title: Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period.
abstract: OBJECTIVE
  To review surgical results of endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis during the past decade.
  
  
  METHODS
  We retrospectively reviewed 155 consecutive patients who underwent surgery from June 30, 2000, through December 31, 2009, for medically refractory palmar-plantar hyperhidrosis using a technique of T1-T2 sympathotomy disconnection, designed for successful palmar response and minimization of complications.
  
  
  RESULTS
  Of the 155 patients, 44 (28.4%) were male, and 111 (71.6%) were female; operative times averaged 38 minutes. No patient experienced Horner syndrome, intercostal neuralgia, or pneumothorax. The only surgical complication was hemothorax in 2 patients (1.3%); in 1 patient, it occurred immediately postoperatively and in the other patient, 10 days postoperatively; treatment in both patients was successful. All 155 patients had successful (warm and dry) palmar responses at discharge. Long-term follow-up (>3 months; mean, 40.2 months) was obtained for 148 patients (95.5%) with the following responses to surgery: 96.6% of patients experienced successful control of palmar sweating; 69.2% of patients experienced decreased axillary sweating; and 39.8% of patients experienced decreased plantar sweating. At follow-up, 5 patients had palmar sweating (3 patients, <3 months; 1 patient, 10-12 months; 1 patient, 16-18 months). Compensatory hyperhidrosis did not occur in 47 patients (31.7%); it was mild in 92 patients (62.2%), moderate in 7 patients (4.7%), and severe in 2 patients (1.3%).
  
  
  CONCLUSIONS
  In this series, a small-diameter uniportal approach has eliminated intercostal neuralgia. Selecting a T1-T2 sympathotomy yields an excellent palmar response, with a very low severe compensatory hyperhidrosis complication rate. The low failure rate was noted during 18 months of follow-up and suggests that longer follow-up is necessary in these patients.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA. atkinson.john@mayo.edu
authors.forename: John L D
authors.initials: JL
authors.lastname: Atkinson
authors.forename: Nicolee C
authors.initials: NC
authors.lastname: Fode-Thomas
authors.forename: Robert D
authors.initials: RD
authors.lastname: Fealey
authors.forename: John H
authors.initials: JH
authors.lastname: Eisenach
authors.forename: Stephan J
authors.initials: SJ
authors.lastname: Goerss
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000453:epidemiology / Q000601:surgery*; D005712:Galvanic Skin Response; D005728:Ganglia, Sympathetic / Q000601:surgery*; D006229:Hand Dermatoses / Q000453:epidemiology / Q000601:surgery*; D006491:Hemothorax / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006945:Hyperhidrosis / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012881:Skin Temperature; D013546:Sweating; D013562:Sympathectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D013906:Thoracoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D016896:Treatment Outcome