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Review
. 2017 Apr;9(Suppl 3):S178-S192.
doi: 10.21037/jtd.2017.04.04.

Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results

Fernando Vannucci  1   2 , José Augusto Araújo  1
Affiliations
Review

Thoracic sympathectomy for hyperhidrosis: from surgical indications to clinical results

Fernando Vannucci et al. J Thorac Dis. 2017 Apr.

Abstract

Sympathectomy and its variations have been performed in thoracic surgery for more than 100 years. However, its indications have undergone profound modifications in this period. Likewise, since then the surgical technique has also evolved dramatically up to the minimally invasive techniques worldwide accessible in present days. Currently, primary hyperhidrosis is, by far, the main indication for thoracic sympathectomy and this procedure is usually carried out thoracoscopically with excellent results. However, until today, hyperhidrosis is a part of thoracic surgery still surrounded by controversy, persisting as an open field over which some confusion still resides regarding its pathophysiology, terms definitions and operative approaches. The aim of this article is to provide a wide but easily comprehensible review of the theme, discussing and clarifying the major concepts with respect to its clinical presentation, all the presently available treatment options and strategies with their potential benefits and risks, the adequate patient selection for sympathectomy, as well as the postoperative clinical results.

Keywords: Sympathectomy; hyperhidrosis; sweating; sympathetic nervous system; video-assisted thoracic surgery.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Surgical anatomy of sympathetic chain at the right side (author’s personal archive).
Figure 2
Figure 2
Sympathetic chain and apical anatomic landmarks on the right side (author’s personal archive).
Figure 3
Figure 3
Sympathetic chain and apical anatomic landmarks on the left side (author’s personal archive).
Figure 4
Figure 4
Kuntz nerve on the left side (author’s personal archive).
Figure 5
Figure 5
Close view of the camera port at the right side, through a 5 mm incision around the areola in a male patient (author’s personal archive).
Figure 6
Figure 6
Same patient of Figure 5: final aspect of incisions at the left side (author’s personal archive).
Figure 7
Figure 7
Same patient of Figures 5,6: final aesthetic aspect bilaterally (author’s personal archive).
Figure 8
Figure 8
Right sided endoscopic thoracic sympathectomy (ETS) at R3 level for palmar hyperhidrosis using harmonic scalpel (author’s personal archive) (30). Available online: http://www.asvide.com/articles/1457
Figure 9
Figure 9
Left sided endoscopic thoracic sympathectomy (ETS) at R3–R4 level with G3 ganglion thermoablation for palmar hyperhidrosis using harmonic scalpel (author’s personal archive) (31). Available online: http://www.asvide.com/articles/1458
Figure 10
Figure 10
Left sided endoscopic sympathetic block (ESB) using metallic clips at R3 level for palmar hyperhidrosis (author’s personal archive) (32). Available online: http://www.asvide.com/articles/1459
See this image and copyright information in PMC

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