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Primary palmar hyperhidrosis is a functionally and socially disabling condition for which thorascopic sympathectomy is now the accepted treatment.1-7 Many studies have shown the benefit of this procedure over the older open surgical techniques but few have reported the use of the laser probe.5
In this paper, we report the results of a single surgeon's experience using the laser probe allowing for the use of a single port with minimal dissection.
Patients and Methods
From 1987 to 2006, 123 patients underwent 233 procedures. Of these, 105 patients had bilateral procedures in one operation, 5 patients had a bilateral procedure performed but each side was a separate occasion, and 13 underwent unilateral procedures.
The patient age range was 9-71 years and 75 (61%) were women. The indications for operation were palmar hyperhidrosis (110), facial blushing (8) and digital ischaemia with tissue loss (5).
The patients were intubated with a double lumen tube and placed in the crucifix position. After clamping the tube to the relevant lung, a Verres needle was inserted in the mid-axillary line in the 4th intercostal space and, depending on the size of the patient, 500-1000 ml of carbon dioxide was insufflated. A 10-mm trocar was then inserted followed by the fibrescope. The anatomy was identified and a Yag laser CL 60 fibre (Neomed UK Ltd, 56 Enterprise Centre, Cranborne Road, Potters Bar EN6 3QD, UK) passed down the scope (Fig. 1). The sympathetic chain was treated with the laser beam at 8-12 W using, in most cases, between 1500-2500 J and at a wavelength of 1064-1066 nm, treating T2, T3 and, occasionally, T4.
After laser treatment, the lung was then re-expanded under direct vision. If a bilateral procedure was performed, a short time interval was allowed to ensure adequate recovery of pulmonary ventilation and perfusion before proceeding to the contralateral side. Patients had a chest X-ray in recovery and oxygen administered overnight. All went home the following day.
Patients were telephoned using available contact details for follow-up telephone interview.
Results
Of the 110 patients planned for bilateral procedure, 5 required the procedure to be performed in separate stages for a variety of causes (Table 1). Eight procedures failed at the first attempt (Table 2). Of these, one patient whose initial procedure failed...