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Nicholas Nissen, MD, has been appointed as director of Hepatobiliary and Pancreatic Surgery at Cedars-Sinai.

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Minimally invasive thoracic surgery for hyperhidrosis, thoracic outlet syndrome

Patients with sweaty palms and thoracic outlet syndrome benefit from minimally invasive thoracic surgery. While many know the impact of minimally invasive thoracic surgery has had on treatment of lung cancer and esophageal cancer, there are other conditions, such as hyperhidrosis and thoracic outlet syndrome, for which minimally invasive thoracic surgery is also very beneficial.

Palmar hyperhidrosis

A female cadet at the police academy dropped bullets from her wet hands as she tried to load her gun. Her supervisor told her to go get that fixed... When a box slipped out of his wet hands, it landed on the feet of a worker at a warehouse and broke his toes... No one would dance with the 13-year-old girl with the cold wet hands... What do these three people have in common?

They all suffer from palmar hyperhidrosis, an under-appreciated, very debilitating condition.It can have a huge negative impact on quality of life, cause embarrassment with social interaction, and ability to work.

When medical management fails to correct the problem, sympathectomy can be performed.It is a simple, outpatient minimally invasive operation performed through one or two tiny incisions.

Thoracic Outlet Syndrome

In one case, a 23-year-old male developed a swollen blue arm after exercising strenuously. Studies showed he sustained an effort thrombus (Paget–Schroetter syndrome). Anti-coagulation dissolved the clot, but studies show that there is a high likelihood of recurrence unless the compression on the subclavian vein is relieved.

In another case, a 33-year-old woman fell at work and landed on her left shoulder. She immediately developed vascular headaches, shoulder and neck pain that radiated to her hand, and numbness in her fourth and fifth fingers. When PT, TENS unit, and medical management failed to solve the problem, she was referred for surgical treatment. An MR performed with her arm and abducted showed compression of the brachial plexus. Because her symptoms responded temporarily to a scalene muscle block, she has approximately, an 80 percent chance of benefit from surgery.

Both patients suffer from manifestations of thoracic outlet syndrome (TOS). The mainstay of surgical treatment for that is resection of the first rib. To improve the safety of the procedure, thoracic surgeons at Cedars-Sinai developed a minimally invasive operation that provides great exposure for the rib, subclavian vessels and the brachial plexus.

Thoracic Surgery at Cedars-Sinai is leading the charge to develop and introduce minimally invasive surgery into our specialty.

Submitted by the Division of Thoracic Surgery in the Department of Surgery.