group 1 and 8 patients (40%) in group 2} requiring more analgesics than the standard doses. Also, minor bleeding that was controlled by diathermy in 1 patient (5%) in group 1 and 3 patients (15%) in group 2. Pneumothorax requiring chest drainage in 2 patients (10%) in group 2, compensatory hyperhidrosis, affecting 2 patients (10%) one in each group, recurrence of symptoms occurred in 1 patient (5%) in group1.

Conclusions

There is no statistically significant difference between VATS cautery ablation and complete resection of T_{2, 3, 4} regarding success rate and patient satisfaction; On the other hand, cauterization carry less postoperative pain and pneumothorax as well as less hospital stay.