title: Video assistance reduces complication rate of thoracoscopic sympathicotomy for hyperhidrosis.
abstract: BACKGROUND
  Thoracoscopic sympathicotomy has proved successful in the treatment of palmar hyperhidrosis. However, up to 8% of patients experience Horner's syndrome, and about 50% show compensatory sweating. This study evaluates the role of video assistance in thoracoscopic sympathicotomy for primary hyperhidrosis of the upper limb.
  
  
  METHODS
  Six hundred fifty-six thoracoscopic sympathicotomies were performed from below T1 to T4 in 369 patients. Of the operations, 558 were done under direct view (CTS group) and 98, with video assistance (VATS group). Follow-up was complete for 78.3% of patients after a median observation period of 16 years.
  
  
  RESULTS
  Dry limbs were immediately achieved in 93% of the CTS group and 98% VATS group (p = 0.98). In the CTS group, Horner's syndrome occurred after 2.2% of all operations and rhinitis in 8.3%. No patient in the VATS group showed any symptom of Homer's triad (p = 0.03 versus CTS group) or rhinitis (p = 0.02 versus CTS group). Compensatory sweating was observed in 66.8% in the CTS group versus 69% in the VATS group (p = 0.73) and gustatory sweating, in 50.4% versus 27.6%, respectively (p = 0.01).
  
  
  CONCLUSIONS
  In performing thoracoscopic sympathicotomy for excessive upper-limb hyperhidrosis, we observed a significant decrease in the incidence of Horner's syndrome, rhinitis, and gustatory sweating when the procedure was guided by video imaging.
authors.affiliation: University Clinic of Surgery, Vienna General Hospital, Austria. johannes.zacherl@akh-wien.ac.at
authors.forename: J
authors.initials: J
authors.lastname: Zacherl
authors.forename: M
authors.initials: M
authors.lastname: Imhof
authors.forename: E R
authors.initials: ER
authors.lastname: Huber
authors.forename: E G
authors.initials: EG
authors.lastname: Plas
authors.forename: F
authors.initials: F
authors.lastname: Herbst
authors.forename: R
authors.initials: R
authors.lastname: Jakesz
authors.forename: R
authors.initials: R
authors.lastname: Függer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006732:Horner Syndrome / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012220:Rhinitis / Q000209:etiology / Q000517:prevention & control; D013547:Sweating, Gustatory / Q000209:etiology / Q000517:prevention & control; D013562:Sympathectomy; D013906:Thoracoscopy; D016896:Treatment Outcome; D014741:Video Recording