Surgery for Palmar Hyperhidrosis: Patient Selection and Extent of Surgery An Evidence-Based Approach

Video-thoracoscopic sympathectomy is an effective therapy for patients with severe primary palmar hyperhidrosis who are reaching the latter part of their teenage years. However, the best level, the extent of sympathectomy, and the optimal technique used to interrupt the sympathetic chain remain subjects of debate. Our review shows that single resection should be preferred to multiple levels of resection. In cases of isolated palmar hyperhidrosis, T3 is the level of choice, although T4 may be also reasonable. All procedures have similar outcomes, but sympathicotomy may be preferred because it is more simple and less extensive than others.