Alan D.L. Sihoe, Clement S.K. Cheung, Ho-Kei Lai, Tak-Wai Lee, Kin-Hoi Thung, Anthony P.C. Yim* Department of Surgery, Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
Received 5 September 2004; received in revised form 28 September 2004; accepted 22 October 2004.
* Corresponding author. Tel.: +86 852 2632 2629; fax: +86 852 2647 8273. (E-mail: yimap@cuhk.edu.hk).
Objective: Chest wall paresthesia is a reported sequela of thoracotomy
and Video-Assisted Thoracic Surgery (VATS) which is distinct
from wound pain. Although needlescopic VATS confers less post-operative
pain and better cosmesis, the incidence of paresthesia after
needlescopic VATS has not been quantified.
Methods: For homogeneity
of the patient cohort, we studied 50 patients who received bilateral
needlescopic VATS sympathectomy (T2-T4 excision) for palmar
hyperhidrosis using 2 or 3mm instruments during a 36-month period
at a single institute. A standard questionnaire was administered
by telephone interview, with 34 patents responding (68.0%).
The median post-operative observation time was 16.5 months (range:
10–40 months). Collected data were compared with a historical
group who received conventional VATS using 10mm ports.
Results:
Paresthetic discomfort distinguishable from wound pain was described by 17 patients (50.0%). The most common descriptions were of
‘bloating’ (41.2%), ‘pins and needles’
(35.3%), or ‘numbness’ (23.5%) in the chest wall.
The paresthesia resolved in less than two months in 12 patients
(70.6%), but was still felt for over 12 months in three patients
(17.6%). Post-operative paresthesia and pain did not impact
on patient satisfaction with the surgery, whereas
compensatory hyperhidrosis in 24 patients (70.6%) did (
P=0.001). The rates
and characteristics of the paresthesia following needlescopic
VATS are similar to those observed after conventional VATS.
Conclusions:
Chest wall paresthesia affects a significant but previously overlooked proportion of patients following needlescopic VATS