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Description of Clinical Program
Primary Palmer and/or axillary hyperhidrosis are conditions marked by excessive perspiration beyond physiological necessity and with no known cause. It is reported to have an incidence of 1% in the Western population. However, this number maybe a gross under estimation. Patients afflicted with this condition often complain of cold, sweaty hands, sometimes even dripping with sweat. This occurs without stimuli and can be further exacerbated by the weather.

Advances in minimally invasive endoscopic techniques with significantly reduced morbidity and mortality rates has established thoracoscopic sympathectomy as a safe and effective treatment for Palmer and axillary hyperhidrosis. High technical success and patient satisfaction rates have paralleled the increased application of this procedure in the treatment of palmer hyperhidrosis. Long term results are variable for other autonomically mediated disorders such as Raynaud's syndrome, causalgia and vasculitis.

Thoracoscopic sympathectomy should be avoided in those patients with previous thoracic operations or pulmonary infections who may have dense adhesions that can impede thorough visualization of he sympathetic chain. A complete preoperative medical evaluation is necessary to exclude patients with underlying or pre-existing diseases of the thorax as well as systemic hypermetabolic disorders.

Thoracoscopic sympathectomy is performed under general anesthesia. Three 1-cm incisions are made along the outer chest and soft plastic ports inserted. The entire procedure is performed endoscopically using a rigid 5mm scope. The 2nd and 3rd sympathetic ganglia are excised. The surgery times ranges between 2-3 hours for a bilateral procedure and the patient is usually released the same day.

The operation has been successful in over 95% of our patients. Potential long-term complications include compensatory sweating and Horner's syndrome occurs in approximately 2% of our patients.

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