Thoracic sympathectomy under video-mediastinoscopy for palmar hyperhidrosis of 522 cases

【Objective】To explore the curative effects of thoracic sympathectomy under Video-Mediastinoscopy(VM) for palmar hyperhidrosis.【Method】522 patients suffering from palmar hyperhidrosis underwent thoracic sympathectomy under VM.Under general anesthesia with endotracheal tubeplacement.The patients were maintained in the 30°～45° semi-sitting position,with abduction of both arms to 90°.The VM entered the thoracic cavity via the third intercostals space on the anterior axillary line.The T4 sympathetic ganglions were resected by electrocautery.【Result】The symptoms of hyperhidrosis disappeared postoperatively in all the case,with patients'both hands becoming dry and warm immediately after operation.The skin temperatures of the right palm were(31.6 ± 1.8)℃ preo-pratively and(34.6 ± 1.4)℃ postoperatively(t=5.732,P =0.031).The skin temperatures of the left palm were(32.3 ± 1.5)℃ preopratively and(35.2 ± 1.2)℃ postoperatively(t=7.341,P =0.024).The surgical outcomes were classified as cure in 510 cases and improvement in 12 cases.There were 62 cases of compensated hyperhidrosis,120 cases of small amount of pneumothorax accompanying mild subcutaneous emphysema,23 cases of pleural effusion(including 11 cases of bilateral effusion),12 cases of wound infection.No Horner's syndrome was observed.【Conclusion】The T4 thoracic sympathectomy under VM for the treatment of palmar hyperhidrosis is safe,reliable,and minimally invasive.