Long-term Outcomes of Partial R3 and Total R4 Thoracoscopic Sympathectomy for Palmar Hyperhidrosis: A Retrospective Cohort Study

Purpose: To evaluate partial R3/total R4 thoracoscopic sympathectomy for palmar hyperhidrosis, balancing efficacy and side effects. Methods: Retrospective analysis of 37 patients (2018–2024). This study was approved by the Public Institutional Bioethics Committee, a nationally accredited institutional review board (IRB) in South Korea (IRB No. P01-202411-01-008). The primary outcomes were satisfaction, recurrence, and compensatory hyperhidrosis. Secondary outcomes included dryness and improvements in various domains of quality of life. Results: Symptom severity decreased significantly after surgery (mean 4.73 ± 0.51 preoperatively to 1.59 ± 0.76 postoperatively, p < 0.001). Recurrence occurred in 48.65% of patients, but recurrent symptoms were generally mild (mean 1.92 ± 1.09). Patient satisfaction was high (mean 4.19 ± 0.81) and showed a significant negative correlation with both recurrence and recurrence severity; however, it was not significantly associated with the presence or severity of compensatory hyperhidrosis or dryness. Quality of life, including social, occupational, mental, and physical domains, improved markedly postoperatively. Conclusion: Partial R3 and total R4 thoracoscopic sympathectomy for palmar hyperhidrosis achieves high long-term patient satisfaction and quality of life improvement, with recurrence being the most important determinant of satisfaction. Although compensatory hyperhidrosis and dryness are common, they do not significantly detract from overall satisfaction, supporting this hybrid approach as a balanced and effective surgical strategy.