title: Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis. The use of harmonic scalpel versus diathermy.
abstract: BACKGROUND
  Upper dorsal thoracoscopic sympathectomy, the treatment of choice for primary palmar hyperhidrosis, is not devoid of long-term complications, like Horner's syndrome and postoperative neuralgia. It has been postulated that propagation of heat induced by diathermy may be responsible for some of these sequelae. To assess this hypothesis, a study was undertaken to evaluate the use of harmonic scalpel, which does not dissipate heat.
  
  
  METHODS
  Sixteen patients with primary palmar hyperhidrosis underwent upper dorsal thoracoscopic sympathectomy using the harmonic scalpel on one side and diathermy on the other. Follow-up was made two years postoperatively.
  
  
  RESULTS
  The length of the procedure with each instrument was similar. There was no localization of postoperative pain, which could be attributed to either device. No Horner's syndrome or postoperative neuralgia occurred.
  
  
  CONCLUSIONS
  The present study proved the safe use of harmonic scalpel for upper dorsal thoracoscopic sympathectomy, but did not detect any important advantage of either instrument over diathermy.
authors.affiliation: Faculty of Medicine, Technion--Israel Institute of Technology, Haifa.
authors.forename: D
authors.initials: D
authors.lastname: Kopelman
authors.forename: H
authors.initials: H
authors.lastname: Bahous
authors.forename: A
authors.initials: A
authors.lastname: Assalia
authors.forename: M
authors.initials: M
authors.lastname: Hashmonai
mesh_terms: D000293:Adolescent; D000328:Adult; D003972:Diathermy; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000294:innervation; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D013562:Sympathectomy / Q000295:instrumentation* / Q000379:methods*; D013906:Thoracoscopy