Abstract
Palmar hyperhidrosis is a debilitating disease that affects a significant portion of the U.S. population. Medical therapy offers temporary relief for this problem while surgical intervention offers a more permanent solution. Endoscopic thoracic sympathectomy is the standard surgical intervention for palmar hyperhidrosis, but the extent of surgery that is required is of debate. Topics of concern include the level of interruption of the sympathetic chain, the method of interruption, and number of ports used. Upon detailed review of the current literature, along with significant experience in the field, we recommend the sympathetic chain should be interrupted at the level of R3 and/or R4, with clips, and though a single port technique when possible.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Strutton DR, Kowalski JW, Pharm D, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol. 2004;51(2):241–8. https://doi.org/10.1016/j.jaad.2003.12.040.
Milanez de Campos JR, Kauffman P, de Campos Werebe E, et al. Quality of life, before and after thoracic sympathectomy: report on 378 operated patients. Ann Thorac Surg. 2003;76(3):886–91. https://doi.org/10.1016/S0003-4975(03)00895-6.
Horslen LC, Wilshire CL, Louie BE, Vallières E. Long-term impact of endoscopic thoracic sympathectomy for primary palmar hyperhidrosis. Ann Thorac Surg. 2018;106(4):1008–12. https://doi.org/10.1016/j.athoracsur.2018.04.063.
Vallières E. Endoscopic upper thoracic sympathectomy. Neurosurg Clin N Am. 2001;12(2):321–7.
Sang HW, Li GL, Xiong P, Zhu MC, Zhu M. Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review. Surg Endosc. 2017;31(11):4357–69. https://doi.org/10.1007/s00464-017-5508-y.
Yazbek G, Wolosker N, Kauffman P, de Campos JRM, Puech-Leão P, Jatene FB. Twenty months of evolution following sympathectomy on patients with palmar hyperhidrosis: sympathectomy at the T3 level is better than at the T2 level. Clinics. 2009;64(8):743–9. https://doi.org/10.1590/S1807-59322009000800006.
Yazbek G, Wolosker N, Milanez De Campos JR, Kauffman P, Ishy A, Puech-Leão P. Palmar hyperhidrosis – which is the best level of denervation using video-assisted thoracoscopic sympathectomy: T2 or T3 ganglion? J Vasc Surg. 2005;42(2):281–5. https://doi.org/10.1016/j.jvs.2005.03.041.
Cerfolio RJ, De Campos JRM, Bryant AS, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg. 2011;91(5):1642–8. https://doi.org/10.1016/j.athoracsur.2011.01.105.
Li X, Tu YR, Lin M, Lai FC, Chen JF, Dai ZJ. Endoscopic thoracic sympathectomy for palmar hyperhidrosis: a randomized control trial comparing T3 and T2-4 ablation. Ann Thorac Surg. 2008;85(5):1747–51. https://doi.org/10.1016/j.athoracsur.2008.01.060.
Liu Y, Yang J, Liu J, et al. Surgical treatment of primary palmar hyperhidrosis: a prospective randomized study comparing T3 and T4 sympathicotomy. Eur J Cardiothorac Surg. 2009;35(3):398–402. https://doi.org/10.1016/j.ejcts.2008.10.048.
Zhang W, Wei Y, Jiang H, Xu J, Yu D. T3 versus T4 thoracoscopic sympathicotomy for palmar hyperhidrosis: a meta-analysis and system review. J Surg Res. 2017;218:124–31. https://doi.org/10.1016/j.jss.2017.05.063.
Sugimura H, Spratt EH, Compeau CG, Kattail D, Shargall Y. Thoracoscopic sympathetic clipping for hyperhidrosis: long-term results and reversibility. J Thorac Cardiovasc Surg. 2009;137(6):1370–8. https://doi.org/10.1016/j.jtcvs.2009.01.008.
Hynes CF, Yamaguchi S, Bond CD, Blair Marshall M. Reversal of sympathetic interruption by removal of clips. Ann Thorac Surg. 2015;99(3):1020–3. https://doi.org/10.1016/j.athoracsur.2014.10.062.
Cheng A, Johnsen H, Chang MY. Patient satisfaction after thoracoscopic sympathectomy for palmar hyperhidrosis: do method and level matter? Perm J. 2015;19(4):29–31. https://doi.org/10.7812/TPP/15-040.
Panhofer P, Ringhofer C, Gleiss A, et al. Quality of life after sympathetic surgery at the T4 ganglion for primary hyperhidrosis: clip application versus diathermic cut. Int J Surg. 2014;12(12):1478–83. https://doi.org/10.1016/j.ijsu.2014.11.018.
Chen Y, Ye W, Yang W, et al. Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Chin Med J. 2009;122(5):1525–8.
Ibrahim M, Allam A. Comparing two methods of thoracoscopic sympathectomy for palmar hyperhidrosis. JAAPA. 2014;27(9):1–4. https://doi.org/10.1097/01.JAA.0000453237.17130.6b.
Murphy MO, Ghosh J, Khwaja N, et al. Upper dorsal endoscopic thoracic sympathectomy: a comparison of one- and two-port ablation techniques. Eur J Cardiothorac Surg. 2006;30:223–7. https://doi.org/10.1016/j.ejcts.2006.04.016.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Smith, S.P., Vallières, E. (2020). The Extent of Surgery for Palmar Hyperhidrosis. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-47404-1_59
Download citation
DOI: https://doi.org/10.1007/978-3-030-47404-1_59
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-47403-4
Online ISBN: 978-3-030-47404-1
eBook Packages: MedicineMedicine (R0)