3-Year Clinical Outcomes Comparing
Unilateral and Bilateral Endoscopic
Thoracic Sympathectomy forPalmar Hyperhidrosis
The 13th International Symposium on Sympathetic Surgery
10th-12th October 2019, Pisa, Italy
Oda Clinic, Day Surgery Center, Fukuoka, Japan
Hitoshi Oda, M.D., Ph.D.

Background
Unilateral endoscopic thoracic sympathectomy(ETS) for the dominant hand of patients with palmar
hyperhidrosis (PH) may improve the psychologicalstress of daily life, such as shaking hands and using apen, resulting in possibly providing a considerable
higher patient satisfaction.

Objectives
The aim of this study is to analyze the resolutionof symptoms, recurrence rate, severity ofcompensatory sweating (CS) and patientsatisfaction comparing to unilateral and bilateral
ETS for PH.

Materials and Methods
In my clinic, 140 patients with PH underwent
unilateral ETS for the dominant hand and 288
patients with PH underwent bilateral ETS in2016. A 3-year follow-up survey targeted atthese patients was performed from late June toearly July in this year.

Extended R4 (R4 + G3 partial ablation) ETSCharacteristics of Extended R4 ETS
 Effectiveness of PH : extended R4 > R4
 Severity of CS : extended R4 < R3
 Recurrent cases after extended R4:
secondary R3 ETS can be performed easily
without adhesion or scar tissues on the 3rd rib.

Recurrence Rates
From October 2007 to December 2018 in myseries, 66 patients (1.4%) out of 4,885 cases
underwent re-operation R3 ETS due to a complete orpartial recurrence.
In the first period (2007. 10 ~ 2009. 06) :R4 ETS : recurrence rate 3.8% (24/631)

 In the second period (2009. 07 ~ 2018. 12) :extended R4 ETS : recurrence rate 1.0% (42/4254)

Response Rate of this SurveyIn unilateral ETS group, 92 of 140 patientswere available in this survey and the response
rate was 65.7%.

In bilateral ETS group, 110 of 288 patientswere available in this survey and the response
rate was 38.2%.

Effectiveness of ETS for PH
Dry

Almost Dry%

Unilateral ETS(n = 92）100755025060.9%

Slightly Wet

Reccurence※The opposite hand was also alleviated toalmost dryness in 33 patients (35.9%) .

31.5%

5.4%

2.2%

0%

4.5%

3.6%0%%

Bilateral ETS(n = 110)10075
5025052.7

Worsening

39.1%

Incidence and Severity of CS
Nothing
46.7%

Mild

Moderate

Severe

2.2%

51.1%

Unilateral ETS(n = 92）

3.6%
33.6%

Bilateral ETS(n = 110)
40.0%

22.8%

Patient Satisfaction
Excellent

27.2%

Good

5.4%

Fair

2.2%

Discomfort

Regret65.2%

Unilateral ETS(n = 92）

7.3%
Bilateral ETS(n = 110)

47.3%

7.3%

38.2%

How were the patients after unilateral ETS ?
 After unilateral ETS, 26 patients (28.3%) were
performed secondary ETS for the opposite hand,and 15 patients (16.3%) hoped the opposite handoperation in a 3-year follow-up survey.
The opposite hand was also alleviated to almost
dryness in 33 patients (35.9%) only by unilateralETS.

 After all, 51 patients (55.4%) did not necessitate
further surgery after unilateral ETS.

CS after Secondary ETS for the Opposite Hand
CS after unilateral ETS

CS after secondary ETS

nothing

14/47

mild

12/43

moderate

0/2

nothing 9 (64.3%)
mild4 (28.6%)
moderate 1 (7.1%)
mild8 (66.7%)
moderate 4 (33.3%)
0

total

26/92 (28.3%)

X% of Unilateral ETS in my Clinic%60504030201002007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Conclusion
In a 3-year follow-up survey, unilateral ETS
had less incidence of severe CS and provided aconsiderable higher level of patient satisfaction
comparing to bilateral ETS. The patients who
underwent unilateral ETS consider the options as
to the treatments for the opposite hand eventually
after having experienced CS.