Bilateral thoracoscopic sympathetic block by clipping

Main cause of dissatisfaction after videothoracoscopic (VATS) sympathectomy in the treatment of hyperhidrosis (HH) and facial blushing (FB) is compensatory sweating (CS). Sympathetic nerve (SN) clipping obtains the same results as sympathectomy in terms of efficacy and safety and levels of CS are similar or lesser than with the standard procedure, with the advantage that if necessary - massive intolerable CS-, this technique theoretically allows to revert the sympathetic block by removing the clips. The surgical procedure is performed through two incisions of 10 mm at the mid axillary and anterior axillary lines (third and fifth intercostal spaces). Through two ports a 30° camera and a diathermy hook are introduced into the pleural cavity. After the identification of the SN, parietal pleura is opened and the chain is isolated. Under video assistance the SN is clipped at the correspondent level with a right-angled endoscopic clip applier. This surgical procedure is illustrated and an overview of the literature is presented.