Introduction not have an e-mail address or did not reply after three e-mails were sent a postal questionnaire. The first survey in the South West of England found TES to be a safe and effective procedure but only analysed data from two centres. The indications for Results intervention, surgical and anaesthetic for TES may have changed since publication of these data with Sixty-one of 78 (78%) surgeons had e-mail addresses improvements in endoscopic equipment and increased and 37 (61%) replied to the questionnaire by e-mail experience. The aim of this survey was to review while 33 replied to the postal questionnaire making current practice of TES in the South West of England the total response rate 90%. Twenty-four surgeons with and to assess e-mail as a medium for conducting a an e-mail address responded to the postal quessurvey of surgical practice. tionnaire. The mean e-mail response time was 20 days (range 1–80 days). Twenty surgeons (30%) performed TES of whom 13 responeed to the questionnaire via the Internet. Methods All surgeons performed TES for palmar hyperhidrosis, 17 (85%) for axillary hyperhidrosis, 5 (25%) A questionnaire was designed to determine the infor Raynaud’s disease, 2 (10%) for facial blushing and dications for operation, surgical technique, peropthere were 7 (35%) other indications (reflex symerative anaesthesia and perioperative analgesia for pathetic dystrophy, post-thrombotic/embolic limbs, TES (Fig. 1). frost bite, angina pectoris, thromboangitis obliterans, All consultant general surgeons in the region were vasculitis). One surgeon used a single axillary port, 11 identified from computerised database. E-mail adused two axillary ports and 9 used one infraclavicular dresses were collated by telephoning consultant secand one axillary port. (One surgeon used 2 methods). retaries or Information Technology departments. A Only 2 surgeons used a harmonic scalpel. Thirteen of hot mail address was registered on the World Wide twenty surgeons (65%) attempted to ablate lateral Web and the questionnaire was e-mailed to all paraberrant sympathetic fibres. Double lumen endoticipants. Second and third e-mails were sent to nontracheal tube was used in all centres and 14 surgeons responders at one and three weeks. Surgeons who did (70%) performed bilateral sympathectomies at a single operation. Methods of perioperative analgesia are shown in Table 2. ∗ Please address all correspondence to: D. R. Lewis, Department of Surgery, Bristol Royal Infirmary, Bristol BS2 8HW. The estimated number of transthoracic endoscopic