Methods: Between March 2012 and May 2015, the data of 47 patients (27 males, 20 females; mean age mean age was 26.9±9.3 years; range 15 to 53 years) who underwent micro-invasive endoscopic thoracic sympathectomy due to primary palmar hyperhidrosis were retrospectively analyzed. Pre- and postoperative Perfusion Index values at five min, compensatory hyperhidrosis at six months, scar formation at the wound site at six months, and the Hyperhidrosis Disease Severity Scale and Quality of Life Questionnaire scores at one and six months were analyzed.

Results: The mean operation time was 27.5±5.6 min. The surgical success rate was 100%. The rate of compensatory hyperhidrosis was 36.2% at six months. While 45 patients (95.7%) did not experience pain in the incision site at six months, two patients (4.3%) complained of mild pain. With regard to scar formation at the wound site, 44 patients (93.6%) described the wound site as “very good” and three patients (6.4%) described it as “good” at six months. A statistically significant improvement was found at the postoperative first- and sixth-month Quality of Life scores, compared to the baseline scores (p<0.001).

Conclusion: Our study results showed an elevated risk of compensatory hyperhidrosis and severity with the increased age and symptom duration. Based on our study results, patients with a high-risk of compensatory hyperhidrosis can be detected with preoperative analyses, and different therapeutic options can be applied due to low patient satisfaction. We consider that endoscopic thoracic sympathectomy with a single incision less than 1 cm should be the standard intervention, as it is associated with minimal pain and scar development in eligible patients.