Video-Assisted Thoracoscopic Sympathectomy: A Comparative Study of Uniportal and Biportal Approaches in the Treatment of Primary Palmar Hyperhidrosis
Majed Al Mourgi and Mohammed Al Saeed
Department of Surgery, Taif University, Saudi Arabia
Department of Surgery, King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia
Background: Palmar hyperhidrosis is unpleasant condition. Both uniportal and biportal video-assisted thoracoscopic sympathectomy (VATS) offers safe and durable solution for the condition. However, most of the studies verified that the uniportal approach has less postoperative pain and less operative time.
Aim of the study: The present study aimed to compare the results of using a single port and two ports to perform VATS for palmar hyperhidrosis.
Patients and methods: This prospective randomized study was conducted in King Abdul Aziz Specialist Hospital, Taif, Saudi Arabia, from August 2011 to January 2015. The study included 40 patients with primary palmar hyperhidrosis. They were randomized into two groups; each of 20 patients. In one group; the uniportal approach was used and biportal approach was used in the second. In both groups the T2 and T3 ganglia were ablated bilaterally using electro-coagulation diathermy hook. Suitable statistical analyses were used to find out significance between the 2 groups.
Results: The mean operating time for bilateral sympathectomy in the uniportal group was 26.0±6.2 minutes versus 34.0±8.1 minutes in biportal group (p = 0.0005). Mild intercostal bleeding occurred in 1 patient of each group (5%). The mean postoperative hospital stay in the uniportal group was 13.0±3.2 hours and in the biportal group was 22.0±5.1 hours (p < 0.001). No deaths occurred and all patients are discharged with dry hands. Neuralgic pain of the chest wall developed in 7 patients (35%) of the sympathectomies of the biportal group and 3 patients (15%) of the uniportal group (p = 0.144). In both groups the pain was mild and was easily controlled by simple analgesic except in 2 patients of the biportal group the pain was moderate in severity and required stronger analgesics to control. In one patient of the uniportal group and in 3 patients of biportal group mild pain persists, but completely disappeared in about one month (p = 0.604). Unilateral transient Horner's syndrome developed in one patient in each group. Compensatory hyperhidrosis of trunk and thighs occurred in 6 patients (30%) in each group. No recurrence was recorded in both groups with mean follow up for 24.0±5.4 months.
Conclusions: This study confirms the effectiveness and safety of uniportal and biportal VATS for treatment of primary hyperhidrosis. However, the uniportal approach has the advantage of shorter operating time, lower incidence of postoperative pain and shorter hospital stay.