title: Evolution of clipping for thoracoscopic sympathectomy in symptomatic hyperhidrosis.
abstract: BACKGROUND
  Severe hyperhidrosis is treated by thoracic sympathetic chain interrupting through chain transection or clipping. Our study compared the efficacy of these 2 methods.
  
  
  METHODS
  Retrospectively, patients who underwent thoracoscopic sympathectomy from 1999 to 2005 had demographic, operative, and postoperative data analyzed.
  
  
  RESULTS
  Fifty-four operations were performed for refractory sweating of the palm (72%), axilla (66%), foot (53%), and head/neck (19%). Thirty-seven (69%) underwent clipping; 17 (31%) underwent chain transection. There was no difference in age, sex, or blood loss. One ganglion level was interrupted in 24.1% and 2 levels in 75.4%. Bothersome compensatory hyperhidrosis occurred in 13% (5-clipping and 2-transection). One patient underwent clip removal for debilitating symptoms. Three small pneumothoraces occurred (all in the transection group); all treated expectantly.
  
  
  CONCLUSIONS
  Thoracoscopic sympathectomy is a safe outpatient procedure. Both methods yield excellent results with minimal compensatory hyperhidrosis. Thoracoscopic sympathetic chain clipping and transection are equivalent.
authors: Section of Thoracic and Foregut Surgery, University of Minnesota, Department of Surgery and Center for Minimally Invasive Surgery, Minneapolis, MN 55455, USA. bwhit@umn.edu
authors: Bryan A
authors: BA
authors: Whitson
authors: Rafael S
authors: RS
authors: Andrade
authors: Peter S
authors: PS
authors: Dahlberg
authors: Michael A
authors: MA
authors: Maddaus
mesh_terms: D000328:Adult; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013562:Sympathectomy / Q000379:methods*; D013906:Thoracoscopy; D016896:Treatment Outcome