Lin CC, Wu HH.   Thoracoscopic T2-Sympathetic Block by Clamping in Treatment of Hyperhidrosis Palmaris ---Results of 831 Cases, 8th International Meeting of Laparoendoscopic Surgeons, SLS Annual Meeting, Endo Expo '99, New York City, December 1999.

Background:  Endoscopic T2-sympathicotomy (ETS) is currently the most acceptable method in treatment of hyperhidrosis palmaris.  Not only the irreversibility of the procedures, but postoperative compensatory sweating follows frequently.  Some patients are disturbed with the sequela and regret to receive the operation.  Prevention of the complication becomes more important when ETS is performed.  A new method, T2-sympathetic block by clamping (T2C), was developed for its reversible character.
Method and Material: From March 18, 1996 to August 31, 1998, there were 831 (387 males and 444 females) in 896 patients underwent thoracoscopic sympathetic block by clamping for treatment of hyperhidrosis palmaris et axillae.  The remaining 65 cases underwent thoracoscopic sympathicotomy.

Results: Thoracoscopic sympathetic block by clamping was performed on 831 cases.  The post-operative results were effective and satisfactory except 44 cases.    30 cases (3.6%) requested reverse operation for intolerable compensatory sweating.   Re-operation was performed on 14 cases (1.7%) for incomplete cessation of unilateral or bilateral sweaty hands.  The causes of incomplete cessation of sweating were incomplete clamping, inappropriate level clamped, and dislodgment of the clips.

Conclusion:  Thoracoscopic sympathetic block by clamping is a better and reversible method than any other endoscopic sympathicotomy.

Lin CC, Wu HS, Lee LS et al "Thoracoscopic T2-Sympathicotomy in Treatment of Hyperhidrosis: Experience with 1005 Cases. (Taiwan). Abstracts. Second International Symposium on Thoracoscopic Sympathicotomy, Boras, Sweden, May 1997.

A total of 1005 patients with hyperhidrosis (mean age 23.5 years) were treated by sympathicotomy (ETS). The operative cure rate was nearly 100 percent and most patients also noted cure of excessive sweating of feet. Most patients noted some degree of compensatory sweating after the procedure. Complications such as bleeding or air-leakage from the lung were rare and there were no cases with Horner's Syndrome or wound infection. Postoperative chest or back pain was only minor and temporary.

Herbst F, Plas EG, Függer R and Fritsch A. "Endoscopic Thoracic Sympathectomy for Primary Hyperhidrosis of the Upper Limbs." Annals of Surgery, 1994, Volume 220, No. 1, pages 86-90.

Follow-up questionnaires were sent to 386 patients with ETS for primary hyperhidrosis. The response rate was 83.7%. The mean follow-up time in this large study was very long: 14.6 years. The initial success rate was very high, as 98.1% of patients were relieved and 95.5% were satisfied. At long-term follow-up the success rate was still high (66.7% fully satisfied and 26.7% partially satisfied).

No severe complications requiring re-intervention occurred. Compensatory sweating was reported in 67.4%, whereas Horner’s syndrome was reported in only 2.5%. Only 1.5% had recurrence of the primary hyperhidrosis problem.

Chen H-J, Shih D-Y, Fung S-T. "Transthoracic Endoscopic Sympathectomy in the Treatment of Palmar Hyperhidrosis." Archives of Surgery, 1994, Volume 129, page 630-633.

180 patients who had ETS surgery for hand sweat were followed-up with questionnaires for up to 2 years. The procedure was a success in 98% of the patients. No air-leakage into the lung requiring chest-tube drainage and no Horner’s syndrome was reported. The most common side-effect was compensatory sweating noted in 70% of the patients.

This procedure is effective, simple and requires only an overnight stay in the hospital. It is recommended as the method of choice for surgical treatment of upper extremity hyperhidrosis.

Shachor D, Jedeikin R, Olsfanger D and coworkers. "Endoscopic Transthoracic Sympathectomy in the Treatment of Primary Hyperhidrosis." Archives of Surgery, 1994, Volume 129, Pages 241-244.

290 ETS procedures were performed in 150 patients with hand sweat. The success rate was 98% and severe complications were rare (air-leakage into thorax in 2.4%, bleeding into thorax in 1%, temporary Horner’s syndrome in 0.7%). 50% reported compensatory sweating whereas recurrence of hyperhidrosis occurred in only 2%.

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