'Needlescopic' video-assisted thoracic surgery for palmar hyperhidrosis

Objective: The video-assisted thoracic surgery (VATS) approach for thoracod orsal sympathectomy has been well accepted. We report the use of ultra-fine thoracoscopic equipment for this procedure, based on the experience from t wo centers in Asia. Materials and methods: Thirty-eight patients with palma r hyperhidrosis underwent bilateral VATS thoracodorsal sympathectomy using 2-mm instruments exclusively. General anesthesia with selective one lung ve ntilation was used. Carbon dioxide insufflation was used when lung collapse was found to be inadequate. In 11 patients, the sympathetic chain was exci sed (T2-T3 for palmar hyperhidrosis alone, extending to T4 for axillary hyp erhidrosis), and in 27 patients, the chain was cauterized. The choice of pr ocedure reflects the surgeon's preference. No chest drains were left after the procedure and no stitching of the wound was necessary. Results: There w as no mortality or major complications. A small pneumothorax was found in t he postoperative chest X-ray in three patients. They all resolved without f urther intervention. Twenty-seven patients were discharged on the same day of admission, and 11 patients were discharged on postoperative day one. Aft er an average followup of 16 months (range 5-28), there has been no recurre nce of symptoms. Compensatory truncal hyperhidrosis was encountered in two patients, but the symptoms were not severe enough to interfere with lifesty le, and this required no further treatment. Conclusion: Thoracodorsal sympa thectomy using 2-mm instruments is technically feasible and is associated w ith an excellent clinical outcome. Limitations of the equipment, however, e xist (narrow held of vision, lower resolution and difficulty in maintaining fine control), and we are currently restricting its use to relatively simp le procedures. (C) 2000 Elsevier Science B.V. All rights reserved.