There is a kind of hand wet all the year round it is called hand sweat, regardless of spring, summer, fall and winter, the hands of the sweat is like did not turn off the faucet like non-stop out of the hand, the hand need to hold a tissue at any time, constantly wipe, can not shake hands with people, can not work normally, affecting the daily life of the life of this trouble even from a special disease – hand sweat. On the network, these patients call themselves “sailors”. Hand sweating is a sweat gland secretion is too exuberant caused by excessive sweating disease, the specific cause is unknown. Hand sweating in medicine belongs to the category of limited hyperhidrosis, is due to local sympathetic nerve damage or abnormal physiological response. For example, nervousness, emotional excitement, stress, irritability, anxiety increase nerve impulses, making the nerves excessively hyperactive, resulting in an abnormal increase in sweating in the small sweat glands in the palm of the hand. The incidence of hand sweating is higher in adolescents, most of whom suffer from hand sweating since childhood, and it gets worse in adolescence. People with excessive sweating tend to have wet palms most of the time, and prolonged wet hands often cause peeling, which is unsightly. Excessive hand sweating often affects school-age youths’ exams. Teenagers are afraid to hold hands with others, and even shaking hands is a problem. In severe cases, eczema and dermatitis may even appear on the palms of the hands. As adults, it also causes inconvenience in their work and social activities. Hand sweating is often combined with sweating in the armpits and soles of the feet, and the sweat produced by the patient usually does not have an odor, which is different from that of a person with xerostomia. We in TCM believe that there are two types of hand sweating. One is the deficiency syndrome: patients due to lack of fluid and lead to Yin deficiency and internal heat, manifested as sweaty hands with dry mouth and tongue, hot hands and feet, dry and knotty stools, etc.; the second is the real syndrome: patients due to diet spicy stimulation, fat, sweet and thick flavors or drinking alcohol and other reasons lead to dampness and heat blocking the spleen and stomach, in addition to sweaty hands, accompanied by bitter taste of the mouth, bad breath, yellow and cloudy urination and other symptoms. The former can use raw land, XuanShen, Maitong, sour date, schizandra, floating wheat, oysters and other Chinese medicine tea or decoction to drink, nourishing Yin astringent sweating; the latter can use Job’s tears, almonds, thick Park, patchouli, half-summers, cardamom kernels and other Chinese medicine tea or decoction to drink, with the role of clearing away heat and dampness, astringent sweating. Hand sweating is not a big disease, but it does cause some impact on learning, work and socialization. There are online discussion groups for such patients, who call themselves “sailors”. For serious cases, experts still recommend active treatment, because hand sweating is also a manifestation of abnormal health conditions, which should be corrected in a timely manner. There are two types of treatment for hand sweating: medical and surgical. Internal medicine, the main use of drugs is to inhibit the sympathetic nervous system drugs, often dry mouth or gastrointestinal disorders and other side effects occur, so that people do not dare to take long-term; there is also a kind of use of medicinal agents applied externally, and the local application of the medicinal agent is also due to the limited time limit, the need to make up for the application of the time, so the internal method has its limitations. Surgical methods mainly involve cutting off the nerves. Today, with the high development of medical science, the application of minimally invasive thoracic sympathetic neurotomy (ETS) has saved people suffering from hand sweating. After the application of this technique in the 1990s, it has been constantly innovated and improved in practice, and has now become the most thorough and effective treatment for hand sweating. The surgery is performed by making an incision of only 0.3 centimeters in diameter in the armpit, and cutting the thoracic sympathetic nerve by means of thoracoscopic technique. The procedure takes only ten minutes and 3 days of hospitalization. Therefore it is a surgery that belongs to minimally invasive, fast, safe and effective, which can completely solve the patients’ troubles and enable them to come out of the shadow of the disease, study and work with peace of mind, and generously give their friends a strong handshake. Q: What is hyperhidrosis? A: A pathological state of undetermined cause, due to the excessive hyperactivity of the sympathetic nerves, the body’s perspiration significantly exceeds the body’s need to regulate body temperature, such a condition is called hyperhidrosis. Excessive sweating of the hands, face, armpits, and feet, as well as facial flushing, are the main manifestations of hyperhidrosis. Excessive sweating on the palms of the hands is the most common form of hyperhidrosis and is called hand sweating. Patients with hyperhidrosis sweat easily in slightly hot environments, under