Sequential Extended Thoracoscopic Sympathicotomy for Palmo-Axillo-Plantar Hyperhidrosis

Area of Science:

• Thoracic surgery
• Dermatology
• Surgical innovation

Background:

• Palmo-axillo-plantar hyperhidrosis (HH) affects a significant patient population.
• Thoracoscopic sympathicotomy (TS) shows variable efficacy for plantar sweating.
• Evaluating extended TS for comprehensive HH treatment is crucial.

Purpose of the Study:

• To assess the feasibility and outcomes of sequential extended thoracoscopic sympathicotomy (T3-T12).
• To evaluate the treatment's effectiveness across palmar, axillary, and plantar sweating domains.
• To determine the impact on patient quality of life.

Main Methods:

• Forty-two patients with severe palmo-axillo-plantar HH underwent sequential extended TS.
• Visual analog scale (VAS) and iodine-starch tests assessed HH severity.
• Keller quality of life questionnaire evaluated patient-reported outcomes preoperatively and 2 years postoperatively.

Main Results:

• Significant reduction in VAS scores for palmar, axillary (mean 0.74), and plantar (mean 1.26) HH at 24 months (p < 0.0001).
• All patients reported improved quality of life, with median scores decreasing from 120.5 to 3.5.
• The procedure demonstrated feasibility and effectiveness in all HH domains.

Conclusions:

• Sequential extended thoracoscopic sympathicotomy is effective for treating combined palmo-axillo-plantar HH.
• The technique provides satisfactory and sustained improvement in sweating and quality of life.
• Further prospective studies are needed to validate this novel approach.