Efficacy and safety of thoracoscopic sympathicotomy for hyperhidrosis of the upper limb - Results of 734 sympathicotomies

Background: Thoracoscopic sympathicotomy (TS) evolved as treatment of choic e in severe hyperhidrosis. The aim of this study was to assess the role of video-assistance in TS (VATS) versus conventional TS (CTS) for primary hype rhidrosis of the upper limb with regard to safety, side-effects and long-te rm outcome. Methods: 734 TS were performed from below T1 to T4 in 406 patients. In the CTS and in the VATS group 558 and 176 procedures were performed, respective ly. Follow-up was completed in 82 % of all patients after a median observat ion period of 16 years. Results: Dry limbs were immediately achieved in 92 % (CTS) and 97 % (VATS, p = 0.98). Only one patient (CTS) underwent conversion due to bleeding. In the CTS group Horner's syndrome occurred in 2.2 % and rhinitis in 9.9 % of procedures. No patient of the VATS group experienced Horner's syndrome (p = 0.025), 3 patients developed rhinitis (p = 0.11). At follow-up compensator y sweating was observed in 67.6 % vs. 55.6 % (p = 0.051) and gustatory swea ting in 50.4 % and 33.3 % (p = 0.01). There were 5 failures or recurrences (1.9 %) in the CTS group and 2 (2.8; p > 0.05) in the VATS group at reevalu ation. Overall 6.5 % (CTS) and 3.6 % (VATS) of patients regret the operatio n (p = 0.7). Conclusions: We observed a significant decrease of the incidence of complet e or incomplete Horner's syndrome and gustatory sweating when the procedure was guided by video-imaging while success rate was similar when compared w ith CTS.