stress, and with light exercise. Many patients have sweaty, cold hands all year round, as if they had just been taken out of ice-cold water. In severe cases, the patient’s clothes are often wet with sweat from the armpits, and his hands are so wet that he dares not shake hands with others, and his writing paper is also wet due to the sweat on his hands. All these inconveniences often make patients feel embarrassed and affect their normal social and work life. Q: Why does hyperhidrosis occur? A: The underlying cause of hyperhidrosis is unknown. Q: What is primary hyperhidrosis? A: Hyperhidrosis that is caused by excessive sympathetic hyperactivity, rather than by another disease, is called primary hyperhidrosis. The vast majority of hyperhidrosis patients suffer from this type of hyperhidrosis, which does not affect their physical health, but causes great inconvenience and disturbance in their lives. This is the most suitable indication for thoracoscopic thoracic sympathectomy/closure. Q: What is secondary hyperhidrosis? A: There are a few people who have increased sweating due to medical conditions called secondary hyperhidrosis, such as hyperthyroidism, endocrine disease, mental illness, and endocrine imbalance during menopause. This type of excessive sweating due to a medical condition must be treated for the condition itself and is not a candidate for sympathetic nerve surgery. Q: What conditions require surgery? A: If your excessive sweating is significantly affecting your socialization, schooling, work, mood and life, and significantly reducing your self-confidence, then surgery is indicated. Q: Why do I sweat excessively? A: In normal people, when there is tension, excitement, stress, or high temperatures in the summer, sympathetic hyperfunction will cause increased sweating. However, hyperhidrosis is often caused by overdeveloped sweat glands or parietal glands and an oversensitive sympathetic nerve that regulates sweat production. In a few cases, excessive sweating is caused by hyperthyroidism. Q: What are the risks of hyperhidrosis? A: Hyperhidrosis can occur from childhood (as soon as you are born) and is more pronounced in adolescence, with the most troubling symptoms being excessive sweating of the palms of the hands, armpits, and soles of the feet. Young people’s emotions are not easy to control, easy to nervousness, uneasiness, shyness, fear, etc., so that sweating is more powerful, the more anxious mood, the more sweating, resulting in a transient vicious cycle. This may cause the patient to be withdrawn, introverted, not good at socializing, lack of confidence in social situations, and even low self-esteem, which may also affect learning and job hunting. Q: What is the prevalence of hand sweating? A: Hyperhidrosis can occur in both men and women, and is quite common in young people of Eastern ethnic groups, with a prevalence rate of 4.36% among the population. The prevalence of sweaty palms in the population is 4.36%. Many patients have a family history of sweaty palms, but it is not necessarily inherited to the next generation, according to a survey in Taiwan, the prevalence of familial primary hyperhidrosis can be up to 12.5%. 2005, Fuzhou City, 12,803 college and high school students to conduct a cross-sectional survey, found that the prevalence of sweaty hands 4.59%, the prevalence of a relatively high, but also confirms that the disease occurs in the Oriental point of view, with a tendency to heredity of 15.3%, we have seen both parents of sweaty hands. We have seen parents with hyperhidrosis, four children have varying degrees of hyperhidrosis. Q: What are the treatment options for hand sweating? A: So far, only surgery has been able to achieve a true cure. The most effective, fast and minimally invasive surgical treatment for hand sweating is thoracoscopic thoracic sympathetic trunk dissection. Q: When is the best time to operate? A: Hand sweating is a persistent condition, so the sooner you treat it, the sooner you can get rid of it. The best time to treat hand sweating is during adolescence, when symptoms are most noticeable. Sweaty palms can be relieved immediately after surgery, and the success rate of the surgery is close to 100%; however, if excessive sweating is already a nuisance and an inconvenience in elementary school, there is no technical difficulty in operating on a child over the age of six, but the most appropriate age for surgery is 12 years old or older. If after the age of forty, the operation is often made difficult by diseases such as pleural adhesions or lung lesions. Q: How long after surgery will my hands stop sweating? A: 10 – 20 minutes after the thoracic sympathetic nerve is cut off by thoracoscopic surgery, the hands will stop sweating and gradually become warm and dry. The patient will wake up and realize that his hands have become warm and dry, and the persistent problem that plagued him has disappeared all of a sudden. Q: Do I have to be hospitalized if I have to undergo surgery to treat hand sweating? A: The traditional surgical method is to cut from the center of the back and remove the second and third sympathetic ganglia on both sides. This method has a longer operation time and recovery time, and there is a wound of about five