The patient was an adult woman who had suffered from primary hyperhidrosis since childhood. Her hands and feet would abnormally secreted excessive amounts of sweat, as if a faucet were constantly left open, severely affecting her daily work and studies. Moreover, the offensive odors caused by this condition have led to unjustified scorn and misunderstandings in social situations. This has caused her significant mental stress, making her increasingly sensitive and insecure.

Later, the patient learned that botulinum toxin injections could help with excessive hand sweating. This treatment works by blocking the release of acetylcholine at nerve endings, with effects generally lasting for 4 to 6 months. To alleviate the discomfort caused by hyperhidrosis, the patient opted for botulinum toxin injections.

​However, the result of this treatment was disappointing. Not only was the treatment process painful, but the effects also lasted for a short time. Although the patient’s symptoms significantly alleviated after the injections, the improvement only lasted for about 3 months before the symptoms reverted to their previous condition. To maintain the therapeutic effects, the patient had to undergo repeated injections, which caused ongoing pain, muscle stiffness, and significant financial burden. Feeling distressed, the patient decided to abandon this conservative approach and chose surgery to treat her hyperhidrosis after careful consideration.

One small and discreet incision of about 5-8 mm was made under each armpit. A 5 mm ultra-high-definition thoracoscope was used to sever the T4 sympathetic nerve chains that controlling sweating, and the entire operation took just 15 minutes. After the surgery, the patient's excessive hand sweating was significantly reduced without the numbness and stiffness that would be caused by the botulinum toxin injections. Moreover, there was no side effect of compensatory sweating.