Endoscopic management of hyperhydrosis

Hyperhidrosis is perspiration in excess of the physiologic amount necessary to maintain thermal homeostasis. Primary or idiopathic hyperhidrosis is characterized by excessive sweating affecting the soles, palms, and axilla in various combinations and with varying degrees of severity. Secondary hyperhidrosis can be focal or generalized. Patients with primary hyperhidrosis have a higher-than-normal basal level of sweat production as well as an increased response to normal stimuli such as emotional or physical stress. One of the underlying mechanisms for a lower threshold and exaggerated response in patients with hyperhidrosis may be excessive sympathetic activityThe first clinical surgical sympathectomy was performed at the level of the neck by Alexander in 1889 and was intended for the treatment of epilepsy. Sympathectomy to abolish hyperhidrosis was reported for the first time by Kotzareff in 1920. During all these years, the focus was on cervical or upper thoracic sympathectomy.The patient undergoing endoscopic operation should be examined medically as regard the fitness for anaesthesia with special stress on the history of previous lung or pleural diseases and history of previous abdominal surgery that may contradict absolutely or relatively the procedure. As one lung anaesthesia will be attended, preoperative chest X-ray should be done to exclude underlying lung pathology as well as abdominal and pelvic studies.