The feasibility of using high-definition thoracoscopy to identify sympathetic ganglia during thoracic sympathicotomy for primary palmar hyperhidrosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 XU Gang , HU Chaoyue , CHEN Cong , LIN Yuancai , ZHU Daolong , LIU Han , WANG Dong

Department of Thoracic Surgery, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210023, P. R. China;

Corresponding?author：

XU Gang, Email: xgdw81@163.com

Keywords：

Palmar hyperhidrosis; high-definition thoracoscopy; sympathicotomy; sympathetic ganglion; near-infrared fluorescence; indocyanine green; feasibility study

DOI：

10.7507/1007-4848.202403041

Video：

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Objective To explore the feasibility of using high-definition thoracoscopy to identify sympathetic ganglia during thoracic sympathicotomy for primary palmar hyperhidrosis. Methods The clinical data of patients with primary palmar hyperhidrosis who underwent high-definition thoracoscopic sympathicotomy in Taikang Xianlin Drum Tower Hospital from June to July 2023 were retrospectively analyzed. Intraoperative visualization rates and anatomical variations of sympathetic ganglia were recorded, and the consistency between white-light thoracoscopy and near-infrared fluorescence imaging was compared. Additionally, surgical videos from previous fluorescence-guided procedures were reviewed. Results Finally 100 patients were collected, including 54 females and 46 males, with an average age of (21.92±6.56) years. All patients underwent endoscopic thoracic sympathicotomy at R3 level. The overall intraoperative ganglion visualization rate was 92.5% (740/800), with G2-G5 rates of 95.5% (191/200), 94.0% (188/200), 94.0% (188/200), and 86.5% (173/200), respectively. Ganglion variations occurred in 32.0% (237/740), predominantly at G3 (29.8%) and G4 (42.6%). In 5 indocyanine green-enhanced patients, the concordance rate between white-light and near-infrared fluorescence imaging was 100.0% (38/38). Video analysis of 14 near-infrared fluorescence-guided surgeries demonstrated a 99.1% (107/108) consistency rate. Postoperative palmar hyperhidrosis improvement reached 100.0% (100/100) with no Horner’s syndrome. Conclusion With the wide clinical application of high-definition thoracoscopy, accurate thoracic sympathicotomy has the feasibility of clinical application.

Citation： XU Gang, HU Chaoyue, CHEN Cong, LIN Yuancai, ZHU Daolong, LIU Han, WANG Dong. The feasibility of using high-definition thoracoscopy to identify sympathetic ganglia during thoracic sympathicotomy for primary palmar hyperhidrosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(4): 578-583. doi: 10.7507/1007-4848.202403041 Copy

1.	Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: a comprehensive review: etiology and clinical work-up. J Am Acad Dermatol, 2019, 81(3): 657-666.
2.	涂遠榮, 劉彥國. 中國手汗癥微創治療臨床指南編寫委員會. 中國手汗癥微創治療臨床指南(2021年版). 中國胸心血管外科臨床雜志, 2021, 28(10): 1133-1139.Tu YR, Liu YG, Writing Board of Clinical Guidelines for Minimally Invasive Treatment of Palmar Hyperhidrosis in China. Chinese clinical guidelines for minimally invasive treatment of palmar hyperhidrosis in China (2021). Chin J Clin Thorac Cardiovasc Surg, 2021, 28(10): 1133-1139.
3.	Lai FC, Tu YR, Li YP, et al. Nation wide epidemiological survey of primary palmar hyperhidrosis in the People's Republic of China. Clin Auton Res, 2015, 25(2): 105-108.
4.	Raveglia F, Rizzi A, Scarci M, et al. Primary hyperhidrosis: an invalidating disease—patients management and surgical recommendations. Shanghai Chest, 2018, 2(5): 1-9.
5.	Santos TS, Bachichi TG, Joaquim DT, et al. Compensatory sweating after thoracoscopic sympathectomy for primary focal hyperhidrosis: a series of 820 cases. Interdiscip Cardiovasc Thorac Surg, 2025, 40(3): ivaf063.
6.	Ersin OE, Yanik F, Karamustafaoglu YA, et al. The effects of sympathectomy ganglion levels on late complications in the treatment of hyperhidrosis. J Minim Access Surg, 2025, 21(2): 175-182.
7.	Martínez-Hernández NJ, Estors-Guerrero M, Galbis-Caravajal JM, et al. Endoscopic thoracic sympathectomy for primary hyperhidrosis: an over a decade-long follow-up on efficacy, impact, and patient satisfaction. J Thorac Dis, 2024, 16(12): 8292-8299.
8.	Ure?a A, Grando L, Rodriguez-Gussinyer L, et al. 20-year efficacy of endoscopic thoracic sympathectomy for primary hyperhidrosis: a cohort study. J Clin Med, 2025, 14(14): 4831.
9.	Sang HW, Li GL, Xiong P, et al. Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review. Surg Endosc, 2017, 31(11): 4357-4369.
10.	Cerfolio RJ, De Campos JR, Bryant AS, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg, 2011, 91(5): 1642-1648.
11.	Talsma J, Peirce CC, Tarfusser I, et al. T3 endoscopic thoracic ganglionectomy using cutting mode cautery for palmar hyperhidrosis. Ann Thorac Surg Short Rep, 2024, 3(2): 456-460.
12.	Weng W, Liu Y, Zhou J, et al. Thoracoscopic indocyanine green near-infrared fluorescence for thoracic sympathetic ganglions. Ann Thorac Surg, 2016, 101(6): 2394.
13.	Pei G, Meng S, Yang Y, et al. Anatomical variations of the thoracic sympathetic ganglions and their effects on sympathicotomy for primary palmar hyperhidrosis. Clin Auton Res, 2023, 33(2): 111-120.
14.	張本斯, 楊新文, 王勇, 等. 經胸腔上肢交感神經切除術的解刨學基礎. 解剖學雜志, 2009, 32(4): 515-517.Zhang BS, Yang XW, Wang Y, et al. Anatomical basis for a successful upper limb sympathectomy via thoracic route. Chin J Anat, 2009, 32(4): 515-517.
15.	Kommuru H, Jothi S, Bapuji P, et al. Thoracic part of sympathetic chain and its branching pattern variations in South Indian cadavers. J Clin Diagn Res, 2014, 8(12): AC09-AC12.
16.	Yong S, Yang X, Cao W, et al. Comparison of the effectiveness and safety between ramicotomy and sympathetic chain interruption in the treatment of primary hyperhidrosis: a meta-analysis. Clin Auton Res, 2025, 35(3): 353-364.
17.	Weng W, Li X, Pei G, et al. Anatomical variation of sympathetic ganglia in R4+R5 sympathicotomy for primary palmar axillary hyperhidrosis. J Thorac Dis, 2023, 15(6): 3106-3114.

