Background: Hyperhidrosis is unnecessary sweating afar the body needs for cooling down the body temperature. It affects nearly 2-3% of the population with equal gender predominance. Both medical and surgical interventions have been utilized to treat primary hyperhidrosis. Over 80% of patients with palmar hyperhidrosis (PH) also experience plantar hyperhidrosis (PLH). An interesting observation in surgically treated patients with PH is that PLH symptoms tend to decrease after undergoing Video-assisted thoracoscopic surgery (VATS).
Objectives: The aim of the present study was to evaluate the efficacy, safety and drawbacks of VATS sympathectomy at thoracic levels (R2-3) versus (R2-4) on PLH associated with primary PH.
Patients and methods: this single center, parallel randomized controlled study involved 72 eligible patients presented with primary palmoplantar hyperhidrosis, where 36 patients underwent VATS sympathectomy at thoracic levels R2-3 (Group A) versus other 36 patients at thoracic level R2-4 (Group B). Both groups underwent bilateral two-port tubeless VATS sympathectomy with the use of electrocautery under general anesthesia in semi-fowler position.
 Results: Following surgery, both groups showed improvement in PLH, but group B had a significantly higher incidence of improvement compared to group A. In group A, 77.7% of patients were satisfied, while in group B, 88.8% of patients reported satisfaction.
Conclusion: VATS sympathectomy is the preferred treatment for effectively curing PH. There is a significant correlation between VATS sympathectomy performed at the R2 to R4 levels and the alleviation of PLH.