Category: Palmar

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T3 Endoscopic Thoracic Ganglionectomy Using Cutting Mode Cautery for Palmar Hyperhidrosis

Ann Thorac Surg Short Rep. 2024 Dec 13;3(2):456-460. doi: 10.1016/j.atssr.2024.12.004. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Understanding the precise anatomy of the upper thoracic sympathetic trunk is crucial for effectively treating palmar hyperhidrosis using the surgical technique of endoscopic thoracic sympathectomy (ETS). The variability in the location of T2 and T3 ganglia in relation to the ribs may contribute to inconsistent clinical outcomes after ETS.

METHODS: For the cadaver study, adult human cadaveric thoraces were dissected to map the locations of T2 and T3 ganglia by identifying their white rami communicantes. For the ETS group, T3 ganglionectomy ETS was performed. Surgical outcome and postoperative incidence of compensatory sweating were assessed.

RESULTS: A total of 74 pediatric patients underwent thoracoscopic T3 ganglionectomy. All patients were satisfied with the surgical outcomes. No patients complained of compensatory sweating. Forty cadavers were dissected: 25 adult female and 15 adult male. The findings showed that a high percentage of T2 ganglia are near the superior border of the third rib, while the T3 ganglion is near the fourth rib.

CONCLUSIONS: Because of the proximity of the T2 ganglion to the third rib, accidental thermal injury to the T2 ganglion may occur when third rib-oriented ETS is performed. A ganglion-oriented T3 ETS can be accomplished by using the white ramus communicans as a guide to accurately locate the T3 ganglion.

PMID:40525165 | PMC:PMC12167563 | DOI:10.1016/j.atssr.2024.12.004

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Achieving high patient satisfaction after sympathectomy through preoperative thoracoscopic sympathetic nerve block in primary hyperhidrosis

J Thorac Dis. 2025 Apr 30;17(4):2050-2055. doi: 10.21037/jtd-2024-2145. Epub 2025 Apr 21.

ABSTRACT

BACKGROUND: Compensatory hyperhidrosis (CH) is a frequent complication following sympathectomy, influencing patient satisfaction. This study was established to evaluate the impact of bilateral thoracoscopic sympathetic nerve block (TSNB) on patient satisfaction after sympathectomy in the treatment of primary hyperhidrosis.

METHODS: From March 2021 to August 2023, 52 patients with primary palmar and craniofacial hyperhidrosis underwent TSNB at T3 using a 2-mm thoracoscope under local anesthesia. One week later, they decided whether to proceed with sympathectomy. Satisfaction was assessed using a 100-point scale, and patients were divided into two groups based on CH occurrence after sympathectomy. The groups were compared in terms of sex, age, hyperhidrosis site, and satisfaction scores.

RESULTS: Among 52 patients who underwent TSNB, 35 (67.31%) proceeded to sympathectomy, and CH occurred in 18 (51.43%) of these patients, while the remaining 17 patients (48.57%) did not develop CH. No significant differences were observed between the CH and no-CH groups regarding age (26.61±9.02 vs. 25.41±10.09 years, P=0.66), sex (61.11% vs. 52.94% male, P=0.88), or primary hyperhidrosis site (palmar: 77.78% vs. 88.24%, P=0.66). Satisfaction scores were comparable between the CH group (92.50±7.33) and the no-CH group (96.18±4.52), with no statistically significant difference (P=0.15).

CONCLUSIONS: Sympathectomy is associated with a high incidence of CH. Through TSNB, patients could preoperatively experience potential effects, including CH, enabling informed surgical decisions. Patients who developed CH reported high satisfaction levels comparable to those without CH, underscoring the utility of TSNB in improving patient-centered outcomes.

PMID:40400983 | PMC:PMC12090137 | DOI:10.21037/jtd-2024-2145

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Case Report: Single-port thoracoscopic surgery for severe primary palmar hyperhidrosis in a 9-year-old child

Front Med (Lausanne). 2025 Apr 15;12:1542064. doi: 10.3389/fmed.2025.1542064. eCollection 2025.

