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Eur J Cardiothorac Surg 2001;19:952
© 2001 Elsevier Science NL

Letter to the Editor

Reply to Kao

Sook Whan Sung, Young Tae Kim, Joo Hyun Kim

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea

Received 25 March 2001; accepted 2 April 2001.

Corresponding author. Tel.: +82-2-760-3637; fax: +82-2-764-3664
e-mail: swsung{at}snu.ac.kr

We appreciate the interest expressed by Dr Kao in our paper [1], which emphasizes easy usability and safety of ultrathin needlescopic sympathicotomy in hyperhidrosis. Dr Kao raised several comments and important surgical tips.

From the early 90s there was upsurge for thoracoscopic sympathicotomy in Europe and Asia and Israel with the general development of endoscopic surgical techniques [2], and Dr Kao was one of leading surgeons for that procedure.

The exact numbering of the ribs is very important for this surgery. There are several endoscopcic landmarks; such as the different curvature pattern of each rib and bundle of superior intercostals vessels and a prominent draining vein. However these landmarks are not constant and sometimes obscured by fatty tissues. In our experience, there has been 1–2% calculation error, even in the case of experienced surgeons. The metal wire positing is a very simple procedure that can tell us the exact number by X-ray.

Our initial surgical approach was ganglion resection, and then we switched to a simpler procedure of division of the sympathetic trunk i.e. sympathicotomy, which was already shown comparable results from the findings of others and ourselves [3,4]. Although we do not have a concrete data of better results, our experience suggests decreased incidence and amount of truncal sweating and less dryness of hands by reducing the division number of the sympathetic trunk.

When using ultra-thin 2-mm ports, spontaneous collapse of the lung is not easy and time consuming. With small volume of CO2 insufflation we can enjoy a good operative field. Although the view is not as clear and sharp as a 10-mm scope, the needlescope is far enough to divide sympathetic nerve as shown by us with a very high success rate and very low complication rates.

References

  1. Sung S.W., Kim Y.T., Kim J.H. Ultra-thin needle thoracoscopic surgery for hyperhidrosis with excellent cosmetic effects. Eur J Cardio-thorac Surg 2000;17:691-696.[Abstract/Free Full Text]
  2. Drott C., Gothberg G., Claes G. Endoscopic procedures of the upper thoracic sympathectic chain. A review. Arch Surg 1993;128:237-241.[Abstract/Free Full Text]
  3. Sung S.W., Cho K.R., Kim Y.T., Kim J.H. Comparison of T2 and T2T3 sympathicotomy in palmar hyperhidrosis. Kor J Thorac Cardiovasc Surg 1998;32:465-470.
  4. Lars O.R., Christer D., Goran C., Rex L.D, Drott C., Claes G., Göthberg G., Dalman P. The Boras experience of endoscopic thoracic sympathicotomy for palmar, axillary, facial hyperhidrosis and facial blushing. Eur J Surg 1998;Suppl 580:23-26.




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