NiVATS sympathectomy for hyperhidrosis: should I stay or should I go? A Narrative Review

Non-intubated video-assisted thoracoscopic surgery (NiVATS) has been shown to be a practicable and beneficial procedure for many thoracic operations. This review summarizes the current literature about NiVATS focusing on patients with hyperhidrosis. Seven studies about NiVATS and its efficacy and/or feasibility have been found and are discussed. There are only two randomized trials, while all other reports are case series. Four studies compare NiVATS with VATS. As seen for many other procedures as wedge resection, pleural biopsy and even anatomical resection, NiVATS sympathectomy for hyperhidrosis is a safe and feasible procedure to perform. Especially, due to the usual young, slim and otherwise healthy patients, this method is well suited to start a NiVATS program. Although NiVATS has a short learning curve, it challenges the whole team including surgeons and anesthesiologists, working on an awake patient. Nevertheless, evidence for clinical advantages of NiVATS compared to VATS is still scarce. The majority of thoracic surgery patients still gets a chest tube for a few days, which might outlast the positive effects of NiVATS, as for example lesser anestesiological trauma. However, there is evidence to show that NiVATS might be suitable in managing thoracoscopic sympathectomy as an outpatient operation, as these patients seem to have a faster general recovery postoperatively.