E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Radiofrequency Ablation Versus Video-assisted Thoracoscopic Sympathectomy for Treating Palmar Hyperhidrosis: A Prospective Comparative Study
Mohamed Abdelghany✉ ,
Amr Rayan ,
Amr Elwany ,
Ihab Zidan ,
Mohamed Agamy
neurosurgery department, Alexandria Faculty of medicine; Cardiothoracic surgery department, Alexandria Faculty of medicine
Accepted: 26/10/2026
Article in Press
Corresponding Author:
Mohamed Abdelghany (mohamedabdelghanyshehata@gmail.com)
Abstract
Aim
Primary palmar hyperhidrosis is characterized by excessive hand sweating that significantly impairs daily functioning and patient well-being. Video-assisted thoracoscopic sympathectomy (VATS) and percutaneous radiofrequency ablation (RFA) are established treatment options with different efficacy and complication profiles. Therefore, this study aimed to compare the safety, efficacy, recurrence, compensatory hyperhidrosis (CH), and patient satisfaction associated with these two treatment modalities.
Material and Methods
This prospective comparative study included 100 patients with severe primary palmar hyperhidrosis (grades 3 and 4 on the Hyperhidrosis Disease Severity Scale). After counseling on both treatment options, patients selected their preferred treatment. Sixty patients underwent bilateral VATS sympathectomy under general anesthesia, whereas 40 underwent percutaneous RFA under local anesthesia with sedation. Patients were followed for 1 year, and their treatment outcomes, complications, CH rate, and patient satisfaction were evaluated.
Results
VATS provided significantly better control of palmar sweating than RFA at all follow-up time points (P < 0.05). The overall complication rates were low and comparable between RFA and VATS (7.5% vs. 5.0%, P = 0.681). However, CH was significantly more common after VATS than RFA (68.3% vs. 22.5%, P < 0.001). Despite these differences, overall patient satisfaction was comparable between groups.
Conclusion
Both VATS and percutaneous RFA effectively treat primary palmar hyperhidrosis. VATS provides superior long-term control of palmar sweating, but is associated with a significantly higher incidence of CH. In contrast, RFA is somewhat less effective but leads to CH less often. Therefore, treatment selection should be individualized according to patient preferences and clinical priorities.
Primary palmar hyperhidrosis is characterized by excessive hand sweating that significantly impairs daily functioning and patient well-being. Video-assisted thoracoscopic sympathectomy (VATS) and percutaneous radiofrequency ablation (RFA) are established treatment options with different efficacy and complication profiles. Therefore, this study aimed to compare the safety, efficacy, recurrence, compensatory hyperhidrosis (CH), and patient satisfaction associated with these two treatment modalities.
Material and Methods
This prospective comparative study included 100 patients with severe primary palmar hyperhidrosis (grades 3 and 4 on the Hyperhidrosis Disease Severity Scale). After counseling on both treatment options, patients selected their preferred treatment. Sixty patients underwent bilateral VATS sympathectomy under general anesthesia, whereas 40 underwent percutaneous RFA under local anesthesia with sedation. Patients were followed for 1 year, and their treatment outcomes, complications, CH rate, and patient satisfaction were evaluated.
Results
VATS provided significantly better control of palmar sweating than RFA at all follow-up time points (P < 0.05). The overall complication rates were low and comparable between RFA and VATS (7.5% vs. 5.0%, P = 0.681). However, CH was significantly more common after VATS than RFA (68.3% vs. 22.5%, P < 0.001). Despite these differences, overall patient satisfaction was comparable between groups.
Conclusion
Both VATS and percutaneous RFA effectively treat primary palmar hyperhidrosis. VATS provides superior long-term control of palmar sweating, but is associated with a significantly higher incidence of CH. In contrast, RFA is somewhat less effective but leads to CH less often. Therefore, treatment selection should be individualized according to patient preferences and clinical priorities.
Keywords
Radiofrequency Ablation
Video Assisted Thoracoscopic Sympathectomy
Palmar Hyperhidrosis