title: Thoracoscopic sympathicotomy in the treatment of palmar hyperhidrosis.
abstract: BACKGROUND
  Primary hyperhidrosis interferes with social activities and requires an effective and safe treatment. We aimed to compare the therapeutic outcomes of unilateral single-port sympathicotomy and open surgery.
  
  
  METHODS
  Forty patients with primary palmar hyperhidrosis underwent sympathicotomy; 20 had open surgery, and 20 had video-assisted thoracic surgery. Complete resection of the T1 to T4 ganglia was performed by open surgery, and cutting and cauterization of the sympathetic chain between the T2 and T3 ganglia in the dominant hand was undertaken using video-assisted thoracic surgery. The patients were followed up at 1, 3, 6, and 12 months after surgery.
  
  
  RESULTS
  The mean operative times were 39.6 ± 1.46 and 79.8 ± 1.53 min in the video-assisted thoracic surgery and open surgery group, respectively. The mean hospitalization was 2.2 ± 0.41 days after video-assisted thoracic surgery and 3.3 ± 0.47 days after open surgery. Complications included delayed hemothorax, compensatory hyperhidrosis, and wound infection. The mean blood loss during surgery and time to return to work were significantly less in the video-assisted thoracic surgery group. Excessive sweating was completely alleviated in the dominant hand in all patients, and in the opposite hand in 60% and 65% of the video-assisted thoracic surgery and open surgery group, respectively.
  
  
  CONCLUSIONS
  Single-port sympathicotomy between the T2 and T3 ganglia ipsilateral to the dominant hand is a safe, minimally invasive, and effective treatment for primary palmar hyperhidrosis. Alleviation of excessive sweating in the opposite hand can also be achieved in a large proportion of these patients.
authors.affiliation: Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran bagherir@mums.ac.ir.
authors.forename: Reza
authors.initials: R
authors.lastname: Bagheri
authors.affiliation: Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Sharifian Attar
authors.affiliation: Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Seyed Ziaollah
authors.initials: SZ
authors.lastname: Haghi
authors.affiliation: Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Salehi
authors.affiliation: Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Rosita
authors.initials: R
authors.lastname: Moradpoor
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D005728:Ganglia, Sympathetic / Q000503:physiopathology / Q000601:surgery*; D006225:Hand / Q000294:innervation*; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D062707:Return to Work; D013546:Sweating; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hyperhidrosis; Sympathectomy; Thoracic surgery; Treatment outcome; video-assisted