Quantitative Evaluation of Palmar
Hyperhidrosis before and after Unilateral
Endoscopic Thoracic Sympathectomy
The 14th International Symposium on Sympathetic Surgery
16th-18th December 2022, Beijing, ChinaOda Clinic, Day Surgery Center, Fukuoka, Japan

Hitoshi Oda, M.D., Ph.D.

The picture of the ISSS board members and their families
from back then during the 12th ISSS in Fukuoka, Japan, 2017

BackgroundOur questionnaire survey of 3-year follow-up showed that unilateralendoscopic thoracic sympathectomy (ETS) for the dominant hand ofpalmar hyperhidrosis (PH) could provide higher level of patientsatisfaction, because of less incidence of compensatory sweating (CS) in
comparison with bilateral ETS. Moreover, PH of the opposite hand was

also alleviated to almost dryness in one third of patients after unilateral
ETS probably due to the improvement of psychological stress of daily
life (the 13th ISSS, Pisa, Italy, 2019).

Objectives
The aim of this study is to analyze quantitatively theresolution of each hand symptoms after unilateral ETS inpatients with PH.

Materials and Methods
From July to October in 2022, 149 patients with PH
underwent unilateral extended R4 (R4 + G3 partial ablation)
ETS for a dominant hand in our institution. Quantitative

analysis of each hand sweat of these patients using theperspiration meter (SKN-2000M, SKINOS Co., Ltd, Japan)
was performed before and after unilateral ETS.

Characteristics of Patients with PH in this Study⚫ Gender : 67 male, 82 female⚫ Age : 26±12 years old (9 – 58 years old)
⚫ Severity of PH :HDSS 2

10HDSS 343HDDS 496

Extended R4 (R4 + G3 partial ablation) ETSPerspiration MeterThe amount of sweating is expressed astransepidermal water evaporation rate and the unitof measurement is mg/cm2/min.
Red: dominant hand, blue: opposite hand

SKN-2000M, SKINOS Co., Ltd, Japan

Representative Records of Perspiration Meter
before and after Unilateral ETS
beforeafter

Red: dominant hand, blue: opposite handGroup 1
dominant hand: dry
opposite hand: wetGroup 2
dominant hand: dry
opposite hand: slightly~ moderately wet
Group 3dominant hand: dry
opposite hand: dry

Quantitative Analysis of Sweating of Each Hand
before and after Unilateral ETS
before operation

after operation

dominant hand

opposite handdominant hand

opposite handGroup 1 (n=69, 46%)1.34±0.56

1.36±0.59

0.18±0.11

1.19±0.43

Group 2 (n=39, 26%)1.11±0.44

1.13±0.47

0.15±0.07

0.68±0.28※

Group 3 (n=41, 28%)1.12±0.44

1.08±0.49

0.17±0.10

0.16±0.14※

Total

1.21±0.51

1.22±0.54

0.17±0.10

0.77±0.55※p<0.001（vs : before operation)

Contol value: 0.19±0.06 mg/cm2/min, n=10)

Possible Reasons of Some Relief of the Opposite
PH after Unilateral ETS for a Dominant Hand
⚫ By not sweating the dominant hand, patients improve
the psychological stress of daily life and reduce theoccasions of sweating opposite hand.
⚫ There might be somewhat cross reactivities between

bilateral sympathetic nerves.

Proportion of Unilateral ETS in Our Institution%
8060402002007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

(Oda Clinic, Day Surgery Center, Fukuoka, Japan in October 2007～December 2021)

Present Status of Patients with PH in Our Institution
Patients with PH
（30％）

（70％）

Bilateral ETS

Unilateral ETS（1 ~ 2％?）
Regret due to Sever CS

more than 1 Year Passed（20％）
Secondary Opposite ETS（80％）
No Additional Therapy

Conclusions
Unilateral ETS for the dominant hand in patients withpalmar hyperhidrosis improved sweating in the opposite

hand at varying levels. The patients may select thesecondary ETS for the opposite hand depending on thedegrees of residual sweating of the opposite hand and of CS
following unilateral ETS.