Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis. The useof harmonic scalpel versus diathermy

Background: Upper dorsal thoracoscopic sympathectomy, the treatment of choi ce for primary palmar hyperhidrosis, is not devoid of long-term complicatio ns, like Horner's syndrome and postoperative neuralgia. It has been postula ted that propagation of heat induced by diathermy may be responsible for so me of these sequelae. To assess this hypothesis, a study was undertaken to evaluate the use of harmonic scalpel, which does not dissipate heat. Method: Sixteen patients with primary palmar hyperhidrosis underwent upper dorsal thoracoscopic sympathectomy using the harmonic scalpel on one side a nd diathermy on the other. Follow-up was made two years postoperatively. Results: The length of the procedure with each instrument was similar. Ther e was no localization of postoperative pain, which could be attributed to e ither device. No Horner's syndrome or postoperative neuralgia occurred. Conclusion: The present study proved the safe use of harmonic scalpel for u pper dorsal thoracoscopic sympathectomy, but did not detect any important a dvantage of either instrument over diathermy.