Videothoracoscopic sympathicotomy: A single-port, drainless, procedure

Purpose: Palmar hyperhidrosis is a very common condition in the teenagers. Conservative treatment is ineffective and open surgical techniques are a challenge for the majority of surgeons with too high a morbidity for the pathology and cosmesis not always acceptable. The endoscope can visualize the sympathetic chain from the steleate ganglion to the 12th segment and a simple, elegant and efficient procedure can be performed. Methods: From December 1992 to April 1998, 328 patients were submitted to bilateral single-port, drainless videothoracoscopic sympathicotomy in the Division of Thoracic and Cardiovascular Surgery at the Chang Gung Memorial Hospital. Ages varied from 7 to 51 with an average of 17 years. In all patients, the hyperhidrosis of the hands was so severe that it impaired school or working activities. Results: In our series, we had two failure due to the presence of severe apical adhesions. In both cases it was impossible to visualize the sympathetic chain. In 16 patients there was a residual pneumothorax that was treated with intensive physiotherapy. There were no bleedings and 100% success in control of the hyperhidrosis besides the two patients in which the sympathetic chain could not be visualized. Conclusions: The patients are being followed every year and there is no recurrence of the palmar hyperhidrosis. Compensatory sweating developed in some, although the majority is quite satisfied with the results. Clinical Implications: Video thoracoscopic sympathicotomy is a safe and effective way of control palmar hyperhydrosis. It should be considered as a routine alternative choice of treatment.