Surgical Approaches and Techniques in the Management of Severe Hyperhidrosis

The idea that a patient suffering from severe hyperhidrosis can benefit from surgery is not new. The first endoscopic sympathetic ablation was described by Kux in the 1950s. With the evolution of modern thoracoscopic techniques over the past 20 years, surgery has now been established as playing an important role in the management of this condition. Controversy still remains, however, as to the best technique for the surgical management of palmar, axillary, and craniofacial hyperhidrosis. Details regarding optimal approach, level, and extent of sympathectomy are discussed.