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CAUSE OF EXCESSIVE SWEATING

Facial blushing and hyperhidrosis, particularly in the facial, axillary or palmar distribution, are socially, professionally, and psychologically debilitating conditions.  Endoscopic thoracic sympathectomy (ETS) can be carried out through multiple ports or by using a single port and a modified thoracoscope with integrated electrocautery.  Carter, Ghosh, Halka, Khwaja, Murphy, Murray, Turner, & Walker (2006) reviewed their own experience to compare outcomes between these methods.  The aim was to analyze and compare the outcomes in patients treated using a one and more standard, multiple port system.

Methods
“During a five period time frame, 179 ETS was carried out on 96 voluntary patients by a surgeon and anesthetist in and inner city teaching hospital.  One-hundred and sixty-six procedures were bilateral and thirteen were unilateral ETS, and ten were on the right.  Four patients went on to have a second operation which was unilateral in all cases.  The majority of all patients were discharged the next day post-procedure.  Follow-up was made by standard 6 week visit which was outpatient, a mailed questionnaire and or a telephone interview” (p. 225) 

Results
“The procedure carried out on 96 patients, complete follow up was carried out on 144 of the 180 procedures.  There were no deaths, conversions, or neurological injuries as a result of the procedures.  The one-port group showed superior outcomes in terms of hospital stay, rate of postoperative pneumothorax, and the need for chest drain insertion.  Twenty-one patients had a later return of symptoms post-procedure” (p. 225). 

Conclusion
In spite of the non-randomized nature of this group study,  Carter, et al. (2006) found that bilateral ETS can be successful when carried out through one port using double lumen intubation as short stay procedure with low complication rates.  We have shown that the operation is particularly effective for facial and palmar symptoms.  “ETS can be safely and effectively carried out using a single port with similar results to the conventional two-port procedure.  The one-port procedure does allow the patient a shorter duration of stay as well as lower rates of complications post-procedure” (p. 226). 

Cause of excessive sweating