Prevention of postoperative complications becomes relatively important when surgical procedures are easy to learn and perform. Endoscopic Thoracic Sympathetic Surgery (ETS), which is now more accessible to surgeons after the 2nd International Symposium of Thoracic Sympathicotomy, would be the typical examples in surgery. Reflex sweating is one of the famous and annoying complications that surgeons endeavor to avoid but in vain in ETS. Incidentally, we found that preservation of sympathetic tone to the head is the main influential factor in avoiding reflex sweating in ETS; and with the lower sympathetic ganglion blocked, the more sympathetic tone to the head is preserved. T4-sympathetic block is an ideal procedure that can treat palmar and/or axillary hyperhidrosis and preserve most of sympathetic tone to head. We used T4-sympathetic block by clamping (ESB4) in treatment of 165 cases of Hyperhidrosis et axillaris and attained excellent operative results without reflex sweating from August 1, 2000 to February 28, 2001. We concluded, ESB4 is the method that can treat hand and axillary hyperhidrosis without inducing reflex sweating.
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