Thoracoscopic sympathectomy for hyperhidrosis: is there a learning curve?

Area of Science:

• Thoracic Surgery
• Surgical Education
• Hyperhidrosis Treatment

Background:

• Primary palmar hyperhidrosis is a condition causing excessive sweating in the palms.
• Thoracoscopic sympathectomy is a surgical option for managing hyperhidrosis.
• Evaluating the learning curve is crucial for optimizing surgical techniques and patient outcomes.

Purpose of the Study:

• To evaluate the learning curve associated with upper dorsal thoracoscopic sympathectomy.
• To identify key indicators of surgical proficiency and improvement over time.

Main Methods:

• A series of 232 upper dorsal thoracoscopic sympathectomies were performed on 116 patients with primary palmar hyperhidrosis.
• Patients were divided into two groups based on the sequence of operations.
• T2-T3 ganglia were resected, and follow-up data were collected.

Main Results:

• All patients achieved dry limbs post-operation with no recurrence of hyperhidrosis.
• Anesthesia time decreased, while operating time, complication rates (compensatory hyperhidrosis, postoperative neuralgia), and patient satisfaction remained similar between groups.
• The primary indicator of the learning curve was a reduction in the incidence of Horner's syndrome.

Conclusions:

• Upper dorsal thoracoscopic sympathectomy is an effective treatment for palmar hyperhidrosis.
• Surgical proficiency, particularly in reducing complications like Horner's syndrome, improves with experience.
• The procedure demonstrates a favorable safety and efficacy profile with a discernible learning curve.