Objective:Open thoracic sympathectomy has been established as a routine treatment for patients with primary hyperhidrosis. Recently, thoracoscopic techniques have allowed surgeons to offer these patients a permanent solution with minimal surgical trauma. Methods:From June 1996 to July 2002, 78 thoracoscopic sympathectomies(TS) were performed. There were 28 males and 50 females with a mean age of 22.4 years (range, 14 to 48 years). The procedures were performed with the patients under general anesthesia using a double-lumen endotracheal tube. In palmar hyperhidrosis the second thoracic sympathetic ganglia are destroyed by electrocautery. In axillary hyperhidrosis the second to fourth ganglion are cut off. Each lung was reinflated on completion of the sympathectomy, and residual pneumothorax aspirated before closure of the incisions. No placement of chest tubes was performed in the operating . Results:All sympathectomies were completed thoracoscopically. The symptoms disappeared completely in all patients immediately after the operation. Their hands were dry and warm when they waked up from anaesthesia. There was no surgical mortality. Median operation time for a bilateral procedure is 28 min. (range, 8-90 min). The average hospital stay was 5.5 days. The mean follow-up time was 43.8 months (range, 3-73months). Compensatory hyperhidrosis was found in 41.03% (32/78) of patients, but the symptoms were not serve enough to interfere with lifestyle, and were not required further treatment. In all 78 patients had a satisfactory result, without recurrence of palmar or axillary hyperhidrosis.Conclusions:Thoracoscopic sympathectomy is the most effective and minimally invasive treatment for palmar and axillary hyperhydrosis.
