Hyperhidrosis treated by thoracoscopic sympathicotomy.

Hyperhidrosis of the palms, axillae and face has a strong negative impact on social and professional life. The existing non-operative therapeutic options seldom give sufficient relief and have a transient effect. A definitive cure can be obtained by upper thoracic sympathectomy. The traditional open surgical techniques are major procedures and few patients and surgeons have found that the risk--benefit consideration favoured surgery. Since 1987, the authors have divided the upper thoracic sympathetic chain on 1163 patients with a simple endoscopic technique by using standard urological equipment. A bilateral procedure takes less than 20 min and requires just one night in hospital. There have been no mortality or life-threatening complications. Ten patients (< 1%) required intercostal drainage because of haemo- or pneumothorax. Horner's syndrome occurred in four cases. Primary failure occurred in 23 cases (< 2%) and 24 (< 2%) developed recurrent symptoms. The patients with failure and recurrence were successfully reoperated on and only three have required a third operation. At the end of postoperative follow-up (median 31 months) 98% of the patients were satisfied. Endoscopic transthoracic sympathicotomy is an efficient, safe and minimally invasive surgical method for the treatment of palmar, axillary and facial hyperhidrosis.