Thoracoscopic Sympathectomy for Primary Hyperhidrosis: A 3 mm Two-Port Approach

Authors

Saman Qadri, Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Zummar Asad, Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Christina Schott, Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Olivia Heutlinger, Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Sora Ely, Department of Surgery, Division of Thoracic Surgery, The George Washington University, Washington, District of Columbia, USA.
Keith Mortman, Department of Surgery, Division of Thoracic Surgery, The George Washington University Hospital, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

12-12-2025

Journal

Journal of laparoendoscopic & advanced surgical techniques. Part A

DOI

10.1177/10926429251405812

Keywords

minimally invasive surgery; primary hyperhidrosis; sweating disorders; thoracoscopic sympathectomy; two-port technique; video-assisted thoracic surgery

Abstract

Primary hyperhidrosis is a debilitating condition characterized by excessive focal sweating, most commonly affecting the axillae, palms, and soles, for which surgical intervention provides a durable solution in patients refractory to medical management. We present our outpatient surgical technique for video-assisted thoracoscopic sympathectomy (VATS) using a two-port, 3-mm incision approach and evaluate its efficacy and outcomes. A case series of 33 consecutive patients undergoing outpatient VATS sympathectomy between 2016 and 2023 was reviewed, with 9 patients excluded for lack of postoperative follow-up. All procedures were performed with electrocautery at the third and fourth ribs posteriorly (T3 and T4). The technique demonstrated consistent efficacy in symptom resolution with short operative times, low postoperative pain, and rapid recovery. Mean operative time was 22.0 ± 3.7 minutes, with same-day discharge achieved in all patients. The average pain score at discharge was 2.0 ± 2.6, and no intraoperative or immediate postoperative complications occurred. Symptom severity scores improved across all regions, most notably in the palms (8.8 ± 2.1 to 1.3 ± 2.1, P < .001) and axillae (7.1 ± 2.9 to 2.2 ± 2.3, P < .001), with improvement also observed in plantar sweating (8.6 ± 2.0 to 4.8 ± 3.0, P < .001), while facial sweating showed a modest, nonsignificant change (2.3 ± 2.8 to 1.5 ± 2.2, P = .21). At 2-4 weeks, complication rates, including compensatory hyperhidrosis and pneumothorax, were comparable to conventional methods. This minimally invasive two-port VATS sympathectomy with 3-mm incisions appears safe, effective, and patient-centered, supporting its use as a surgical approach for primary hyperhidrosis.

APA Citation

Qadri, Saman; Asad, Zummar; Schott, Christina; Heutlinger, Olivia; Ely, Sora; and Mortman, Keith, "Thoracoscopic Sympathectomy for Primary Hyperhidrosis: A 3 mm Two-Port Approach" (2025). GW Authored Works. Paper 8407.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8407

Department

Surgery