Minimally invasive dorsal sympathicotomies for the treatment of hyperhidrosis: palmar microcirculatory assessment as an intraoperative-aid

Background: Endoscopic transthoracic sympathicotomy has proven to be an effective and durable surgical treatment for severe primary hyperhidrosis. Anyhow, in some cases, especially in overweight patients, a thick overlying subpleural fat may obscure the sympathetic chain, precluding access to the ganglia and partial or total completion of the procedure. The aim of this study was to assess the value of palmar laser Doppler flowmetry (LDF) as an intraoperative-aid during minimally invasive dorsal sympathicotomies (T3) for the treatment of primary palmar hyperhidrosis. Methods: The method was tested during 40 upper dorsal video-assisted minimally invasive sympathicotomies in 20 patients with bilateral palmar primary hyperhidrosis. Results: The mean baseline LDF values were 36.05 pU (SD = 21.85 pU). The mean immediate postoperative LDF values were 75.94 pU (SD = 37.89 pU). A statistically significant difference was observed between preoperative and immediate (about 5 s after the sympathicotomies) postoperative values (p = 0.00000009). Conclusions: According to our data, LDF allowed to obtain reliable and fast intraoperative evidence of a correct section of T3 ganglia. As such, we recommend LDF as a useful intraoperative tool when dealing with dorsal sympathicotomies for the treatment of palmar hyperhidrosis, both for the unexperienced surgeon and when the sympathetic chain is not clearly visualized. Level of Evidence: Level IV, therapeutic study.