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Primary hyperhidrosis, or excessive sweating, is a vexing problem in young people that predominantly affects the palms, but may also affect the axillae, face, and plantar surfaces.
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Quality of life studies have shown that hyperhidrosis often interferes significantly with daily social and professional activities. Hyperhidrosis may have such a severe impact on life that patients will tailor their professional activities to their symptoms. The incidence of hyperhidrosis is not well known, however it has been suggested to be as high as 1% of the general population. It is likely that ethnicity and level of awareness influence reporting.
Medical treatment of hyperhidrosis includes topical agents, oral anticholinergic agents, and botulinum toxin injections. Often these forms of therapy will, however, be insufficient, provide transient relief requiring ongoing or multiple treatments, or pose difficulties with compliance.
VATS Sympathectomy for Hyperhidrosis
Thoracic sympathectomy is a definitive form of treatment for primary hyperhidrosis. Sympathectomy for hyperhidrosis was first reported in 1920 through a supraclavicular incision. In this index report the procedure was unilateral, and the patient was hospitalized for 13 days. The surgical technique has evolved over the last 85 years to an outpatient, minimally invasive, bilateral procedure.
Minimally invasive sympathectomy consists of thoracoscopically clipping the sympathetic chain through two 5 mm submammary incisions. Metallic clips are applied on the sympathetic chain at the appropriate level for the affected area. The operation is performed under general anesthesia, takes approximately 40 minutes to complete, and does not require chest tube placement. The patient is discharged within hours of the procedure.
The beneficial effects of VATS sympathectomy are immediate, and can be confirmed in the recovery room. Success rates for palmar and axillary hyperhidrosis are 94% to 100%, and 89% to 99% respectively. The principal side effect of thoracoscopic sympathectomy is compensatory sweating; however it is significantly less disturbing than the initial symptoms for the vast majority of patients. Overall, 92% of patients report satisfaction with their surgery and would recommend it to someone else. Surgical complications such as pneumothorax requiring a chest tube, bleeding requiring re-operation, or wound infection occur in less than 1%.
The impact of thoracoscopic sympathectomy on patient lifestyle is very dramatic and gratifying. We have performed over 50 minimally invasive sympathectomies with outstanding results and are currently retrospectively assessing quality of life in these patients. In an effort to provide an evidence-based approach to this disease, we are starting a unique prospective study with objective measurements of skin evaporation rates and a validated quality of life assessment.