ABSTRACT

Primary palmar hyperhidrosis (PPH) is a somatic condition characterized by excessive sweating of the hands. It mainly affects adolescents and young adults and is rarely observed among children. This condition significantly impairs patients’ academic performance, daily activities, and social interactions and can even lead to insurmountable psychological burdens. Surgical intervention for PPH is typically reserved for individuals aged 16 years and older, as compensatory hyperhidrosis occurs at a high rate (65%) postoperatively among children younger than 14 years. Therefore, the decision for surgery is controversial and has been rarely documented in the literature. Here, we report a 9-year-old child with a 3-year history of bilateral palmar hyperhidrosis. Conservative treatment with medications for 6 months led to no improvement. The patient had signs of low self-esteem, social withdrawal, and aversion to school, alongside recurrent skin damage at the fingertips. Both the child and parents expressed a strong desire for effective treatment. Single-port endoscopic thoracic sympathectomy (ETS) was conducted after comprehensive risk disclosure and obtaining informed consent from the parents, achieving remarkable therapeutic outcomes. At the 12-month follow-up, the patient exhibited no recurrence of symptoms, no compensatory hyperhidrosis, and no complications, such as Horner’s syndrome. Both hands remained warm and dry, the lesions of fingertip skin healed, and the patient’s personality became noticeably more positive. Furthermore, the surgical incision was aesthetically pleasing.

PMID:40303365 | PMC:PMC12037579 | DOI:10.3389/fmed.2025.1542064

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Investigation and analysis of personality characteristics of primary palmar hyperhidrosis patients: a cross-sectional observational study

Eur J Med Res. 2025 Apr 23;30(1):323. doi: 10.1186/s40001-025-02575-7.

ABSTRACT

BACKGROUND: Patients with primary palmar hyperhidrosis (PPH) may exhibit distinct personality traits that influence their perception of the condition. These traits can manifest as heightened sensitivity to physical symptoms, as well as feelings of anxiety or depression, especially in social settings.

METHODS: This study is a retrospective cross-sectional observational study aimed to evaluate and analyze the personality characteristics of patients with primary palmar hyperhidrosis using the Personality Diagnostic Questionnaire-Version 4 (PDQ-4). This study explored the relationships between personality traits and various factors, including age, gender, body mass index (BMI), onset age, the age when symptoms began to impact daily life (Impact age), the choice of thoracic sympathectomy nerve segment, and postoperative satisfaction. The study enrolled primary palmar hyperhidrosis patients treated at the Thoracic Surgery Department of Beijing Haidian Hospital between 2016 and 2021, with a total of 791 patients meeting the inclusion criteria. Statistical analyses, such as the Chi-square test and Mann-Whitney U-test, were conducted using SPSS 26.0 to investigate associations between personality traits and various variables.

RESULTS: Primary palmar hyperhidrosis patients exhibited a higher prevalence of personality disorders at 16.18% compared to the general population, which ranges from 6.1 to 9.5%. Male patients exhibited a statistically significantly higher prevalence of schizoid, narcissistic, and antisocial personality disorders compared to female patients (P < 0.05). Furthermore, postoperative satisfaction among patients with primary palmar hyperhidrosis declined over time, with a statistically significant difference (P < 0.05). Notably, primary palmar hyperhidrosis patient comorbid personality disorders experienced a more pronounced decline in satisfaction.

CONCLUSIONS: Patients with primary palmar hyperhidrosis demonstrate a relatively high prevalence of personality disorders.

PMID:40269968 | DOI:10.1186/s40001-025-02575-7

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Quality of life and compensatory hyperhidrosis following thoracoscopic sympathectomy: a retrospective cohort study

J Cardiothorac Surg. 2025 Mar 21;20(1):160. doi: 10.1186/s13019-025-03393-y.

ABSTRACT

BACKGROUND: Palmar hyperhidrosis (PH), characterized by excessive palm sweating, significantly impacts quality of life (QOL) in affected individuals, particularly young adults. This study aimed to evaluate the efficacy of video-assisted thoracoscopic sympathectomy (VATS) in improving symptoms and QOL among 816 patients with PH.

METHODS: This retrospective study included 816 patients with PH, all of whom underwent VATS under general anaesthesia. One-year follow-up via phone surveys was used to assess symptom changes and side effects. Paired t tests were used to compare pre- and postoperative QOL scores, and linear regression was used to analyse the effects of various factors on QOL changes.

