title: Sympathotomy for palmar hyperhidrosis: the cutting versus clamping methods.
abstract: OBJECTIVE
  Endoscopic thoracic sympathectomy/sympathotomy for the treatment of palmar hyperhidrosis is generally performed by either cutting or clamping the sympathetic chain. However, it remains unclear as to which of these methods is more effective and has fewer side effects. This study was conducted to compare the effects of sympathotomy by cutting or clamping at T3 on two outcomes--postoperative palmar sweating and compensatory sweating; it also evaluated postoperative patient satisfaction.
  
  
  METHODS
  The participants were among 289 patients who underwent bilateral sympathotomy at T3 for palmar hyperhidrosis. These patients were sent questionnaires by mail to assess their self-reported degree of postoperative palmar sweating and compensatory sweating, as well as their level of satisfaction. Of the 92 patients who responded to the questionnaire, 54 had undergone sympathotomy by cutting (cutting group) and 38 by clamping (clamping group).
  
  
  RESULTS
  The degree of postoperative palmar sweating was significantly lower in the cutting group than in the clamping group. However, compensatory sweating was significantly more severe in the cutting group than in the clamping group. No significant difference was observed in the degree of patient satisfaction between the groups.
  
  
  CONCLUSIONS
  Sympathotomy by clamping at T3 was less effective in reducing the primary symptom of postoperative palmar sweating, but induced less compensatory sweating than did sympathotomy by cutting at T3. However, both methods were similar with regard to patient satisfaction. The degree of postoperative palmar sweating and the severity of compensatory sweating were inversely correlated with the degree of patient satisfaction.
authors.affiliation: Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hida
authors.affiliation: Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. tscat@fb3.so-net.ne.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
authors.forename: Maya
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Tamagawa
authors.affiliation: Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Abe
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000473:pathology; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013525:Surgical Instruments; D013546:Sweating / Q000502:physiology; D013562:Sympathectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Clamping method; Hyperhidrosis; Postoperative compensatory sweating; Postoperative satisfaction; Thoracic sympathotomy