Upper dorsal sympathectomy has been performed for a wide variety of indications, the most common of which is palmer
hyperhydrosis. With the development of video-assisted thoracic surgery, its application has extended to include
thoracoscopic sympathectomy. In the present study we describe our experience with this recent technique and evaluate its results in comparison with the standard open surgical supraclavicular approach.
Forty-five cases of thoracoscopic sympathectomy were studied in comparison with 20 cases of open supraclavicular
sympathectomy performed for various indications. The two groups were well matched regarding age, sex, side of surgery, and indication for the procedure (p>0.05).
Relief of symptoms was achieved in 42 patients (93.3%) in the thoracoscopic group versus 18 patients (90%) in the open
surgical group (p>0.05). Recurrent hyperhydrosis occurred in one patient in the thoracoscopic group six months after the
procedure. No perioperative deaths or major complications were encountered in either group. Horner's syndrome occurred in three patients in the thoracoscopic group and in two patients in the open surgical group (p>0.05). Minor complications included surgical emphysema (one patient), and intercostal neuralgia (one patient) in the thoracoscopic group. In the open surgical group, minor wound complications (hematoma, chylous discharge) occurred in two cases. The mean operative time was significantly shorter for the thoracoscopic technique compared to the open surgical procedure (32.9±11.6 mm. versus 73.3±33.3 min., p<0.0001). The mean hospital stay was also significantly shorter for the thoracoscopic group compared to the open surgical group (1.12±0.4 days versus 2.81±2.5 days, p<0.0001).
In conclusion, the present study supports the superiority of the thoracoscopic approach for upper dorsal sympathectomy.
Its technical ease, increased patient acceptance, minimal morbidity, and excellent results make it the approach of choice for this procedure