title: An objective assessment of the sudomotor response after thoracoscopic sympathectomy.
abstract: OBJECTIVE
  Thoracoscopic sympathectomy has become an accepted therapeutic option for palmar hyperhidrosis. Objective assessment of sweat output after sympathectomy, however, has not been reported to date. We report for the first time sweat output measurements after sympathectomy during a 3-year postoperative period.
  
  
  METHODS
  Thoracoscopic sympathectomy was performed by division of T2 and T3 sympathetic ganglia in 17 healthy adult patients with no comorbidities. Preoperative and postoperative sweat measurements were done at 29 degrees C (below sweat threshold, at baseline, after conversation, and after a mental arithmetic challenge) and at 40 degrees C (baseline and after exercise) with the ventilated capsule technique in left palm, sole, and chest wall. Serial postoperative measurements were conducted at 1 and 6 months and 1, 2, and 3 years.
  
  
  RESULTS
  Sweat output fell significantly after sympathectomy relative to preoperative levels under all experimental conditions (P < .001, analysis of variance) in the left palm. Differences in sweat outputs in the left palm were statistically significant between groups at baseline and postoperatively after mental arithmetic challenge and exercise at 40 degrees C (P < .05, analysis of variance). Compensatory increases in the sweat outputs from the left sole and chest were observed after sympathectomy. No patients had recurrence of preoperative sweat output values at follow-up.
  
  
  CONCLUSIONS
  According to objective sweat output measurements, thoracoscopic sympathectomy results in long-term control of palmar hyperhidrosis. This evaluation method is valuable in investigating recurrence of symptoms or compensatory hyperhidrosis after sympathectomy, providing a robust and objective criterion for planning intervention.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK. prambond@hotmail.com
authors.forename: Pramod
authors.initials: P
authors.lastname: Bonde
authors.forename: Nnamdi
authors.initials: N
authors.lastname: Nwaejike
authors.forename: Colin
authors.initials: C
authors.lastname: Fullerton
authors.forename: Judith
authors.initials: J
authors.lastname: Allen
authors.forename: James
authors.initials: J
authors.lastname: Mcguigan
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis / Q000517:prevention & control / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D017060:Patient Satisfaction; D011184:Postoperative Period; D012016:Reference Values; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013546:Sweating; D013562:Sympathectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013904:Thoracic Vertebrae; D016896:Treatment Outcome