Video assistance reduces complication rate of thoracoscopic sympathicotomyfor hyperhidrosis

Background. Thoracoscopic sympathicotomy has proved successful in the treat ment of palmar hyperhidrosis. However, up to 8% of patients experience Home r's syndrome, and about 50% show compensatory sweating. This study evaluate s the role of video assistance in thoracoscopic sympathicotomy for primary hyperhidrosis of the upper limb. Methods. Six hundred fifty-six thoracoscopic sympathicotomies were performe d from below T1 to T4 in 369 patients. Of the operations, 558 were done und er direct view (CTS group) and 98, with video assistance (VATS group). Foll ow-up was complete for 78.3% of patients after a median observation period of 16 years. Results. Dry limbs were immediately achieved in 93% of the CTS group and 98 % VATS group (p = 0.98). In the CTS group, Homer's syndrome occurred after 2.2% of all operations and rhinitis in 8.3%. No patient in the VATS group s howed any symptom of Homer's triad (p = 0.03 versus CTS group) or rhinitis (p = 0.02 versus CTS group). Compensatory sweating was observed in 66.8% in the CTS group versus 69% in the VATS group (p 0.73) and gustatory sweating , in 50.4% versus 27.6%, respectively (p = 0.01). Conclusions. In performing thoracoscopic sympathicotomy for excessive upper -limb hyperhidrosis, we observed a significant decrease in the incidence of Horner's syndrome, rhinitis, and gustatory sweating when the procedure was guided by video imaging. (C) 1999 by The Society of Thoracic Surgeons.