Video-assisted thoracoscopic sympathetic ramicotomy for hyperhidrosis--a way to reduce the complications.

Endoscopic resectional surgery of sympathetic nerves is now the most acceptable method to treat palmar hyperhidrosis, though the resection of the sympathetic trunk and ganglia can result in the irreversible compensatory hyperhidrosis. The ideal way to treat the palmar hyperhidrosis, without the undesirable complication of the compensatory hyperhidrosis, is still pending. We adapt endoscopic cutting of the second and third sympathetic rami without injury to the sympathetic ganglia and trunk, and find that it is a good way to reduce the complications. Most importantly, it has a cure rate comparable with the conventional technique. The longer operation time and the higher operation risk are the drawbacks.