Yonago Acta medica 2008;51:55–60

Patient Satisfaction after Endoscopic Thoracic
Sympathectomy for Palmar Hyperhidrosis
Hiroshige Nakamura, Tomohiro Haruki, Yoshin Adachi, Shinji Fujioka, Ken Miwaand Yuji Taniguchi
Division of General Thoracic Surgery, Tottori University Hospital, Yonago 683-8504 Japan

Endoscopic thoracic sympathectomy (ETS) for palmar hyperhidrosis was performed
using a 3-mm small endoscope at our hospital, and we conducted a questionnaire forthe purpose of studying the conditions and satisfaction after surgery. The subjects werecomprised of 50 patients, of which 35 patients (75%) answered the survey. The average age of the respondents was 27 years old (range: 12–62 years old) including 13 males
and 22 females and the average postoperative observation period was 33 months (1–114months). The results showed the good effects of surgery in all of the patients for palmar
sweating while patient satisfaction was 79.4 points, which concluded that ETS was sufficiently accepted as treatment for palmar hyperhidrosis. However, compensatory sweating (CS) developed in 97.1% of the patients, and 82.9% answered that they were disturbed because it was more than they had expected. This result makes us realize further the importance of preoperative informed consent for CS. The problem of palmar
hyperhidrosis is very serious for patients, and hence it is important to give treatment
with a thorough understanding of the effectiveness and problems of ETS for palmar hyperhidrosis according to the analytical results of this questionnaire.
Key words: compensatory sweating; endoscopic thoracic sympathectomy; palmar hyperhidrosis; patient satisfaction

Palmar hyperhidrosis is a disorder of unknown
cause with excessive sweating on the palms andtends to increase with the recent upsurge of stressin society as a background. It mostly develops inlater childhood, and because emotional distressis great, some people become introverted after
having this problem for many years. We havesuccessfully performed endoscopic thoracic sympathectomies (ETS) for the present disorder using
a 3-mm small endoscope, and afterwards, conducted a questionnaire for the purpose of studying
long-term sweating conditions and satisfaction after surgery in patients with palmar hyperhidrosis
who underwent surgery at our hospital.

Subjects and Methods
A questionnaire was given by mail as a response
system for 50 patients with palmar hyperhidrosis
who had ETS at Tottori University Hospital from
August 1998 to December 2007. Before ETS,
we explained the operative indications, procedures, complications and adverse effects including
compensatory sweating (CS) to the patients as
informed consent. Especially regarding CS, wenoticed that it would occur in all the patients to agreater or lesser degree. For surgery, ETS at the2nd and 3rd levels (T2 and T3 sympathectomy)

Abbreviations: CS, compensatory sweating; ETS, endoscopic thoracic sympathectomy55

H. Nakamura et al.

abFig. 1. Comparison of the preoperative and postoperative conditions of the palms of a patient with palmar hyperhidrosis. a: Before endoscopic thoracic sympathectomy (ETS). b: After ETS.

was performed under general anesthesia usinga small 3-mm endoscope. After dissection of
the mediastinal pleura, the thoracic sympathetic
trunk was cut and coagulated with end-scissors
or electro-cauterized on the second and third rib.
Palmar sweating stopped in all of the patients
immediately after the surgery (Fig. 1). For thequestionnaire, the current sweating condition, CS,

Amount of sweat on palms
AB
CDE

Increased
Increased slightly
Unchanged
Small amountCompletely stopped

000
629

daily life, anxiety over the surgery for palmar hyperhidrosis and postoperative patient satisfaction
were studied. Answers were obtained from 35 patients (75%). The average age of the respondents
was 27 years old (12–62 years old). There were
13 males and 22 females and the average postoperative observation period was 33 months (1–114months). There were no complications in the all
patients during the peri-operative period.

Results

D

Current sweating conditions

EThe amount of palmar sweating completely stopped
in 29 patients (82.9%) but still occurred slightly in
6 patients (17.1%), which showed the positive effective of this surgery for all of the patients (Fig. 2).
Facial and cervical sweating decreased in 25 patients (71.4%), but for sweating in the axilla and thesole of the foot, no change was observed in 12 patients (34.3%) and 17 patients (48.6%), respectively.
These were the highest numbers recorded.

Fig. 2. Current conditions of sweating.

• Are there any new areas
where you experience sweating (CS)? (yes: 34; no: 1)
For those who answered “yes”• How much are you sweating (CS) compared toyour expectations?
A Much more than expected
B Slightly more than expected
C As expected
D Slightly less than expected
E Much less than expected

209500CBCSACS occurred in 34 patients (97.1%), and 29 patients (82.9%) answered they were disturbed because it was more than they expected, and thisnumber of patients was considered to be quite
high (Fig. 3). The sites for sweating included theFig. 3. Compensatory sweating (CS).

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