title: Biportal thoracoscopic sympathectomy: surgical techniques and clinical results for the treatment of hyperhidrosis.
abstract: OBJECTIVE
  To describe a bilateral thoracoscopic sympathectomy procedure, using a biportal approach, for the treatment of severe hyperhidrosis.
  
  
  METHODS
  Between May 1996 and September 2000, 103 consecutive patients underwent thoracoscopic sympathectomy procedures to treat bilateral hyperhidrosis (206 procedures). Operative results, complications, and patient satisfaction were determined by reviews of hospital and office charts and by follow-up assessments in the outpatient clinic. Long-term results were determined with clinical examinations, follow-up office visits, and follow-up questionnaires.
  
  
  RESULTS
  Ninety-three patients presented with primary palmar hyperhidrosis, eight with primary axillary hyperhidrosis, and two with primary craniofacial hyperhidrosis. Rates of complete resolution in the primary area affected were 100% in palmar and craniofacial cases and 75% in axillary cases. The average length of hospitalization was 1.06 days, and 96 patients (93.2%) were discharged on or before the end of the first postoperative day. Of 59 patients (57.3%) who developed compensatory hyperhidrosis, only 11 patients (10.7%) reported that it was bothersome and none considered it disabling. All postoperative complications were transient; five patients experienced unilateral Horner's syndrome, three patients experienced intercostal neuralgia, and two patients required a chest tube after surgery because of a pneumothorax.
  
  
  CONCLUSIONS
  Thoracoscopic sympathectomy using a biportal approach effectively treats hyperhidrosis and is associated with short hospital stays, high patient satisfaction rates, and low rates of compensatory hyperhidrosis or other complications.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013-4496, USA.
authors.forename: Patrick P
authors.initials: PP
authors.lastname: Han
authors.forename: Oren N
authors.initials: ON
authors.lastname: Gottfried
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Kenny
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Dickman
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D005728:Ganglia, Sympathetic / Q000473:pathology / Q000601:surgery; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D013525:Surgical Instruments; D013562:Sympathectomy / Q000295:instrumentation*; D020708:Thoracoscopes; D016896:Treatment Outcome