Thoracoscopic treatment of palmar hyperhidrosis

Zahavi Cohen

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Upper thoracic sympathectomy is indicated in the treatment of a variety of sympathetic disorders, including palmar hyperhidrosis, facial blushing, Raynauds disease, splanchnic pain, and reflex sympathetic dystrophy. In my experience, hyperhidrosis was the only indication for surgical intervention in children. Primary hyperhidrosis is considered a very distressing and embarrassing condition affecting the hands and sometimes axillae and feet. Conservative treatment may be effective only in the mild forms (Cullen 1975; Scholes et al. 1978; White 1986). Operative treatment is the method of choice in severe cases (Adar et al. 1977; Bogokowski et al. 1983; Mares et al. 1994), its goal being to achieve a constant anhidrotic state of the palms. Various surgical approaches have been described for conventional "open" thoracic sympathectomy (Adson et al. 1935; Atkins 1954; Ellis and Morgan 1971; Gask 1933; Telford 1935). The thoracoscopic technique has simplified surgery on the upper thoracic chain and, indeed, proved to be superior in almost every respect (Cohen et al. 1995, 1996; Kao et al. 1994; Kux 1977; Malone 1986). The therapeutic aim in the treatment of hyperhidrosis is to interrupt the sympathetic impulse transmission from the lower sympathetic ganglia through the stellate ganglion to the hands. Thoracoscopic electrocautery transection of the sympathetic chain at the level of T2 and T3 has been the preferred treatment in my experience with more than 600 thoracoscopic sympathectomies.

Original languageEnglish
Title of host publicationEndoscopic Surgery in Infants and Children
PublisherSpringer Berlin Heidelberg
Number of pages5
ISBN (Print)9783540001157
StatePublished - 1 Dec 2008
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine


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