Primary palmar hyperhidrosis is a pathological condition of excessive perspiration of unknown aetiology. It causes severe emotional, occupational and social handicaps at an early age.
A variety of treatment methods are used to control or reduce the profuse sweating which involves, mainly the plams and axillae. Sympathectomy remains the standard by which other treatment must be judged. For thoracic sympathectomy a variety of surgical approaches are used. This study evaluates the thoracoscopic approach.

Patients and Methods: Between August 1999 and November 2001, 41 patients underwent bilateral T2 sympathectomy for an isolated palmar hyperhidrosis (n=29) and T3-4 sympathectomy simultaneously for a combined axillary hyperhidrosis (n-12).A preoperative chest radiograph is essential to exclude pulmonary pathology. The patients are anaesthetized using a double lumen endotracheal tube.

Results: Fourty one patients included in our study. There were 30 males and 11 females of mean age 21.3 years (range 14-32 years). The area affected before operation were hands alone in 29 patients (70.7%) and both hands with the axillae in 12 patients (29.2%). Eight patients (19.5%) have a positive family history. In all patients, immediate dry hands were recorded. There was no mortality and no serious morbidity. Homer's syndrome occurred in 1 patients (2.4%). It resolved in 6 weeks. Surgical emphysema in 2 patients (4.8%). Pneumothorax in one patient (2.4%) who need reinsertion of the intercostal tube. Compensatory hyperhidrosis (CH) developed in 9 patients (21.9%) within 6 months after surgery. The primary areas of CH were the upper back (55%), buttock (52%), and the anterior chest (45%) in developing orders. 6 of 9 patients experienced spontaneous improvement in CH within 9 months of operation. No recurrence was noted during the follow-up period of one year duration.

Conclusion: Thoracoscopic sympathectomy has now stood the test of time. It is easier to perform, and so safer than open procedures. It is far more comfortable for the patients, cosmetically superior and costs less. However, patients should be advised of the possibility of compensatory hyperhidrosis.