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Comparing between thoracoscopic limited T2-T3 sympathicotomy and open T1 to T4 sympathetic chain resection in the treatment of primary palmar hyperhidrosis
reza bagheri, Sr.1, Seyed ziaollah haghi1, Maryam Salehi2, Rozita Moradpoor1.
1Cardio- Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Mashhad university of medical sciences, mashhad, Iran, Islamic Republic of, 2Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran, mashhad, Iran, Islamic Republic of.

OBJECTIVE: Primary Hyperhidrosis which is focal oversweating in specific areas of the body including palms, soles, armpits, face and scalp, interferes with social activities and requires an effective and safe treatment.
This study aimed to compare the therapeutic outcome of unilateral single-port sympathicotomy with open surgery.
METHODS: In this historical clinical trial study, patients with primary palmar hyperhidrosis were divided into two groups based on the surgical approach: open surgery and Video-assisted thoracic surgery (VATS). Complete resection of T1-T4 ganglia was performed in open surgery and cutting and cauterization of the sympathetic chain between T2 and T3 ganglia in the dominant hand side was done in VATS. Complications of procedure, length of hospitalization, operation time and therapeutic results were recorded in prepared forms. Patients were followed up at 1, 3, 6 and 12 months after surgery.
RESULTS: The mean hospitalization period was 2.2±0.41 and 3.3±0.47 days in VATS and open surgery groups, respectively (P=0.02). The average operation times were 39.6±1.46 and 79.8±1.53 minutes in VATS and open surgery groups, respectively (P<0.001). Complications were as follows: delayed hemothorax (1 patient, VATS), compensatory hyperhidrosis (2, open surgery) and wound infection (1 patient, open surgery). The mean blood loss during surgery and time to return to work were significantly less in the VATS group (P<0.001). Oversweating was completely alleviated in the dominant hand in all patients. Alleviation was achieved in opposite hand in 60 and 65 percent of VATS and open surgery groups, respectively. (P=0.74)
CONCLUSIONS: Single port ipsilateral to dominant hand sympathicotomy between T2 and T3 ganglia, is a safe, minimally invasive and effective method in the treatment of primary palmar hyperhidrosis. Also, alleviatetion of the opposite hand’s oversweating is achieved in a large group of patients.

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