Efficacy of Thoracoscopic Sympathectomy Including Asymmetric Resection for Treating Palmar Hyperhidrosis : A Retrospective Study

Abstract Objective:This study aims to retrospectively evaluate the effectiveness of single-segment thoracic sympathotomy in treating palmar hyperhidrosis. Methods:We conducted a retrospective study at our center from January 2018 to January 2022. A total of 226 patients with palmar hyperhidrosis, who underwent single-segment endoscopic sympathectomy, were divided into R3, R4, and asymmetric segment groups (R3 / R4 group). We analyzed the effectiveness, side effects, and patient satisfaction of the three treatments through telephone and online patient consultations. Results: All groups experienced similar surgery duration, hospital stay, and blood loss. The R3 group (104 patients) had the lowest recurrence rate (1 case), followed by the R4 group (92 patients, 3 cases), and the R3/R4 group (30 patients, 1 case). Compensatory hyperhidrosis was observed in 21 cases in the R3 group and 19 in the R4 group. The R3/R4 group reported compensatory hyperhidrosis in 24 cases, mostly Grade I and II. Satisfaction was highest in the R3 group, closely followed by the R3/R4 group and then the R4 group. This indicates that both R3 and R4 single-segment resections are effective, with R3 showing higher patient satisfaction and lower recurrence, and the asymmetric R3/R4 approach also proving to be a viable option. Conclusion: Single-segment resection of either R3 or R4 can effectively manage palmar hyperhidrosis. Patients who underwent R3 resection experienced fewer recurrences and reported higher satisfaction than those who underwent R4 resection. Furthermore, compensatory hyperhidrosis didn't notably rise. Asymmetric single-segment resection, with its thicker vascular coverage, is also a viable treatment option.