Improvements in video-endoscopic sympathicotomy for the treatment of palmar, axillary, facial, and palmar-plantar hyperhidrosis

Abstract

Video-endoscopic sympathicotomy for the treatment of palmar, axillary, facial and palmar-plantar hyperhidrosis was modified as to the type of surgical access and the level of incision in the sympathetic chain and communicating rami, depending on the clinical indications. Under general anaesthesia, using a single lumen endotracheal tube, the patient is put in lateral decubitus and pneumothorax is induced. The patient is then placed in ventral decubitus, with the head elevated, to make two punctures in the posterior axillary line, at the level of the 4th and 7th intercostal spaces, to introduce two ports of 5 and 10 mm in size, respectively. The sympathetic chain and the communicating rami are viewed and severed, according to the indications, at different levels to treat palmar, axillary, facial and palmar-plantar hyperhidrosis and combinations of the above. The operation is performed on both sides of the thorax during the same period of anaesthesia. One hundred-forty patients (280 procedures) have been operated on from 1993 to 1997 using this technique. All were operated on as outpatients. Our results are: 100% of those with facial and palmar hyperhidrosis and 96% of those with axillar hyperhidrosis were cured, and 94% with plantar hyperhidrosis were relieved from 50 to 100%, with the follow-up of between one and 47 months.