1. Nawrocki S, Cha J. The etiology, diagnosis, and management of hyperhidrosis: a comprehensive review: etiology and clinical work-up. J Am Acad Dermatol, 2019, 81(3): 657-666.
2. 涂遠榮, 劉彥國. 中國手汗癥微創治療臨床指南編寫委員會. 中國手汗癥微創治療臨床指南(2021年版). 中國胸心血管外科臨床雜志, 2021, 28(10): 1133-1139.Tu YR, Liu YG, Writing Board of Clinical Guidelines for Minimally Invasive Treatment of Palmar Hyperhidrosis in China. Chinese clinical guidelines for minimally invasive treatment of palmar hyperhidrosis in China (2021). Chin J Clin Thorac Cardiovasc Surg, 2021, 28(10): 1133-1139.
3. Lai FC, Tu YR, Li YP, et al. Nation wide epidemiological survey of primary palmar hyperhidrosis in the People's Republic of China. Clin Auton Res, 2015, 25(2): 105-108.
4. Raveglia F, Rizzi A, Scarci M, et al. Primary hyperhidrosis: an invalidating disease—patients management and surgical recommendations. Shanghai Chest, 2018, 2(5): 1-9.
5. Santos TS, Bachichi TG, Joaquim DT, et al. Compensatory sweating after thoracoscopic sympathectomy for primary focal hyperhidrosis: a series of 820 cases. Interdiscip Cardiovasc Thorac Surg, 2025, 40(3): ivaf063.
6. Ersin OE, Yanik F, Karamustafaoglu YA, et al. The effects of sympathectomy ganglion levels on late complications in the treatment of hyperhidrosis. J Minim Access Surg, 2025, 21(2): 175-182.
7. Martínez-Hernández NJ, Estors-Guerrero M, Galbis-Caravajal JM, et al. Endoscopic thoracic sympathectomy for primary hyperhidrosis: an over a decade-long follow-up on efficacy, impact, and patient satisfaction. J Thorac Dis, 2024, 16(12): 8292-8299.
8. Ure?a A, Grando L, Rodriguez-Gussinyer L, et al. 20-year efficacy of endoscopic thoracic sympathectomy for primary hyperhidrosis: a cohort study. J Clin Med, 2025, 14(14): 4831.
9. Sang HW, Li GL, Xiong P, et al. Optimal targeting of sympathetic chain levels for treatment of palmar hyperhidrosis: an updated systematic review. Surg Endosc, 2017, 31(11): 4357-4369.
10. Cerfolio RJ, De Campos JR, Bryant AS, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Ann Thorac Surg, 2011, 91(5): 1642-1648.
11. Talsma J, Peirce CC, Tarfusser I, et al. T3 endoscopic thoracic ganglionectomy using cutting mode cautery for palmar hyperhidrosis. Ann Thorac Surg Short Rep, 2024, 3(2): 456-460.
12. Weng W, Liu Y, Zhou J, et al. Thoracoscopic indocyanine green near-infrared fluorescence for thoracic sympathetic ganglions. Ann Thorac Surg, 2016, 101(6): 2394.
13. Pei G, Meng S, Yang Y, et al. Anatomical variations of the thoracic sympathetic ganglions and their effects on sympathicotomy for primary palmar hyperhidrosis. Clin Auton Res, 2023, 33(2): 111-120.
14. 張本斯, 楊新文, 王勇, 等. 經胸腔上肢交感神經切除術的解刨學基礎. 解剖學雜志, 2009, 32(4): 515-517.Zhang BS, Yang XW, Wang Y, et al. Anatomical basis for a successful upper limb sympathectomy via thoracic route. Chin J Anat, 2009, 32(4): 515-517.
15. Kommuru H, Jothi S, Bapuji P, et al. Thoracic part of sympathetic chain and its branching pattern variations in South Indian cadavers. J Clin Diagn Res, 2014, 8(12): AC09-AC12.
16. Yong S, Yang X, Cao W, et al. Comparison of the effectiveness and safety between ramicotomy and sympathetic chain interruption in the treatment of primary hyperhidrosis: a meta-analysis. Clin Auton Res, 2025, 35(3): 353-364.
17. Weng W, Li X, Pei G, et al. Anatomical variation of sympathetic ganglia in R4+R5 sympathicotomy for primary palmar axillary hyperhidrosis. J Thorac Dis, 2023, 15(6): 3106-3114.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The feasibility of using high-definition thoracoscopy to identify sympathetic ganglia during thoracic sympathicotomy for primary palmar hyperhidrosis

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