to seven centimeters after the operation, which is more painful and needs to be hospitalized; the current surgical method has been changed to thoracoscopic sympathetic ganglionectomy, and the wounds are in the axillae of the two sides, each of which is about 7.5px, and general anaesthesia is used. The operation time and recovery period are shorter and the pain is mild. For safety reasons, the patient is usually hospitalized for 1 to 2 days after the operation. Q: Do I need special care at home after the surgery? A: After the surgery for hand sweating, you will feel a little chest tightness and slight pain in the armpit incision, which is normal. There may be a small amount of sweating in the palms of the hands and the body within a week after the surgery, which is usually stabilized after a week. Both sides of the wound is generally not stitched, if the stitches in the removal of stitches before do not touch the water, if accidentally wet, should be immediately replaced with sterile gauze, so that the wound stays dry, 1 to 2 days after the operation can be discharged from the hospital to go home and rest, without special care, generally within a week to return to work. On the 7th day after surgery, go to the local health center or hospital outpatient clinic to remove the stitches. You can take a shower 2 days after the stitches are removed. Q: When is the best time to have the surgery? Surgery is available at any time of the year. Due to the large number of surgeries, it is best to call 13802447736 to make an appointment before preparing for the surgery, as this will save you a lot of time. Surgery during the summer and winter vacation is ideal for students who are in school. Q: What are the reasons for unsuccessful surgery? A: The success rate of thoracic sympathectomy is close to 100% for normal young people. Most of the unsuccessful cases are due to the patient’s past pneumonia, trauma or other adhesions to the lung lobes and pleura, which prevent the sympathetic nerve from being visualized by the thoracoscope. This situation can not be detected before the surgery even by chest x-ray. Therefore, early treatment can be early to get rid of the trouble, the best time for the treatment of hand sweating is puberty, at this time the success rate of the operation can be almost 100%, if after 40 years old, often due to the lobes of the lungs, pleura adhesion or lung disease, the operation is difficult to carry out, the failure rate increases. Some patients who are overweight or oversized also have increased difficulty with surgery. Patients who have undergone thoracoscopic surgery and have had their hyperhidrosis stopped, only to have it recur after a period of time, are able to undergo the surgery again, but the success rate will be reduced because of the possibility of adhesions in the pleura of the lung lobes that may have been caused by the first surgery, making it impossible to visualize the sympathetic nerves on the thoracoscope. If there are no adhesions, the success rate is as normal. However, if the surgery is unsuccessful due to adhesions at the first surgery, the surgery should not be repeated. Q: How much time is needed for recovery? A: Recovery from surgery is quick and most patients can get out of bed after 6-10 hours after surgery. They are discharged from the hospital 1-2 days after surgery and can return to school and work one week after surgery. Q: Can you guarantee the efficacy? A: It is impossible to achieve 100% success rate for any kind of surgery. Currently, the cure rate for hand sweating is close to 100%, and the cure rate for facial sweating and facial flushing is 95%, which is already very high. The success rate decreases significantly if the patient has had previous chest surgery or a serious lung infection. Both of these conditions can result in severe pleural adhesions, making it difficult to locate the sympathetic trunk during surgery and rendering surgery ineffective. As with any surgical procedure, surgical visualization is difficult in severely obese patients, and thus surgical success is reduced. Q: What is the recurrence rate? A: Statistically, the recurrence rate after hyperhidrosis surgery is about 1%, with experienced surgeons having a recurrence rate of less than 1%. The reason for recurrence is often due to some adhesion during the surgery, which prevents the nerve from being completely cut off or the nerve grows back. A second surgery can still be performed after a recurrence of hand sweating, with a success rate of about 85%. Q: Is it necessary to cut all the sympathetic nerves? A: Not all of the thoracic sympathetic trunks are cut. The upper thoracic sympathetic ganglion, which innervates the sweat glands of the face, palms, and armpits, is located at the top of the thoracic cavity. Because of excessive sympathetic hyperactivity, the amount of sweating exceeds the body’s need to regulate body temperature, and therefore, blocking the thoracic sympathetic innervations is the goal of the surgery. Traditionally, the sympathetic trunks of thoracic 2, 3, and 4 are cut or only thoracic 2 is cut, but now we mainly cut the thoracic 3 sympathetic trunks, so that the incidence of compensatory hyperhidrosis is much lower in the postoperative period, which