Video-Assisted Thoracic Surgery Sympathectomy for Hyperhidrosis

HYPOTHESIS: Video-assisted thoracic surgery sympathectomy is efficacious for patients with hyperhidrosis. DESIGN: An experience with patients undergoing bilateral video-assisted thoracic surgery sympathectomy was reviewed to evaluate the operative technique and to determine morbidity and outcomes. SETTING: Academic health center. PATIENTS: The cohort included 31 patients (22 women and 9 men). All but 2 patients were of Asian descent, and the average age was 24.9 years. All patients had palmar hyperhidrosis. Two patients also had craniofacial hyperhidrosis, and another 2 had pedal hyperhidrosis. INTERVENTIONS: Bilateral video-assisted thoracic surgery sympathectomy with resection of the second and third ganglia was performed in all patients. Small chest tubes were removed on the first postoperative day. In 30 patients, the procedures were simultaneous; and in 1, it was staged to accommodate lumbar sympathectomy for pedal disease. RESULTS: Perioperatively, no patients died. The only hospital complication was an intraoperative injury to an intercostal artery that required conversion to an open thoracotomy. The average hospital length of stay was 1.2 days (range, 1-3 days). No patient developed Horner syndrome. Long-term follow-up was 2.6 years (range, 3 months to 7 years). Both hands in all patients were warm and dry at the last follow-up, as were the face and scalp in the 2 with craniofacial hyperhidrosis. Ten patients (32%) experienced compensatory sweating, which improved within 6 months. CONCLUSIONS: In this experience, palmar hyperhidrosis is predominantly a disease of young Asian women. Simultaneous bilateral video-assisted thoracic surgery sympathectomy is effective and can be accomplished with minimal morbidity and a short hospitalization. Compensatory sweating occurs in a third of patients, but is generally self-limiting.