Radiofrequency Ablation versus Video Assisted Thoracoscopic Sympathectomy for Treatment of Palmar Hyperhidrosis

Background: Palmar hyperhidrosis is characterized by excessive sweating of the hands that significantly impairs daily function and quality of life (QOL). Two commonly used interventions are video-assisted thoracoscopic sympathectomy (VATS) and radiofrequency ablation (RFA), each with distinct risk-benefit profiles. The aim of this work was to assess the effectiveness of RF and VATS as treatment options for hyperhidrosis, and to compare between them regarding safety, efficacy, QOL, compensatory hyperhidrosis (CH), and patient satisfaction. Methods: This prospective study was carried out on 100 patients, with severe primary palmar hyperhidrosis, score 3 and 4 according to Hyperhidrosis Disease Severity Scale. Patients were randomly allocated into two groups: First group (n=60): subjected into thoracoscopic sympathectomy (VATS) under general anesthesia, and second group (n=40): subjected to percutaneous RFA under local anesthesia while patients were sedated. Results: The comparison between the RF and VATS groups based on patient evaluations after the procedure regarding hand dryness demonstrated significantly better outcomes in the VATS group across all follow-up intervals (P<0.05). Complication rates were low in both groups (7.5% RF vs 5% VATS; p = 0.681). However, CH was significantly more common in the VATS group (68.3%) than in the RFA group (22.5%) (p < 0.001). Conclusions: Both VATS and RFA effectively treat primary palmar hyperhidrosis. VATS provides better long-term symptom relief and lower failure rates, while RFA has a lower risk of CH.