is about 3-5%, and there is no severe compensatory hyperhidrosis. Q: Is there a section of sympathetic trunk removed during thoracoscopic surgery? A: No. Sympathectomy is an older surgical method. The newer method simply cuts off the sympathetic trunk and does not remove any sympathetic nerve tissue. This improves the safety of the surgery. Q: Are there any dangers or side effects of the surgery? A: Any surgery has varying degrees of risk and a certain percentage of complications. Thoracoscopic thoracic sympathectomy also has some risks and complications, but in the case of this surgery, the risks and complications of the procedure are very low. Possible complications include hemothorax due to bleeding in the chest or pneumothorax due to rupture of the membranes and alveoli of the lungs. Other potential dangers, as with any surgery, include allergies to anesthetic drugs, and there are rare reports in the literature of injuries to celiac disease and large blood vessels. It is therefore important to choose an experienced surgeon. The overall incidence of complications is less than one percent, and close postoperative monitoring should allow for rapid detection of complications, which can be cured with further treatment and are mostly curable. The most common postoperative complication is compensatory sweating (common in the back, abdomen, and lower extremities), which is tolerated by the majority of patients, with no more than 5% having difficulty tolerating it. In many patients, compensatory sweating diminishes with time after surgery. A very small number of patients have odorous sweating, but the vast majority are not affected. Now that we have improved the procedure by cutting mainly the thoracic 3 sympathetic trunk, the incidence of postoperative compensatory sweating is much lower, about 3 to 5%, and no severe compensatory sweating occurs. Horner’s syndrome (mild eyelid ptosis) occurs in a very small number of patients, with an incidence of less than 1%, and has not been reported by too many surgeons, probably related to the procedure. Most of these complications recover gradually over time. This complication affects aesthetics but does not affect vision. Very few people have this complication permanently, and it can be corrected with cosmetic surgery. Q: Can all people with hand sweating be treated with thoracoscopic thoracic sympathectomy? A: Of course, there are some limitations to this procedure; for example, people with congenital pulmonary adhesions or those who have suffered from tuberculous pleurisy, lung disease, and those who have undergone surgery for hand sweating and have severe pleural adhesions are not candidates for this procedure and should be evaluated by a physician before making a decision. For children under 12 years of age with hand sweating, we believe that hand sweating may cause inconvenience in the learning process, but it will not affect academic performance, so parents do not need to worry too much about it, and when the child grows up, he or she can decide whether or not he or she needs to undergo surgical treatment. Q: Does the reduction in hand sweating mean less sweating? A: In addition to the decrease in hand sweat, most patients also sweat less in their armpits and feet after surgery. However, normal people sweat to reduce body temperature, so appropriate sweating is still necessary; after the decrease in sweat in the hands, sweat will increase in other places such as the abdominal wall, back, buttocks, and thighs to form the phenomenon of metastasis. With advances in surgical techniques, severe metastatic sweating is rare. Q: Will foot sweating improve after surgery in patients with sweaty palms? A: Surgery for hyperhidrosis of the palms of the feet has a 60% to 80% chance of improving the condition. Even if there is no improvement in the sweating on the palms of the feet, it is not likely to worsen after surgery (compensatory sweating on the soles of the feet is very rare). However, since the cure rate for foot hyperhidrosis is not very high, this surgery is not recommended for patients who have foot hyperhidrosis without hand hyperhidrosis. Q: What are the side effects of hand sweating surgery? A: In addition to the compensatory sweating mentioned above, some people may feel that their hands are too dry in winter and need to wear hand cream, but there is rarely any dryness and cracking, and a small number of people may experience recurrence (about 1% in the literature). Q: What is compensatory sweating? A: The so-called compensatory, or reflex, sweating is a phenomenon in which the sweat that used to be on the palms of the hands and face increases on the trunk, especially on the back and thighs, after the surgery has been lifted. Patients must be aware that if there is significant compensatory sweating after sympathectomy, this sweating cannot be restored to its original condition before surgery by surgery or other means. Generally speaking, compensatory sweating after surgery is mild, and patients are satisfied with the absence of moisture in the palms of the hands, face, and armpits after surgery. Therefore, compensatory sweating of the lower back or legs is acceptable, and only a small number of patients (less than 2%) find compensatory