Video-assisted thoracoscopic T2 sympathetic block by clipping for palmar hyperhidrosis:: Analysis of 52 cases

Background: Endoscopic thoracic sympathectomy or sympathicotomy is a standard method in treating palmar hyperhidrosis, but postoperative compensatory sweating may be troublesome in some patients. Therefore, we designed a new technique for only T-2 sympathetic blocking by clipping instead of interruption of the sympathetic trunk. Patients and Methods: Between September 2000 and July 2001, we saw a total of 100 patients with palmar hyperhidrosis who underwent video-assisted thoracoscopic sympathetic blocking of the T-2 ganglion. All patients were placed in a semisitting position under single-lumen intubated anesthesia. We performed sympathetic blocking by clipping of the T-2 ganglion at the level of the second and third rib beds using an 8-mm, 0 degrees thoracoscope (Storz). Results: We supposed that the postoperative improvement in palmar hyperhidrosis would be perfect. The operation could be accomplished within 30 minutes. All patients were discharged within 4 hours after the operation. Surgical complications were minimal, without surgical mortality. A few patients were willing to receive the reverse operation and should get improvement of compensatory sweating after removal of the endo clips. Conclusion: We believe that video-assisted thoracoscopic T-2 sympathetic block by clipping will be a safe and effective method of treating patients with palmar hyperhidrosis. Compensatory sweating may be improved by the reverse operation: removal of the endo clip.