RESULTS: The cohort consisted of 359 males and 457 females, with a mean age of 24.98 ± 6.47 years. All patients underwent VATS, with a 91% success rate, and the mean operative time was 53.2 ± 24.7 min. Postoperative complications included 43 cases of incision infections, 194 cases of chest pain, and 82 cases of pneumothorax; compensatory hyperhidrosis (CH) occurred in 53.80% of the T3 group and 43.74% of the T4 group after one month, with significant differences noted at the 24-month follow-up. Furthermore, the QOL scores significantly improved from 38.25 ± 3.61 preoperatively to 69.07 ± 3.48 at one year postoperatively (P < 0.05).

CONCLUSIONS: VATS offers a reliable and effective treatment for severe PH, significantly enhancing patients’ overall QOL. Future research should focus on long-term outcomes and the applicability of this treatment across diverse populations to further advance the clinical management of PH.

PMID:40119450 | DOI:10.1186/s13019-025-03393-y

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CT-guided Percutaneous Ethanol Sympatholysis for Hyperhidrosis: How I Do It

Radiology. 2025 Mar;314(3):e241430. doi: 10.1148/radiol.241430.

ABSTRACT

Hyperhidrosis, excessive sweating from the eccrine sweat glands, is caused by overactivity of the sympathetic nerves. Facial, axillary, and/or palmar hyperhidrosis (excessive sweating of the face, armpits, and hands) has a reported prevalence of 1%-1.6%. This condition is initially treated conservatively using a combination of topical and pharmacologic treatments. Surgical sympathectomy or percutaneous sympatholysis are treatment options for severe hyperhidrosis (grade 3 or 4) that does not respond to conservative management. The aim of intervention is to permanently disrupt the sympathetic signal by targeting the thoracic vertebral levels T2, T3, and T4 of the paravertebral ganglia, located on the anterolateral surface of the vertebral body. This review presents the step-by-step technique for CT-guided percutaneous ethanol sympatholysis and discusses patient selection for the procedure, potential complications, and treatment outcomes. Although more than 90% of patients report complete resolution of hyperhidrosis immediately after sympatholysis, as many as 40% report symptom recurrence within 6 months. The probability of remaining hyperhidrosis-free long term (ie, more than 6 months) after CT-guided sympatholysis is 60%. Procedural risks include a 15% risk of compensatory hyperhidrosis elsewhere in the body, 8% risk of Horner syndrome (mostly self-limiting), 5% risk of pneumothorax, and 3% risk of severe intercostal neuralgia due to nontarget ethanol deposition. Despite the risks, this intervention can be life-altering for those with severe disease.

PMID:40100019 | DOI:10.1148/radiol.241430

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Systemic effect of sympathectomy in the treatment of localized hyperhidrosis

Updates Surg. 2025 Mar 10. doi: 10.1007/s13304-025-02163-8. Online ahead of print.

ABSTRACT

Hyperhidrosis is thought to result from excessive stimulation of sweat glands due to increased sympathetic activity; however, data on systemic responses following bilateral thoracic sympathectomy as the definitive treatment have not yet been sufficiently evaluated. This study, designed as a prospective cohort investigation, included 24 patients who underwent sympathectomy for palmar and axillary hyperhidrosis at our center in 2023, along with an age-matched control group of equal size. In the sympathectomy group, pupillometry measurements were performed 1 day before surgery and on the 7th postoperative day, while the control group underwent measurements at corresponding intervals. Data from the sympathectomy group were analyzed both preoperatively and postoperatively and compared with the control group. According to the Hyperhidrosis Disease Severity Scale, all patients had severe hyperhidrosis. Sympathectomy was performed at the T3 level in 9 patients and at both T3 and T4 levels in 15 patients. The postoperative satisfaction rate was recorded as 95.8%. No statistically significant differences were observed between preoperative pupillometry measurements of the sympathectomy group and those of the control group. However, when comparing preoperative and postoperative data within the sympathectomy group, significant differences favoring increased parasympathetic activity were noted in the latency of contractions and photopic low values (p = 0.016 and p = 0.038, respectively). Our study is one of the pioneering works to objectively demonstrate, through a quantitative method, that sympathectomy for hyperhidrosis enhances the parasympathetic system response in the ocular region.

PMID:40064815 | DOI:10.1007/s13304-025-02163-8

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Predictors of Compensatory Sweating and Satisfaction Following Endoscopic Thoracic Sympathetic Chain Clipping for Palmar/Axillary Hyperhidrosis

J Clin Med. 2025 Jan 8;14(2):326. doi: 10.3390/jcm14020326.

