Endoscopic thoracic sympathectomy for palmar hyperhidrosis.

Primary palmar hyperhidrosis is a disorder of excessive perspiration. In severe cases it can be socially and professionally debilitating and conservative therapy is usually unsatisfactory. Endoscopic thoracic sympathectomy (ETS) is considered an effective treatment for palmar hyperhidrosis. However, many different procedures have been used: simple resection of the sympathetic ganglion, transection or ablation with cautery, or simple clipping of the sympathetic chain with titanium clips. Furthermore, the extent of sympathectomy has also varied from single (T2 or T3) to extensive (T2-T5). We have performed ETS procedures since 1995. One hundred eighty four patients have undergone ETS for treatment of palmar hyperhidrosis. All patients felt extremely conscious of their severe palmar hyperhidrosis. There were 101 females and 83 males aged from 12 to 60 years old (mean age: 27 years, median age 22). Ninety five percent of patients presented with plantar hyperhidrosis. The following distribution of hidrosis was noted: axillae (63%), face (15%), and body trunk (10%). In the earlier period, from 1995 to 2000, the second and third thoracic ganglions (T2 and T3) were resected. Subsequently, from 2000 to 2003, only T2 was resected. Since then we have reverted back to T2 and T3 resection. It is difficult to identify the thoracic ganglions precisely and determine what to resect exactly during operation. In the present paper we used the terms ‘T2 resection’ as the resection of the sympathetic trunk and thoracic ganglions which are located in the second intercostal space (the space from the lower edge of the second rib to the upper edge of the third rib) and ‘T2 and T3 resection’ as the resection of the sympathetic trunk and thoracic ganglions which are located in the space from the lower edge of the second rib to the upper edge of the fourth rib. We usually inject lidocaine hydrochloride usEndoscopic Thoracic Sympathectomy for Palmar Hyperhidrosis