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J Thorac Cardiovasc Surg 2001;122:633
© 2001 The American Association for Thoracic Surgery

Letters to the Editor

Needlescopic surgery for palmar hyperhidrosis

Ming-Chien Kao, MD, DMSc

Professor, and Chief, Division of Neurosurgery, National Taiwan University Hospital, 7, Chung-Shan South Rd,
Taipei, Taiwan, Republic of China

To the Editor:

I read with interest the article on needlescopic surgery for palmar hyperhidrosis by Yamamoto and associates.Go 1 I congratulate them on their excellent results. On the basis of my extensive experience using thoracoscopic sympathectomy to treat patients with palmar hyperhidrosis, I would like to comment on several important points.

After correct sympathectomy, which usually consists of T2 sympathectomy, a significant increase of palmar skin perfusion of more than 50% above the original level is noted. However, palmar skin temperature usually rises approximately 2°C to 3°C, which is not as much as the 50% increase noted by the authors.Go Go 2,3

Regarding the position of the patient and the anesthetic technique used, I believe the semi-Fowler position using single-lumen endotracheal general anesthesia is satisfactory for thoracoscopic sympathectomy, rather than having the patient in a sitting position with a double-lumen endobronchial tube.Go 4

Regarding the location of the ribs, two anatomic landmarks are very helpful. The first is the superior intercostal vessels. The vessels are very often visible and vertically cross the second rib near or slightly lateral and parallel to the sympathetic trunk. The second landmark is a prominent draining vein, which is clearly visible and is always located at the lower medial corner of the third rib head. In addition to these two landmarks, further aid in monitoring palmar skin temperature, such as fluoroscopic rib counting, as mentioned by the authors, is not necessary.Go 5

12/8/115416

doi:10.1067/mtc.2001.115416

References

  1. Yamamoto H, Kanehira A, Kawamura M, Okada M, Ohkita Y. Needlescopic surgery for palmar hyperhidrosis. J Thorac Cardiovasc Surg. 2000;120:276-9.[Abstract/Free Full Text]
  2. Kao MC, Tsai JC, Lai DM, Hsiao YY, Chiu MJ. Autonomic activities in hyperhidrosis patients before, during, and after endoscopic laser sympathectomy. Neurosurgery. 1994;34:262-8.[Medline]
  3. Kao MC. Endoscopic sympathectomy. J Neurosurg Spine. 2000;93:342-3.
  4. Kao MC, Chern SH, Cheng LCJ, Hsiao YY, Lee YS, Tsai JC. Video thoracoscopic laser sympathectomy for palmar hyperhidrosis. Ann Acad Med Singapore. 1994;23:38-42.[Medline]
  5. Kao MC, Transthoracic endoscopic sympathectomy. Surg Neurol. 2000;54:96-7.[Medline]



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[Abstract] [Full Text] [PDF]

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