sweating unacceptably disturbing. After improving the surgical method, compensatory sweating has been significantly reduced (mild to moderate about 3-5%, no severe compensatory sweating), and very few of our patients now complain of compensatory sweating. Q: How do I identify myself as having excessive sweating of the hands and feet due to sympathetic hyperactivity? Which department should I go to for this test? A: There is currently no way to detect the cause of sweaty hands and feet. However, cutting off the thoracic sympathetic nerve has been shown to be effective in treating sweaty hands. This treatment is effective whenever there is excessive sweating of the hands. For differential diagnosis, you can go to the hospital to do a T3, T4 and blood glucose laboratory tests, except for hyperthyroidism and diabetes mellitus. Hyperthyroidism causes the body’s basal metabolic rate to increase, resulting in excessive heat production and increased sweating throughout the body. Q: I have this problem in my hands, armpits, and feet, and it is very serious. Will all three parts of my body return to normal after this surgery? A: The best treatment effect for hand sweating is close to 100%, the chance of curing armpit sweating at the same time is 95-98%, and the chance of curing foot sweating at the same time is 60-80%. Q: I recently heard that 5% alum solution can be used to soak once a day or 3% -5% formalin solution can be cured by external rubbing, what they say can be? A: These two methods are not possible to cure sweaty hands and feet. These two methods, may be localized skin cuticle destruction, temporarily have some effect. Thus, at that time, the skin of the hands and feet will be destroyed and become rough and unsightly, and the skin sensation may be abnormal, and the symptoms will surely come back after a long time when the new skin grows out. The effective period may be about 50 days. Unless you wash every day and are not afraid to damage your hands and feet. Scientifically, thoracic sympathectomy is currently the only cure for this condition. Q: Does age affect the choice of surgery and can the symptoms be reduced as I get older? A: Age does not usually affect surgery. The disease does not usually go away with age. Q: Will the 2 incisions from the surgery heal well? Will there be any scarring? A: There is an incision of about 5 millimeters in each armpit, which is very small and along the direction of the skin line. This kind of incision can be called a “mini” incision, and it is not obvious after healing as long as you are not a keloid, and it is hidden in the armpit, which will not affect the aesthetics. Q: How can Horner’s syndrome be prevented? A: Injury to the stellate ganglion results in Horner’s syndrome, which manifests itself in symptoms such as eyelid ptosis on the injured side. The surgical field of the thoracoscopic technique that we now use is very clear. Surgery for hand sweating is basically non-invasive because it is performed farther away from the stellate ganglion. For the treatment of facial flushing, the surgical site is higher and there is a possibility of injury, so we have a special preventive method. Q: What is Botox? Is it an alternative to surgery? A: Botulinum toxin (botulinum toxin A) is a drug that has been used abroad for many years to treat facial wrinkles. It paralyzes the nerves that innervate facial muscles and sweat glands. Only recently has botulinum toxin been used to treat hyperhidrosis, and its efficacy is unknown. For sweaty hands and armpits, many injections are often required, and many patients report excruciating pain. Moreover, sweating can only be reduced, not eliminated, after Botox injections, and excessive sweating usually reappears after 6 months. Many patients experience a loss of grip strength in their hands. Many patients also require surgical treatment after Botox injections have failed to work. Q: Is surgery for hand sweating covered by Medicare? A: It is covered by Medicare and the New Rural Cooperative Medical Service (NRCMS). Q: Can I go to surgery alone? A: It is best to be accompanied by someone, mainly because it involves a surgical signature, and our current pre-operative consent form is mainly signed by the patient and family members together. You will feel more confident when you are hospitalized with a friend or relative by your side, and they will take better care of you. Q: Can sympathectomy treat bad breath? What is the principle? A: There are two types of sweat glands in human beings, one is small and distributed all over the body, its main function is to perspire and regulate body temperature; the other is a larger gland, called the large sweat gland (parietal plasma gland), which is distributed in the armpits, the pubic area and other special zones, of which the armpits are the most numerous. The plasma secreted by the sweat glands (parietal plasma glands) is an odorless liquid, but when the plasma stays in the armpits and is broken down by bacteria, it becomes a foul-smelling liquid, commonly known as halitosis. Patients with sweaty armpits are prone to bacterial growth and have a particularly strong odor, causing great distress in their lives. The basic principle of treatment is to keep the area clean and