Materials and Methods:
In our prospective study from April 2018 to August 2019, we enrolled 213 consecutive patients diagnosed as primary hyperhidrosis. We managed the patients in the Cardiothoracic Surgery and Vascular Surgery departments, Menoufia university hospitals. The Ethical committee of Menoufia Faculty of Medicine approved data collection and waived the need for patient consent.
We used The Hyperhidrosis Disease Severity Scale (HDSS) scoring system to evaluate patients’ quality of life throughout the study. We included patients with moderate to severe quality of life impairment; those patients are patients who scored 3 or 4 in the scale. They were managed by bilateral simultaneous drainless one-port thoracoscopic sympathectomy (DOTS), starting by right side then left one in the same session.
Anesthesiologist used general anesthesia with double lumen endotracheal tube to allow the single lung ventilation. Positioning in 45° anti-Trendelenburg supine position with both arms abducted at 90° enhanced the both sides to be operated on same session without repositioning. It ended up saving more time.
We operate with only one skin incision. In males, the incision was in 3rd or 4th space anterior axillary line; while in females, it was placed under mammary crease for cosmetic purpose. Through this single opening, we introduce 10-mm camera and electrocautery endoscopic spatula; no insufflator was required.
Parietal pleura overlying the chain was incised using electrocautery; then the sympathetic chain was divided by 5 seconds continuous cautery at top and bottom of R2, R3, R4. The lateral aspect of each rib was cauterized for 1-2 cm to ensure a complete cut of any Kuntz’s inter-neuronal connections; if left uncut, it may cause failure of the sympathetic denervation.
With coordination with anesthesiologist, lung expansion was observed under direct vision using continuous positive pressure for a few seconds at the end of the procedure. One or two stitches were applied to close the port site; the other side was operated afterwards using the same technique.
Post-operatively, follow-up of patients in the recovery room after being extubated was continued till full recovery from anesthesia. Normal equality of air entry and oxygen saturation were necessary for discharge to ward. Paracetamol or non-steroidal anti-inflammatory drugs (NSAIDS) were the drugs we used for pain control. We performed a chest x-ray film to detect post-operative hemothorax or pneumothorax. We recorded neurological problems (as: Horner’s syndrome) and hospital stay (in hours).
Follow-up in the outpatient clinic was after one week, one month, 6 months, and 1 year after discharge. Every visit, we checked for: improvement of hyperhidrosis (using HDSS Score), recurrence, CH (site and severity), and wound infection.
Statistical analysis: Collected data was expressed as mean and standard deviation (M±SD) or number and percent (n, %). Comparison between the two groups was performed using t test, Chi square analysis (χ2), or Fischer’s exact test when appropriate. The data were considered significant if P-value was less than 0.05. Statistical analysis was performed with the aid of the IBM Statistical Package for Social Science (SPSS) version 20 (IBM corporation, Chicago, IL, USA).