Thoracic endoscopic T2-T3 sympathectomy in palmar hyperhidrosis: experience of 112 cases

Palmar hyperhidrosis is a troublesome and embarrassing disorder that causes professional, psychological, and social handicaps. Its etiology is unknown, although surgical treatment by thoracic sympathectomy is presently believed to be the best method of cure. Up to now, numerous methods of sympathectomy, including open thoracotomy, as well as posterior and supraclavicular approaches have been described. We favor endoscopy at this time due to both its simplicity and its resultant short hospital stay. During the period between March 1988 and October 1990, 112 patients (55 males, 57 females) suffering from palmar hyperhidrosis underwent 222 thoracoscopic T2-T3 sympathectomies under general anesthesia in our department. The remaining 2 hands had a second operation of unilateral open thoracotomy due to pleural adhesion. The patients' ages ranged from 15 to 45 years. A total of 220 hands became dry while the others showed improvements. There were 5 patients who required unilateral chest tube insertion, 2 for post-thoracotomy drainage and 3 for intrathoracic hemorrhage after thoracoscopic pneumonolysis. The average operative time (bilateral) was 30.8 min and hospital stay was 2.87 days. Compensatory hyperhidrosis was the major complication. There was no mortality. We therefore consider thoracoscopic sympathectomy to be a simple, safe, and effective method for treating palmar hyperhidrosis.