Biportal thoracoscopic sympathectomy for palmar hyperhidrosis in adolescents

Clinical article

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Palmar, axillary, and plantar hyperhidrosis is often socially, emotionally, and physically disabling for adolescents. The authors report surgical outcomes in all adolescents treated for palmar hyperhidrosis via bilateral thoracoscopic sympathectomy at the Barrow Neurological Institute by the senior author.


A prospectively maintained database of all adolescent patients undergoing bilateral thoracoscopic sympathectomy between 1998 and 2006 (inclusive) was reviewed. Additional follow-up was obtained as needed in clinic or by phone or written questionnaire.


Fifty-four patients (40 females) undergoing bilateral procedures were identified. Their mean age was 15.4 years (range 10–17 years). Average follow-up was 42 weeks (range 0.2–143 weeks). Hyperhidrosis involved the palms alone in 10 patients; the palms and axilla in 6 patients; the palms and plantar surfaces in 17 patients; and the palms, axilla, and plantar surfaces in 21 patients. Palmar hyperhidrosis resolved completely in 98.1% of the patients. Resolution or improvement of symptoms was seen in 96.3% of patients with axillary and 71.1% of those with plantar hyperhidrosis. Hospital stay averaged 0.37 days with 68.5% of patients discharged the day of surgery. One patient experienced brief intraoperative asystole that resolved with medications and had no long-term sequelae. Otherwise, no serious intraoperative complications occurred. No patient required chest tube drainage. The percentage of patients who reported satisfaction and willingness to undergo the procedure again was 98.1%.


Biportal, bilateral thoracoscopic sympathectomy is an effective and low-morbidity treatment for severe palmar, axillary, and plantar hyperhidrosis.

Article Information

Current affiliation for Dr. Lekovic: House Institute, Los Angeles, California.

Address correspondence to: Scott D. Wait, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email:

© AANS, except where prohibited by US copyright law.



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    Overhead view of the setup of the operating room during thoracoscopic sympathectomy. The patient is in lateral decubitus position. The surgeon and assistant stand on the ventral side of the patient and the anesthesiologist is at the head. Modified from Dickman CA, Mican C: Thoracoscopic approaches for the treatment of anterior thoracic spinal pathology. BNI Quarterly 12(1):4–19, 1996. With permission from Barrow Neurological Institute.

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    Surgical outcome of biportal thoracoscopic sympathectomy for palmar, plantar, and axillary hyperhidrosis. Graphs indicate the resolution of palmar (A), axillary (B), and plantar (C) hyperhidrosis in 54 patients undergoing biportal thoracoscopic sympathectomy.

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    The presence and severity of compensatory sweating as a function of the levels at which the sympathetic chain was divided.



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