Objective: The video-assisted thoracic surgery (VATS) approach for thoracodorsal sympathectomy has been well accepted. We report the use of ultra-fine thoracoscopic equipment for this procedure, based on the experience from two centers in Asia.
Materials and methods: Thirty-eight patients with palmar hyperhidrosis underwent bilateral VATS thoracodorsal sympathectomy using 2-mm instruments exclusively. General anesthesia with selective one lung ventilation was used. Carbon dioxide insufflation was used when lung collapse was found to be inadequate. In 11 patients, the sympathetic chain was excised (T2-T3 for palmar hyperhidrosis alone, extending to T4 for axillary hyperhidrosis), and in 27 patients, the chain was cauterized. The choice of procedure reflects the surgeon's preference. No chest drains were left after the procedure and no stitching of the wound was necessary.
Results: There was no mortality or major complications. A small pneumothorax was found in the postoperative chest X-ray in three patients. They all resolved without further intervention. Twenty-seven patients were discharged on the same day of admission, and 11 patients were discharged on postoperative day one. After an average follow-up of 16 months (range 5-28), there has been no recurrence of symptoms. Compensatory truncal hyperhidrosis was encountered in two patients, but the symptoms were not severe enough to interfere with lifestyle, and this required no further treatment.
Conclusion: Thoracodorsal sympathectomy using 2-mm instruments is technically feasible and is associated with an excellent clinical outcome. Limitations of the equipment, however, exist (narrow field of vision, lower resolution and difficulty in maintaining fine control), and we are currently restricting its use to relatively simple procedures.