remove secretions to reduce bacterial reproduction; the use of topical antiperspirant aromatics, regular scrubbing and medication can provide temporary relief. Surgery is required to permanently remove the odor. The traditional surgical treatment is to remove the sweat glands in the armpits. During the surgery, one or two incisions of nearly 10 centimeters are made in each armpit, and the sweat glands are directly removed, and the wounds are then sutured. However, this method has the disadvantages of large wounds, obvious scars and long recovery time. In recent years, the use of thoracoscopic sympathetic nerve surgery, more than ninety-five percent of the patients underarm sweating significantly reduced or stopped sweating, a very significant improvement in the odor in the past, due to the thoracoscopic surgery on the human body invasion of a small and rapid recovery time, has gradually replaced the trend of traditional surgery. Q: Can this technique cure underarm sweating alone? A: If there is a combination of hand sweating, then the success rate of curing axillary sweating or significantly reducing axillary sweating is significantly increased. This technique does not seem to be suitable for excessive underarm sweating alone. This technique can successfully treat isolated axillary sweating, but it requires severing multiple segments of the thoracic sympathetic trunk, which significantly increases the complications of compensatory sweating. Q: Can this technique treat bad odor? A: Thoracoscopic sympathectomy is effective if the odor is due to excessive underarm sweating. If the underarms are already smelly without sweating, thoracoscopic sympathectomy does not work well and it is recommended that you should see a plastic surgeon or general surgeon for traditional deodorant surgery. Q: What do I have to do if I want to come to your hospital for surgery? A: You can first call (13802447736) to make an appointment for the date of surgery, admission to the hospital before 6:00 p.m. on the second day before the operation, the next day to do all the preoperative preparations, the next day from 12:00 p.m. after the ban on food and drink, the next day surgery. After surgery, you will be hospitalized for about 1 day. Q: Can hyperhidrosis of the face be treated with this method? A: Since the sweat glands of the face are also controlled by the thoracic sympathetic nerve, the thoracic sympathetic ganglion, the treatment of facial hyperhidrosis is similar to that of hand sweating, in that thoracoscopic surgery is performed to regulate the sympathetic nerve’s function. In fact, the treatment of facial hyperhidrosis was first derived from the experience of patients with hand hyperhidrosis and facial hyperhidrosis who experienced improvement in facial hyperhidrosis after treatment of hand sweating. Thoracoscopic surgery has also shown a significant reduction in facial sweating after treatment of hand sweating, however, if facial sweating is completely removed, complications of excessive compensatory sweating may occur. Q: Is the incidence of compensatory sweating high and is it tolerable? A: The incidence of metastatic sweating has been greatly reduced by the continuous improvement of surgical techniques, and even with metastatic hyperhidrosis, the vast majority of patients can tolerate it. Q: It is said that mediastinoscopic surgery requires only one incision on one side, is it less invasive than thoracoscopic surgery? A: When mediastinoscopy is done for mediastinal examination, only one incision can be made because of the anatomy, so the device manufacturer made an endoscope with an operating channel and named it mediastinoscope. Because of the operating channel, most current mediastinoscopes have a diameter of 1 to 37.5 px. Mediastinoscopes have been borrowed for thoracoscopic surgery with the advantage of cutting only one hole, but one hole is not always superior. Because the diameter of the thoracoscopes we now use for hyperhidrosis is below 12.5px, and the diameter of the other operative hole is also around 5px, while the length of the incision using mediastinoscopy is generally 2-75px, and the mediastinoscope may have to be propped up for the operation, the incision may be larger, and part of the chest wall muscle may have to be cut off. In normal people, the width of the intercostal space where hyperhidrosis surgery is performed is usually no more than 8 millimeters, and there are intercostal blood vessels and nerves in this space. The thicker the object passes through, the more likely it is to cause bleeding and nerve damage, so the smaller the diameter, the less likely it is to cause bleeding and nerve damage, both theoretically and practically, and which surgical operation is greater is obvious when you think about it. In addition, it is more difficult to both observe and operate with mediastinoscopy through one hole, and if pleural adhesion or bleeding is encountered during the operation, it is almost impossible to complete the operation with this type of endoscopic surgery, whereas with the thoracoscopic two-hole method we can more easily deal with pleural adhesion and complete the operation. In conclusion, both lumens can complete the surgery, depending on the experience of the surgeon.