Original article: general thoracic
Thoracoscopic sympathectomy for hyperhidrosis: indications and results

Presented at the Thirty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 31–Feb 2, 2003.
https://doi.org/10.1016/j.athoracsur.2003.06.003Get rights and content

Abstract

Background

Hyperhidrosis can cause significant professional and social handicaps. Although treatments such as oral medication, botox, and iontophoresis are available, surgical sympathectomy is being increasingly utilized.

Methods

Between January 1997 and December 2002, 180 patients with palmar, axillary, facial, or plantar hyperhidrosis underwent a thoracoscopic sympathectomy. Surgical technique evolved during our study period and included excision of the sympathetic ganglia at T2, T3, or T4 depending on the location of the sweating using monopolar cautery.

Results

Patient demographics included 33% males (59/180) and 67% females (121/180), with a mean age of 29.2 years old (range 12 to 76 years old). Ethnic origin was 67% white (122/180), 19% Asian (34/180), 8% Black (14/180), and 6% Hispanic (10/180). Positive family history of hyperhidrosis was noted in 57%. Preoperatively, 49% patients (86/180) had palmar sweating only, 7% patients (12/180) axillary only, 24% patients (43/180) palmar and axillary, 16% patients (28/180) face/scalp only, and 7% patients (11/180) all of the above; additionally 69% patients (125/180) had plantar hyperhidrosis. All procedures were performed through 3-mm and 5-mm ports, and 98% (177/180) were completed as an outpatient procedure. Complications included a mild temporary Horner's Syndrome (n = 1; 0.5%), air leak requiring chest drainage (n = 9; 5%), and bleeding (n = 3; 1.6%) requiring thoracoscopic reexploration (n = 1) and chest drainage (n = 2). Success rates were palmar 100% (109/109), axillary 98% (48/49), and face/scalp 93% (26/28). Plantar hyperhidrosis responded with improvement in 82% (72/88) of all patients. Seventy-eight percent patients (96/123) experienced compensatory hyperhidrosis, usually affecting the stomach, chest, back, and neck. Overall satisfaction was 94% (139/148).

Conclusions

Thoracoscopic sympathectomy is a safe and effective outpatient method for managing hyperhidrosis. Although overall satisfaction is high, patients should be fully informed about the potential for compensatory sweating.

Section snippets

Operative technique

All procedures are performed with the patient supine with their arms extended under general anesthesia with double-lumen endotracheal intubation so that the lung on the operative side can be deflated. Three separate 3-mm incisions are then made along the inframammary fold, first on the right side, through which three sealed thoracoscopic ports are placed (Fig 1). Carbon dioxide (CO2) insufflation less than 8 mm Hg of pressure is used routinely to improve exposure of the dorsal sympathetic

Results

During the period between January 1997 and December 2002, 180 patients with palmar, axillary, plantar, or facial hyperhidrosis underwent video-assisted thoracoscopic sympathectomy at our institution. Complete follow-up was achieved in 100% of patients. All procedures were scheduled on an outpatient basis. Patient demographics included 59 males (33%) and 121 females (67%), mean age 29.2 years old (range 12 to 76 years old). Ethnic origin was 122 white (67%), 34 Asian (19%), 14 Black (8%), and 10

Comment

The therapeutic options for the management of hyperhidrosis have traditionally been nonoperative. These include topical astringents, absorbing powders, and anticholinergic drugs. Other methods of treatment have included biofeedback, iontophoresis, botulinum toxin, and percutaneous phenol block. These methods seldom give sufficient relief, their effects are usually transient, and they are not without associated side effects [12]. The anticholinergics commonly cause dry mouth and blurry vision,

References (27)

  • R. Adur et al.

    Palmar hyperhidrosis and its surgical treatmentA report of 100 cases

    Ann Surg

    (1977)
  • M. Hashmonai et al.

    Upper thoracic sympathectomy for primary palmar hyperhidrosisLong-term follow-up

    Br J Surg

    (1992)
  • Y. Doo et al.

    Needle thoracic sympathectomy for essential hyperhidrosisIntermediate-term follow-up

    Ann Thorac Surg

    (2000)

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    Copyright © 2004 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.