Endoscopic thoracic sympathicotomy for primary palmar hyperhidrosis: A retrospective multicenter study in China

Published:August 02, 2019DOI:



      This study aimed to evaluate the clinical efficacy and safety of endoscopic thoracic sympathicotomy and to explore strategies to decrease the incidence of transfer hyperhidrosis (TH).


      From January 2003 to July 2016, 10,275 patients with primary palmar hyperhidrosis underwent endoscopic thoracic sympathicotomy in 15 different institutions. We carried out a retrospective analysis of these patients who were grouped into group A, those with nonretained R2 (R2, R2–3, or R2–4 ablation), and group B, those with retained R2 (single R3 or R4 ablation).


      All procedures were performed successfully. Both hands of all patients became warm and dry immediately after endoscopic thoracic sympathicotomy. Pneumothorax occurred in 146 patients, and 39 patients had intraoperative bleeding. Follow-up was carried out from 6 months to 13 years. A total of 531 patients (5.2%) were lost to follow-up. The effective rate for primary palmar hyperhidrosis was 100%. Palmar hyperhidrosis recurred in 73 patients (0.7%). Transfer hyperhidrosis appeared in 7,678 patients (78.8%). For groups A and B, the incidence of TH was 80.4% and 78.5%, respectively (P > .05), but the incidence of grade III+IV TH in group B (1.6%) was less than that in group A (4.8%; P < .001).


