Thoracoscopic Sympathicolysis for Essential Hyperhidrosis
Thoracoscopic sympathicolysis for essential hyperhidrosis:
effects on pulmonary function
M. Noppen, W. Vincken
ABSTRACT: Bilateral interruption of the upper dorsal sympathetic chain at the
D2 and D3 level represents the only permanent cure for essential hyperhidrosis.
Following surgical sympathectomy, significant and symptomatic changes in pulmonary
function have been observed. Since functional effects of the surgical intervention
cannot be excluded, we wondered whether such alterations also occurred
after thoracoscopic sympathicolysis; these should then be attributable to the surgical
denervation itself.
Pulmonary function tests (PFTs), including spirometry and body plethysmographic
measurement of lung volumes and airway resistance and conductance, were compared
before and 6 weeks after thoracoscopic sympathicolysis in 47 patients. In
order to virtually exclude any effects of thoracoscopy on the test results, PFTs were
repeated 6 months after thoracoscopic sympathicolysis in 35 patients.
Essential hyperhidrosis was completely relieved in all patients, thereby confirming
the interruption of the D2-D3 sympathetic chain. None of the patients developed
respiratory symptoms after thoracoscopic sympathicolysis. Forced expiratory
volume in one second (FEV1) (-3%), forced expiratory flow after exhaling 75% of
vital capacity (FEF75) (-8%) and total lung capacity (TLC) (-3%) were slightly but
significantly reduced at six weeks after thoracoscopic sympathicolysis; whereas airway
resistance (Raw) had increased (+12%). After correction for the small decrease
in lung volume (FEV1/forced vital capacity (FVC), specific airway resistance (sRaw),
specific airway conductance (sGaw))significant changes in “volume-dependent” PFT
parameters were no longer observed. Smoking status had no influence on the reduction
in FEF75. At 6 months after thoracoscopic sympathicolysis, TLC had returned
to preoperative values, whereas FEF75 remained decreased (-8.6%). The decrease in
airway calibre was confirmed by small but significant changes in FEV1/FVC (-2%)
and Raw (+29%).
We conclude that thoracoscopic sympathicolysis in patients with essential hyperhidrosis
causes only minimal and subclinical changes in pulmonary function secondary
to a temporary small decrease in lung volume, which in turn is probably
inherent to the thoracoscopic procedure. D2-D3 sympathicolysis, in itself, is responsible
only for a small and permanent decrease in forced expiratory flow, which suggests
that, at least in essential hyperhidrosis patients, airway bronchomotor tone is
influenced by sympathetic innervation.