Palmar hyperhidrosis: Intraoperative monitoring with laser doppler blood flow as a guide for success after endoscopic thoracic sympathectomy

Abstract

OBJECTIVE: Video-assisted endoscopic thoracic sympathectomy is an effective surgical procedure for treating patients with palmar hyperhidrosis. An increase by more than 1 °C in palmar temperature has been observed to be predictive of good outcome. In this study, we investigated the use of palmar laser Doppler flowmetry as an intraoperative assessment of the efficacy of the operation. METHODS: One hundred sixty-six patients underwent a total of 330 endoscopic thoracic sympathectomy procedures from March 1996 to June 2001. We studied 17 patients (15 men, 2 women) who underwent a total of 33 procedures. The patients' mean age was 27.07 ± 7.92 years, and the mean hospital stay was 2.23 ± 0.66 days. RESULTS: Mean baseline laser Doppler blood flow was 2.63 ± 2.56 ml/min/100 g. After the procedure, mean blood flow increased significantly to 7.24 ± 5.88 ml/min/ 100 g (r = 0.768, P < 0.000, 95% confidence limit, -6.1060, -3.0946), a 232.18 ± 219.12% increase. Mean palmar temperature increased to 1.44 ± 1.44°C. All patients experienced relief after the operation. Compensatory hyperhidrosis occurred in 10 (58.8%) of 17 patients. CONCLUSION: Monitoring of palmar laser Doppler blood flow changes is a useful adjunct during endoscopic thoracic sympathectomy surgery, and, when coupled with the established methods of endoscopic visualization and palmar temperature, it can predict the success of the procedure accurately.