A 22-year-old Korean man presented with abnormally patterned sun tanning 2 months after undergoing a video-assisted thoracoscopic sympathectomy (VATS). He had no remarkable medical history except for palmar hyperhidrosis, which had persisted since he was a child.
Two months prior to the visit, he had received bilateral VATS under general anesthesia with a single-lumen endotracheal tube. A 2-mm thoracoscope was inserted through the third intercostal space midaxillary line after carbon dioxide inflation of the pleural space to collapse the lung. After visual confirmation of the sympathetic chain for palmar hyperhidrosis, a cautery device was introduced via another tiny incision just anterior to the thoracoscope incision. The sympathetic chain was transected over the second, third, and fourth ribs using electrocautery. After a full expansion of the lung, the procedure was repeated on the other side.
Cho SB, Kim JB, Jung JY, Oh SH. Decreased Tanning Response After Video-Assisted Thoracoscopic Sympathectomy. Arch Dermatol. 2008;144(9):1240-1241. doi:10.1001/archderm.144.9.1240