ABSTRACT

Background: Endoscopic thoracic sympathetic chain clipping (ETSC) is a definitive treatment for primary palmar and/or axillary hyperhidrosis (PPAH); however, compensatory sweating (CS) remains a feared complication. The aims of this study were to investigate the factors associated with CS and satisfaction with the treatment and to evaluate the post-operative quality of life (QoL). Methods: From January 2011 to August 2023, 180 patients who had undergone two-stage ETSC were prospectively asked to complete pre- and post-operative questionnaires on satisfaction, CS, and QoL in several daily activities. Results: Seventy-nine patients (45.7%) were male, and fifty-two (30.1%) were active smokers, with a mean body max index (BMI) of 22.6 ± 3.14. The majority of the population (112 (62.2%)) was operated on for combined palmar and axillary primary hyperhidrosis (PH), whereas 56 (31.1%) patients had only palmar and 12 (6.7%) only axillar PH. Only 122 (67.8%) patients completed ETSC on both sides and the follow-up in the study period. CS was 50.8% (62 patients), and there was severe CS in 7 cases (5.7%); 9 (7.4%) patients developed a gustatory CS. The final effectiveness of ETSC was 95.9%, with a reported improvement in QoL in 95.3% of cases (mainly in manual work and socialization); 94.1% of patients were satisfied and would undertake ETSC again. At multivariable analysis, only older age (>24 years) was a predictor of CS (p = 0.007) and severe CS (p = 0.042). No predictor for satisfaction was found. Conclusions: ETS by clipping can improve QoL in cases of palmar/axillary hyperhidrosis. Older patients must be informed of a higher risk of CS.

PMID:39860332 | DOI:10.3390/jcm14020326

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Endoscopic thoracic sympathectomy for primary hyperhidrosis: an over a decade-long follow-up on efficacy, impact, and patient satisfaction

J Thorac Dis. 2024 Dec 31;16(12):8292-8299. doi: 10.21037/jtd-24-1407. Epub 2024 Dec 20.

ABSTRACT

BACKGROUND: Endoscopic thoracic sympathectomy is a well-known and effective treatment for palmar and axillary primary hyperhidrosis (PHH). Its most frequent drawback and the main complaint among patients who underwent surgery is the appearance of compensatory sweating (CS). To date, no long-term studies using internationally standardized tools have assessed the efficacy and impact of this surgery on patients. In this study we performed a very long-term follow-up of the patients using an internationally validated tool. The aim of this article is to assess the technique as a treatment for hyperhidrosis, focusing on its long-term efficacy, side effects (CS), and patient satisfaction with the procedure.

METHODS: A closed cohort study was performed conducting a review of the clinical records to identify 100 consecutive patients who underwent bilateral endoscopic thoracic surgery with a minimum follow-up period of 2 years. Patients with diagnoses other than primary palmar or axillary hyperhidrosis or those for whom follow-up was impossible were excluded. A structured telephone survey, including the International Hyperhidrosis Society “Hyperhidrosis Disease Severity Scale” (HDSS) was conducted for all patients. Data were summarized using median (1st and 3rd quartiles) for quantitative variables and relative and absolute frequencies for qualitative variables. To study the likelihood of a patient recommending the surgery, a Bayesian logistic regression model was used reporting results as odds ratio (OR).

RESULTS: A total of 91 patients were included in the follow-up. The median follow-up duration was 10.66 (5.68, 11.98) years. The most affected zone was the hands (29.67%), and the most common sympathectomy levels were R2 and R3 (68.13%). The overall surgical efficacy rate was of 94.50% and CS appeared in 36.26% of the patients, with 75.76% of these cases being mild and severe in only one patient. In total, 97.8% of patients improved their HDSS score after surgery. The OR of recommending the surgery for a lower HDSS index was 0.24 and 0.18 for the apparition of CS. Despite it, 91.21% of patients recommend the surgery, with an overall satisfaction rate of 93.95%.

CONCLUSIONS: Endoscopic thoracic sympathectomy is an effective and safe treatment for palmar and axillary PHH, with a relatively low rate of CS which, when present, is typically mild, making it a highly satisfactory treatment option for patients.

PMID:39831229 | PMC:PMC11740069 | DOI:10.21037/jtd-24-1407