21 yo female affected by severe primary hyperhidrosis (palmar, plantar, axillary). We performed a T3-T4 thoracic sympathicotomy with a bi-portal 5-mm thoracoscopic approach. As shown in the video, we started with the right side using electrocautery (hook) and 5-mm 30° camera. The topic steps were: - to locateT3 and T4 ganglia, - to open the parietal pleural layer over the ribs avoiding the vessels (especially on the right side), - to dissect the sympathetic chain, - to extend the dissection about 4 cm over the internal rib surface. The overall OR time was 33 minutes (for both sides). The patient was discharged home in POD 1 with an uneventful postoperative course. The three months F/U confirmed the effective results with minimal compensatory back-sweating.
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