Recent Research on Sympathectomy for Hyperhidrosis: 41th Annual Meeting of the Society of Thoracic Surgeons, 2005 One-year Follow-up after Thoracoscopic Sympathectomy for Hyperhidrosis: Outcomes and Consequences. T.M. Dewey, Dallas, Tx “Thoracoscopic Sympathectomy is recognized as an effective treatment for patients with severe hyperhidrosis…we reviewed our results in patients were at least one year from surgery…121 patients were identified…Patient- perceived effectiveness of the procedure vary depending on the level of Sympathectomy: T2-50% [for face/scalp in this study] effective, T3-95.6% [for palmar in this study], T4-100% [for axillary in this study]…Patients with T2 were significantly more likely to have severe compensatory sweating than those with other levels.  Patients with levels other than T2 [i.e., with T3 or T4 sympathectomy]reported high degrees of satisfaction irrespective of postoperative compensatory sweating.  Patient satisfaction and perceived effectiveness with Sympathectomy for palmer and axillary hyperhidrosis remain high even one year after the procedure…We recommend limiting sympathectomy to either the T3 or T4 level." Interactive Cardiovascular and Thoracic Surgery 3:437-441(2004) Minimally Invasive Thoracoscopic Sympathectomy for Palmar Hyperhidrosis via a Transaxillary Single-Port Approach. Georgios P. Georghiou et al., Tel Aviv, Israel “…176 consecutive patients with hyperhidrosis underwent thoracoscopic sympathectomy via a 12-mm single-port approach…Thirty-day mortality was zero. Complications included unilateral transient Horner's syndrome  residual pneumothorax requiring chest drainage from the port entry  and segmental atelectasis of the lung  which was treated conservatively. Complete relief of symptoms was observed in all patients at the 6-month follow-up; 45% experienced compensatory hyperhidrosis. Single-port thoracoscopic sympathectomy produces excellent medical and cosmetic results in patients with hyperhidrosis, and is associated with a short hospital stay and a low risk of complications. Overall satisfaction is high. A few patients may experience compensatory symptoms.” Annals of  Thoracic Surgery 2004;78:1801-1807 Long-Term Results of Thoracoscopic Sympathectomy for Hyperhidrosis Pascal Dumont, MD et al., Tours, France “…124 patients who were previously afflicted with bilateral thoracoscopic sympathectomy 6 years earlier was conducted. [99] Patients [who replied to a] questionnaire regarding the results and side effects. The main indication was palmo-plantar hyperhidrosis (34%)…there were no intraoperative complications. Postoperative pneumothorax occurred in 9 patients and 3 patients required a chest drain….Postoperative pain occurred in 78% of the patients. Neurologic complications (Horner syndrome, radial paralysis, and dysesthesia of the arm) occurred in 3 patients and disappeared after 2–6 months. Two patients required single-side reoperation because of failure with the first intervention. Eighty-nine replies to questionnaires were received (72%). The results for hands were favorable in 98% and in 63% for axillae. Compensatory sweating occurred in 87% of the patients (serious in 36% and incapacitating in 6%). Despite this 90% of the patients were satisfied or very satisfied. This study confirms that thoracoscopic sympathectomy is a suitable method of treatment for severe palmar hyperhidrosis but emphasizes the need to offer the patient more informative information, especially regarding compensatory sweating which seems inescapable. [This study refers to the technique of “clipping/clamping” as preferred.] Annals of Thoracic Surgery 2004;77:410-414 Thoracoscopic Sympathectomy for Hyperhidrosis: indications and results Neelan Doolabh, MD et al.,, Dallas, Texas “Hyperhidrosis can cause significant professional and social handicaps. Although treatments such as oral medication, botox, and iontophoresis are available, surgical sympathectomy is being increasingly utilized…180 patients with palmar, axillary, facial, or plantar hyperhidrosis underwent a thoracoscopic sympathectomy…Positive family history of hyperhidrosis was noted in 57%...98% (177/180) were completed as an outpatient procedure. Complications included a mild temporary Horner's Syndrome (n = 1; 0.5%), air leak requiring chest drainage (n = 9; 5%), and bleeding (n = 3; 1.6%) requiring thoracoscopic reexploration (n = 1) and chest drainage (n = 2). Success rates were palmar 100% (109/109), axillary 98% (48/49), and face/scalp 93% (26/28). Plantar hyperhidrosis responded with improvement in 82% (72/88) of all patients. Seventy-eight percent patients (96/123) experienced compensatory hyperhidrosis, usually affecting the stomach, chest, back, and neck. Overall satisfaction was 94% (139/148). Thoracoscopic sympathectomy is a safe and effective outpatient method for managing hyperhidrosis. Although overall satisfaction is high, patients should be fully informed about the potential for compensatory sweating. Surg Laparosc Endosc Percutan Tech. 2002 Endoscopic thoracic sympathectomy for hyperhidrosis: experience with both cauterization and clamping methods. Reisfeld et al, Los Angeles, CA 90035 The goal was to review results of sympathectomy, performed with use of either cauterization or clamping, in patients with hyperhidrosis (n = 1,312)...Palmar hyperhidrosis was cured in all but one patient, with a 98% satisfaction rate in the clamping group and 94.3% and 95.1% in the two cauterization groups...Facial sweating or blushing was cured in the majority (88%)...Severe compensatory hidrosis occurred in less than 6% (3% of the clamping group; clamping (cauterization). Recurrence rate was 3.0%. A number of factors were related to outcome. Endoscopic thoracic sympathectomy with clamping appears to be at least as safe and effective as earlier cauterization techniques, with the potential advantage of reversibility in those patients unhappy with the outcome.