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T4 or T3 or T2 level Endoscopic Thotacic Sympathectomy (ETS) for Palmar Hyperhidrosis (Excessive Sweating) ?

By: Hratch Karamanoukian, MD and Raffy Karamanoukian, MD

August 5, 2008

T4 Level Endoscopic Thoracic Sympathectomy (ETS) Favored for Palmar Hyperhidrosis – Less Compensatory Sweating for Palmar Hyperhidrosis
Researchers at the Department of Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt have published their retrospective review looking at the efficacy of T2 and T3 Endoscopic Thoracic Sympathectomy (ETS) versus T4 ETS in relieving palmar hyperhidrosis (hyperhidrosis of the palms). The authors looked at outcomes in 60 patients and noted that treatment success at follow-up was 90% for the T2 ETS, 95% for T3 ETS and 100% for T4 ETS.
Important findings in this study (Surgery volume 143; 2008: pages 784-789) was that compensatory sweating was mild in the T4 group and moderate-to-severe in the T2 and T3 ETS groups.
About 40% of T2 ETS patients and 25% of T3 ETS patients were unsatisfied with their operation as conducted by Drs. Mahdy and colleagues. However, all patients in the T4 group were satisfied with the outcome. As such, this group advocates T4 sympathectomy (ETS) for patients with palmer hyperhidrosis.
Dr. Karamanoukian’s note – this is yet another study, albeit small, which advocates T4 level Sympathectomy for palmar hyperhidrosis.
For more information about hyperhidrosis and ETS contact Dr. Karamanoukian at or contact the Center for Excessive Sweating at 716-839-3638 to talk to Dr. Karamanoukian or our Nurse Practitioner.
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For more information about hyperhidrosis (excessive sweating) , as well as surgical and non-surgical hyperhidrosis treatment options, contact Dr. Karamanoukian at The Center for Excessive Sweating, a National Center of Excellence for Hyperhidrosis Treatment by email or by phone at (716) 839-3638.

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