Thoracoscopic Upper Thoracic Sympathectomy for Upper Limb Hyperhidrosis

Abstract

Objectives: To present a 30-month experience in thoracoscopic upper thoracic sympathectomy (TUTS) in Kuwait in 20 patients with upper limb hyperhidrosis (ULH). Methods: We performed 40 TUTSs in 20 patients with bilateral ULH. The T2–4 or T2–5 sympathetic ganglia were resected in 36 cases. Only the T2–3 ganglia were resected in 4 cases due to difficult localization of the 4th ganglion. Both sides were performed simultaneously. Chest tube drainage was performed at the end of each procedure. Results: The male:female ratio was 9:1, ranging in age from 13 to 43 years (mean age 26.95 years). Two patients had bilateral dense pleural adhesions, but the procedure was successful. Most patients were discharged on the 2nd postoperative day. Follow-up at 5–30 months (mean 16.3 months) was excellent both for immediate and permanent relief of ULH. Eleven of the 15 patients with pedal hyperhidrosis also had dry feet. Two patients developed transient Horner’s eye syndrome. One patient had persistent right pneumothorax that required chest tube drainage for 7 days. Four patients developed compensatory hyperhidrosis of the trunk and upper thighs. Fifteen patients (75%) expressed complete satisfaction. Five patients (25%) reported return of some moisture to their hands and axillae. Conclusion: TUTS is minimally invasive, feasible and effective. It has a low complication rate. We recommend this procedure as the method of choice for the management of ULH.