Abstract
Endoscopic transthoracic sympathectomy (ETS) has become an established treatment for primary hyperhidrosis. Hyperhidrosis is generally benign, so the size of the wound should be kept as small as possible. To this end, we performed ETS using thin instruments in 74 patients who were treated under two port punctures 2mm in diameter on each side. A MiniSite GOLD laparoscope (USSC171348: USA) and a Kirschner wire were inserted through these punctures. Thoracic sympathetic chains were electrocauterized on the second to the third (or fourth) ribs. Questionnaires were sent to the first 68 patients to investigate the subjective changes in sweating. Forty-five patients were inspected by finger plethysmography to evaluate the peripheral vessels. Thirty-two patients underwent Holter ECG to evaluate the sympathetic function of the heart. Sweating in the palms stopped immediately after the surgery. There were no serious complications. Ninety-two percent of the patients were satisfied with the operation. The wave height on the finger plethysmogram was increased postoperatively. The average heart rate decreased especially in the daytime. ETS under two punctures of 2 mm in diameter was sufficient for the treatment of primary hyperhidrosis. Our method is the most minimally invasive ETS reported to date, because of the tiny size of the punctures.
