Overnight-stay Bilateral Thoracosopic Sympathectomy in Patients With Palmar Hyperhidrosis

Avinash N Katara, MS DNB MRCSEd, Ramya Behera, MS, Deepraj S Bhandarkar, MS FRFACS FICS FAIS FIAGES, Tehemton E Udwadia, MS FCPS FRCSEng FRCSEdin FICS. PD Hinduja National Hospital & Medical Research Centre, Mumbai

Introduction: Thoracoscopic sympathectomy is the gold standard for treatment of patients with primary palmar hyperhidrosis. This study assesses the feasibility of thoracoscopic sympathectomy as an overnight-stay procedure in the treatment of primary palmar hyperhidrosis and its efficacy.

Material and procedures: The data on 60 patients undergoing thoracoscopic sympathectomy on an overnight-stay basis (<24 hours) were prospectively collected and retrospectively analysed. All procedures were performed under general, double-lumen endotracheal anaesthesia with the patient in supine position. Two 5-mm ports under the axillary fold were used on each side. The sympathetic chain was identified and transected at T2 and T3 levels using diathermy. In case of severe axillary hyperhidrosis, the T4 level was also ablated. Intercostal drains were not used routinely. A chest x-ray was obtained 4 hours after surgery.

Results: There were 60 patients (M: F = 3:2) with a mean age of 28 years (range = 16 to 61 years). In addition to the palmar hyperhidrosis all had plantar and 11 complained of axillary hyperhidrosis. All but one patient were discharged within 24 hours of surgery. At a mean follow up of 72 weeks (range 7-90 weeks) the palmar sweating stayed resolved in all patients. Fifty-nine out of 60 patients also had a complete resolution of their plantar hyperhidrosis while in 1 patient it was significantly better. All 8 patients with axillary hyperhidrosis had complete relief. Complications included minor injury to lung parenchyma requiring post-operative chest drain in 1 patient (resulting in a 2-day hospital stay) and a temporary paraesthesia in the left axilla in another. One patient experienced bothersome compensatory hyperhidrosis of the trunk and lower limbs.

Conclusion: Thoracoscopic sympathectomy at T2 and T3 levels can be safely and effectively carried out as an overnight-stay procedure in patients with palmar hyperhidrosis. It carries minimal morbidity and a small risk of compensatory sweating.

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