Transthoracic Endoscopic Sympathectomy in the Treatment of Palmar Hyperhidrosis

Ming-Chien Kao, MD, DMSc
Arch Surg. 1995;130(11):1244. doi:10.1001/archsurg.1995.01430110102021.
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In the article "Transthoracic Endoscopic Sympathectomy in the Treatment of Palmar Hyperhidrosis"1 two statements concerning the temperature change of palmar skin after T2 sympathectomy (pages 631-632) may be inappropriate or misprinted. My colleagues and I first developed the technique of "video" transthoracic endoscopic sympathectomy in 1989 to treat palmar hyperhidrosis and also advocated the importance of intraoperative sympathetic monitoring as an aid in confirming the adequate ablation of the proper sympathetic segment.

Based on our abundant clinical experience, we found that a palmar temperature elevation of approximately 3°C indicated the achievement of an adequate sympathectomy for a long-lasting therapeutic effect for palmar hyperhidrosis. It is easily demonstrated that any minor stimulation of the patient will induce a small fluctuation of palmar skin temperature (about ±0.5°C) before accomplishing a sufficient ablation of the T2 segment; therefore, an elevation of 0.3°C cannot be considered an indicator of an adequate sympathectomy for


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