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Updated: Jul 15, 2026
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Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy
Published on: January 10, 2019
A retrospective study comparing T3 ganglionectomy and R4 sympathicotomy for reducing compensatory hyperhidrosis in
Ji Hoon Kim1, Duk Hwan Moon1, Sungsoo Lee1
1Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Journal of Thoracic Disease
|July 14, 2026
Summary
T3 ganglionectomy significantly reduces compensatory hyperhidrosis (CH) and improves patient satisfaction for palmar hyperhidrosis compared to R4 sympathicotomy. This suggests T3 ganglionectomy is a more effective surgical option for managing this condition.
Area of Science:
- Thoracic surgery
- Neurosurgery
- Dermatology
Background:
- Compensatory hyperhidrosis (CH) is a common concern after endoscopic thoracic sympathectomy (ETS) for primary palmar hyperhidrosis.
- Evaluating alternative surgical techniques is crucial to minimize postoperative CH and enhance patient outcomes.
Purpose of the Study:
- To compare the early clinical outcomes of T3 ganglionectomy versus R4 sympathicotomy for primary palmar hyperhidrosis.
- To determine which surgical approach yields lower rates of CH and higher patient satisfaction.
Main Methods:
- Retrospective analysis of medical records for patients undergoing T3 ganglionectomy or R4 sympathicotomy.
- Evaluation of demographic data, operative complications, CH incidence, and patient satisfaction at 3 weeks and 3 months post-surgery.
Main Results:
- T3 ganglionectomy (n=44) showed significantly lower CH rates (9.1% at 3 weeks, 11.4% at 3 months) compared to R4 sympathicotomy (n=225) (63.6% at 3 weeks, 66.7% at 3 months).
- Patient satisfaction was significantly higher in the T3 ganglionectomy group (P<0.001).
- No significant differences in baseline characteristics or operative complications were observed between the groups.
Conclusions:
- T3 ganglionectomy demonstrates superior outcomes for primary palmar hyperhidrosis management, with reduced CH and increased patient satisfaction compared to R4 sympathicotomy.
- Further prospective studies with long-term follow-up are warranted to validate these findings.
