Efficacy and Outcome Prediction of Unilateral Video-Assisted Thoracoscopic Sympathectomy in Primary Palmar Hyperhidrosis: A Comparative Study with Bilateral Sympathectomy

Abstract

Objective: To compare unilateral dominant-side video-assisted thoracoscopic sympathectomy (U-VATS) with bilateral procedures (B-VATS) in terms of efficacy and complications and to identify predictors of outcome after U-VATS.

Methods: A prospective multicenter cohort study in which patients presented with primary palmar hyperhidrosis were treated by either U-VATS (82 cases) or B-VATS (112 cases). The demographic, clinical, operative, and postoperative findings were collected for all patients and compared in both groups. The factors associated with outcome were identified, and predictors of outcome in U-VATS were investigated to identify best candidates for unilateral sympathectomy.

Results: Both groups were balanced regarding demographic and preoperative clinical data. U-VATS was associated with significantly less postoperative pain and shorter hospital stays. Compensatory sweating was significantly less frequent in U-VATS with significantly better improvement in planter hyperhidrosis. Both groups were comparable as regards recurrence rate, patient satisfaction, and quality of life at 1 year. Preoperative Hyperhidrosis Quality of Life Questionnaire scores predicted outcome in U-VATS, and the best cutoff point was identified.

Conclusions: U-VATS proved to be equally effective as B-VATS with less postoperative pain, shorter hospital stay, less frequent compensatory sweating, and better improvement of planter hyperhidrosis. The results suggest that patients with preoperative Hyperhidrosis Quality of Life Questionnaire scores >80 are better operated via B-VATS, whereas lower scores are indicated for U-VATS.

Keywords: Hyperhidrosis; Palmar; Predictors; Sympathectomy; Thoracoscopic; Unilateral.