Endoscopic Thoracic Sympathectomy for Palmar Hyperhidrosis: A Randomized Control Trial Comparing T3 and T2-4 Ablation

Background Compensatory sweating is a major and troublesome complication noted frequently after sympathectomy in patients with primary palmar hyperhidrosis. This randomized clinical trial was projected to measure the impact of limited denervation on compensatory sweating while performing endoscopic thoracic sympthectomy. Methods Two hundred thirty-two patients with primary palmar hyperhidrosis were randomly allocated to either a T3 sympathectomy treatment, called group T3, or a T2–4 sympathetic treatment, called group T2–4. The patients underwent bilateral sympathetic ablation at corresponding levels. All patients were followed up and evaluated for comparison of symptom resolution, postoperative complication, levels of satisfaction, and severity of compensatory sweating between the two groups. Results Sex, age, family history, and distribution of sweating were similar in both groups. The postoperative complications were minor, and Horner's syndrome was not detected in either group. The frequency of mild and moderate compensatory sweating was not significantly different between the two groups, but the incidence of severe compensatory sweating was significantly lower after T3 sympathectomy (3% versus 10%). As for satisfaction rate, group T3 was superior to group T2–4 (96.6% versus 89.6%). The rate of symptom resolution was 100%, and no recurrence was found in either group. Conclusions The single-level sympathetic denervation under thoracoscopy is a safe and effective procedure to treat primary palmar hyperhidrosis. This method reduces the incidence of severe compensatory sweating postoperatively without compromising the patient's satisfaction.