Thoracoscopic T2 sympathicotomy under local anesthesia

초록

Background. Hyperhidrosis of the palm, axilla and face has a strong negative impact on social and professional life. A definitive cure can be obtained by upper thoracic sympathicotomy. However, sympathicotomy has been performed under the general anesthesia by either a single lumen or double lumen endotracheal intubation. It is very tedious to perform general anesthesia and therefore have post-operative recovery period after a short time of surgery, and we have performed thoracoscopic sympathicotomy under local anesthesia in order to avoid that. Method. From April 1998 to July 1998, 17 cases of thoracoscopic sympathicotomy with 2 mm video-thoracoscope were performed under the local anesthesia. The second thoracic sympathetic chain was cut on the inner side of second rib using endoscissors. Results. Bilateral procedure took less than 25 minutes and the patients were discharged on same day as the operation day. There has been no mortality nor life-threatening complications and there were no primary failure and no recurrent hyperhidrosis. At end of postoperative follow 뻰p( median 2 months) 70.5% of the patients were satisfied with the result. Compensatory sweating occurred in all 17 cases(100%) with five(29.5%) of those classified as either embarrassing or disabling. Conclusion. Thoracoscopic sympathicotomy under the local anesthesia is safe, minimally invasive method and it is an alternative surgical method for the treatment of palmar and craniofacial hyperhidrosis