AUTONOMIC ACTIVITIES IN HYPERHIDROSIS PATIENTS BEFORE, DURING, AND AFTER ENDOSCOPIC LASER SYMPATHECTOMY

THREE HUNDRED PALMAR hyperhidrosis (PH) patients have been treated wit h video endoscopic laser sympathectomy during the last 2 years. Monito ring the palmar skin perfusion (PSP) and palmar skin temperature (PST) has been used intraoperatively to aid the confirmation of the correct sympathetic segment for laser ablation. The preoperative and postoper ative PSP and PST and sympathetic skin response (SSR) also have been m easured to evaluate the therapeutic effect of this method. An apparent increase of PSP would occur intraoperatively after the interruption o f the T2 sympathetic segment, and then a gradual elevation of PST woul d follow after the extirpation of the segment. A rise of PST of about 3 degrees C after laser ablation of the appropriate segment indicated sufficient denervation of the hand and predicted long-lasting relief o f PH. Furthermore, both PSP and PST also significantly increased after the operation. The postoperative elevation of the PST (usually about 3 degrees C) is similar to that recorded during intraoperative monitor ing. The amplitude and the latency of SSR in the palm and sole were re corded both before and after sympathectomy. A remarkable decrease of p almar SSR amplitude and its ratio was found postoperatively by compari ng it with that of plantar SSR in the same patient. These autonomic ac tivity changes have correlated well with the postoperative satisfactio n of the patients. Based on our study, the anatomic identification con firmed by the sympathetic monitorings has proved essential to achieve a definite and adequate sympathectomy leading to a satisfactory resolu tion of PH without the need of a tissue diagnosis. In most cases, an e n bloc ablation of the T2 segment would result in a significant temper ature elevation of the palm and thus it is sufficient to relieve PH wi th the least complication and without substantial increased risk of re currence.