A 5-Year experience of 51 endoscopic transthoracic dorsal sympathectomies for idiopathic palmar hyperhidrosis in 26 patients is presented. Fifty-two percent complained of excessive sweating over their hands, 28% of axillary sweating and 20% over both areas, with a mean duration of 10 years. The second, third and fourth thoracic ganglia and their interconnecting fibres on the affected side were ablated using diathermy cautery. Over a mean follow up time of 26 months, this procedure was successful in curing or improving intractable sweating in 92%. However, axillary sweating was less well controlled than in the palms with 20% of patients describing residual wetness in the axilla. Compensatory sweating (75%) and gustatory sweating (48%) were the commonest side effects; despite this, most patients were satisfied with the functional and cosmetic outcome. Other complications included a temporary Horner's syndrome in one patient, a pneumothorax in the immediate post-operative period in another and a unilateral non-infective reactionary pleural effusion in a third. Two patients developed recurrence of palmar hyperhidrosis within 6 months of surgery. One has been successfully treated by re-operation on the affected side. All patients complained of mild to moderate interscapular chest pain which was easily controlled by non-steroidal anti-inflammatory agents, and resolved within 7–10 days post-operatively. The technique of endoscope transthoracic sympathectomy is effective, relatively simple to perform and usually requires only an overnight stay. It is recommended as the surgical treatment of choice for upper limb hyperhidrosis unresponsive to conservative measures.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment.Ann Surg 1977;186: 34–41.
Kux M. Thoracic endoscopic sympathectomy in palmar and axillary hyperhidrosis.Arch Surg 1978;113: 264–266.
Skoog T, Thyresson N. Hyperhidrosis of the axilla.Acta Chir Scand 1962;124: 531–538.
Jemec B. Abrasio axillae in hyperhidrosis.Scand J Plast Reconstr Surg 1975;9: 44–46.
Ashby EC, Williams JLI. Cryosurgery for axillary hyperhidrosis.Br Med J 1976;2: 1173–1174.
Tofield J. Treatment of bilateral axillary hyperhidrosis by suction assisted lipolysis technique.Ann Plast Surg 1988;21: 99.
Telford E. The technique of sympathectomy.Br J Surg 1935;21: 113–130.
Bogokowsky H, Slutzki S, Bacalu L, Abramsohn R, Negri M. Treatment of primary hyperhidrosis.Arch Surg 1983;118: 1065–1067.
Keaveny T, Fitzgerald P, Donnelly C, Shanik G. Surgical management of hyperhidrosis.Br J Surg 1977;64: 570–571.
Golueke P, Garrett W, Thompson J, Talkington C, Smith B. Dorsal sympathectomy for hyperhidrosis—the posterior paravertebral approach.Surgery 1988;103: 568–572.
Cloward R. Hyperhidrosis.J Neurosurg 1969;30: 545–551.
Palumbo L. Anterior transthoracic approach for upper thoracic sympathectomy.Arch Surg 1982;72: 659–666.
Atkins HJB. Sympathectomy by the axillary approach.Lancet 1954;i: 538–539.
Campbell W, Cooper M, Sponsel W, Baird R, Peacock J. Transaxillary sympathectomy—is a one stage bilateral procedure safe.Br J Surg 1982;69 (suppl): S29-S31.
Roos D. Experience with first rib resection for thoracic outlet syndrome.Ann Surg 1971;173: 429–442.
Wilkinson H. Radiofrequency percutaneous upper thoracic sympathectomy.N Engl J Med 1984;311: 34–36.
Kux E.Thorakoskopische eingriffe am nerven system. Stuttgart: Georg. Theime Verlag, 1954.
Greenhalgh R, Rosengarten D, Martin P. Role of sympathectomy for hyperhidrosis.Br Med J 1971;1: 332–334.
Kuntz A. Distribution of the sympathetic rami to the brachial plexus.Arch Surg 1927;15: 871–877.
Kirgis HD, Kuntz A. Inconstant sympathetic neural pathways.Arch Surg 1942;44: 95–102.
Lee FC. Regeneration of nervous tissue.Physiol Rev 1929;9: 575–623.
Simeone FA. Pressure, vascular tone and sympathectomy.Surgery 1963;53: 1–18.
About this article
Cite this article
Masters, A., Rennie, J.A. Endoscopic transthoracic sympathectomy for idiopathic upper limb hyperhidrosis. Clinical Autonomic Research 2, 349–352 (1992). https://doi.org/10.1007/BF01824306