Twenty patients with primary palmar hyperhidrosis were selected for bilateral thoracoscopic electrocautery of the
sympathetic chain. Five out of the 20 patients had as well, axillary hyperhidrosis. The second and third thoracic ganglia were electrocoagulated and in patients associated with axillary hyperhidrosis, the fourth thoracic ganglion was also coagulated.
The procedure was successfully completed bilaterally in 17 patients (85%). Unilateral failure to identify the sympathetic
chain occurred in 3 patients (15%) which required conversion to open surgery on these limbs. The mean operative time for each limb was 37 minutes. The mean postoperative hospital stay was 2.5 days and the patients resumed normal activity within 10 days postoperatively. Chest pain was the commonest postoperative complaint. It was usually relieved by a single dose of opiates given during hospital stay; however, 3 patients (15%) needed oral analgesics after hospital discharge for a mean period of 4 days. Complications in our study were few and mild: unilateral pneumothorax occurred in 2 patients (10%), unilateral hemothorax and transient Horner's syndrome occurred in 1 patient (5%). Burst of palmar sweating for some hours, during the first postoperative week, occurred in 3 patients (15%). Mild compensatory hyperhidrosis and gustatory sweating occurred in 6 patients (30%) and 2 patients (10%) respectively and they did not cause discomfort to our patients. Unilateral moderate recurrence of hyperhidrosis occurred in one patient (5%) after 4 months and he refused any more surgical interference. Some of our patients, who had plantar hyperhidrosis as well, noticed postoperative decrease of their feet sweating.
The thoracoscopic approach for palmar hyperhidrosis seems to offer the ideal surgical solution with excellent results,
minimal complications, short hospital stay and early recovery.