      Endoscopic thoracic sympathicotomy is a minimally invasive, safe, and effective therapeutic method for primary palmar hyperhidrosis. Although the overall incidence of TH is high, the incidence of grade III to IV TH can be decreased by reserving R2, lowering the level of thoracic sympathicotomy, and single severing of R3 or R4.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sato K.
        • Kang W.H.
        • Saga K.
        • Sato K.T.
        Biology of sweat glands and their disorders. II. Disorders of sweat gland function.
        J Am Acad Dermatol. 1989; 20: 713-726
        • De Campos J.R.
        • Kauffman P.
        • Werebe Ede C.
        • et al.
        Quality of life, before and after thoracic sympathectomy: Report on 378 operated patients.
        Ann Thorac Surg. 2003; 76: 886-891
        • Malone P.S.
        • Cameron A.E.
        • Rennie J.A.
        Endoscopic thoracic sympathectomy in the treatment of upper limb hyperhidrosis.
        Ann R Coll Surg Engl. 1986; 68: 93-94
        • Heckmann M.
        • Plewig G.
        • Hyperhidrosis Study Group
        Low-dose efficacy of botulinum toxin a for axillary hyperhidrosis: A randomized, side-by-side, open-label study.
        Arch Dermatol. 2005; 141: 1255-1259
        • Lai F.C.
        • Tu Y.R.
        • Li Y.P.
        • et al.
        Nation-wide epidemiological survey of primary palmar hyperhidrosis in the People’s Republic of China.
        Clin Auton Res. 2015; 25: 105-108
        • Krasna M.J.
        Thoracoscopic sympathectomy: A standardized approach to therapy for hyperhidrosis.
        Ann Thorac Surg. 2008; 85: S764-S767
        • Cerfolio R.J.
        • De Campos J.R.
        • Bryant A.S.
        • et al.
        The society of thoracic surgeons expert consensus for the surgical treatment of hyperhidrosis.
        Ann Thorac Surg. 2011; 91: 1642-1648
        • Lai Y.T.
        • Yang L.H.
        • Chio C.C.
        • Chen H.H.
        Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy.
        Neurosurgery. 1997; 41 (discussion 113–115): 110-113
        • Chen J.F.
        • Lin J.B.
        • Tu Y.R.
        • Lin M.
        • Li X.
        • Lai F.C.
        • et al.
        Nonintubated transareolar single-port thoracic sympathicotomy with a needle scope in a series of 85 male patients.
        Surg Endosc. 2016; 30: 3447-3453
        • Lin M.
        • Tu Y.R.
        • Lai F.C.
        • et al.
        Transaxillary concealing single incision endoscopic thoracic sympathectomy in the treatment of palmar hyperhidrosis: A novel surgical approach.
        Zhonghua Yi Xue Za Zhi. 2013; 93: 3300-3301
        • Kamberov Y.G.
        • Wang S.
        • Tan J.
        • et al.
        Modeling recent human evolution in mice by expression of a selected EDAR variant.
        Cell. 2013; 152: 691-702
        • Chen J.
        • Lin M.
        • Chen X.
        • et al.
        A novel locus for primary focal hyperhidrosis mapped on chromosome 2q31.1.
        Br J Dermatol. 2015; 172: 1150-1153
        • Kuntz A.
        Distribution of the sympathetic rami to the brachial plexus: Its relation to sympathectomy affecting the upper extremity.
        Arch Surg. 1927; 15: 871-877
        • Tu Y.
        • Luo R.
        • Li X.
        • Lin M.
        • Qiu M.
        Hypermyelination and overexpression of neuregulin-1 in thoracic sympathetic nerves in patients with primary palmar hyperhidrosis.
        J Clin Neurosci. 2012; 19: 1651-1653
        • Singh B.
        • Moodley J.
        • Allopi L.
        • Cassimjee H.M.
        Horner syndrome after sympathectomy in the thoracoscopic era.
        Surg Laparosc Endosc Percutan Tech. 2006; 16: 222-225
        • Lin C.C.
        • Telaranta T.
        Lin-Telaranta classification: The importance of different procedures for different indications in sympathetic surgery.
        Ann Chir Gynaecol. 2001; 90: 161-166
        • Li X.
        • Tu Y.R.
        • Lin M.
        • Lai F.C.
        • Chen J.F.
        • Dai Z.J.
        Endoscopic thoracic sympathectomy for palmar hyperhidrosis: A randomized control trial comparing T3 and T2-4 ablation.
        Ann Thorac Surg. 2008; 85: 1747-1752
        • Mahdy T.
        • Youssef T.
        • Elmonem H.A.
        • Omar W.
        • Elateef A.A.
        T4 sympathectomy for palmar hyperhidrosis: Looking for the right operation.
        Surgery. 2008; 143: 784-789
        • Licht P.B.
        • Pilegaard H.K.
        Severity of compensatory sweating after thoracoscopic sympathectomy.
        Ann Thorac Surg. 2004; 78: 427-431
        • Yano M.
        • Kiriyama M.
        • Fukai I.
        • et al.
        Endoscopic thoracic sympathectomy for palmar hyperhidrosis: Efficacy of T2 and T3 ganglion resection.
        Surgery. 2005; 138: 40-45
        • Schmidt J.
        • Bechara F.G.
        • Altmeyer P.
        • Zirngibl H.
        Endoscopic thoracic sympathectomy for severe hyperhidrosis: Impact of restrictive denervation on compensatory sweating.
        Ann Thorac Surg. 2006; 81: 1048-1055
        • Miller D.L.
        • Force S.D.
        Outpatient microthoracoscopic sympathectomy for palmar hyperhidrosis.
        Ann Thorac Surg. 2007; 83: 1850-1853
        • Katara A.N.
        • Domino J.P.
        • Cheah W.K.
        • So J.B.
        • Ning C.
        • Lomanto D.
        Comparing T2 and T2–T3 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis: A randomized control trial.
        Surg Endosc. 2007; 21: 1768-1771
        • Lyra Rde M.
        • Campos J.R.
        • Kang D.W.
        • Loureiro Mde P.
        • Furian M.B.
        • Costa M.G.
        • et al.
        Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis.
        J Bras Pneumol. 2008; 34: 967-977
        • Sugimura H.
        • Spratt E.H.
        • Compeau C.G.
        • Kattail D.
        • Shargail Y.
        Thoracoscopic sympathetic clipping for hyperhidrosis: Long-term results and reversibility.
        J Thorac Cardiovasc Surg. 2009; 137 (discussion 1376–1377): 1370-1376