Thoracoscopic Sympathectomy

A procedure called a sympathectomy can treat excessive sweating in the hands and underarms. This surgery involves cutting and sealing a portion of the sympathetic nerve chain that runs down the back inside the chest, parallel to the spine. This operation permanently interrupts the nerve signal that is causing the body to sweat excessively.

Advances in visually assisted endoscopic surgery have made it possible for surgeons to perform sympathectomy with only a few small incisions less than one inch each. Using a fiberoptic camera and small surgical instruments, the surgeon can locate and cut the right portion of the sympathetic chain. This minimally invasive approach is considered an outpatient surgery, and most patients do not require an overnight stay in the hospital.

The Endoscopic Thoracic Sympathectomy (ETS) Procedure

In a procedure known as thorascopic sympathectomy, or more commonly as endoscopic thoracic sympathectomy or ETS, patients are placed under general anesthesia. Their arms are propped up at a 90-degree angle to the body to provide access to the area just below the underarm through which the operation is performed.

Starting on one side of the body, the anesthesiologist deflates one lung so that the surgeon can reach the sympathetic nerve chain. He or she makes one or two small incisions underneath the armpit, usually between the second and third ribs.

A small camera on a scope is placed through the incision to show the surgeon the inside of the chest and the sympathetic nerve chain. Through the scope, the surgeon uses a device called low voltage electrocautery that cuts and seals the nerve chain where it will best relieve the patient’s hyperhidrosis. The incision is then closed with self-dissolving stitches. The patient usually goes home from the hospital the same day, and can usually return to work or school a few days later.

Patients with severe hyperhidrosis who have exhausted other medical treatments are finding that the surgery offers a permanent solution to their problem. In almost all cases, it cures excessive sweating in the hands and underarms. The effect of the surgery is often immediate. Patients are often amazed when they wake up and find their hands warm and dry for the first time in years.

Potential Risks of ETS

The risks associated with ETS are minimal, but many people have reported experiencing side effects from the procedure. These are either a result of the procedure itself or from complications that may occur during the surgery.

These risks include:

• Compensatory Hyperhidrosis – The most common side effect reported by people who undergo ETS is noticing that they sweat more in another part of the body – such as the chest, back or legs – even as they no longer experience excessive sweating in their hands or underarms. In effect, the body is redirecting the signal to sweat. This happens in up to half of patients who have the procedure –sometimes temporarily, sometimes permanently and at varying intensities. However, most people prefer this increased sweating in other areas to the excessive sweating in the hands and underarms they previously experienced.
• Gustatory Sweating – Although rare, some people experience increased sweating when they eat.
• Horner Syndrome – Resulting from inadvertent damage to the highest nerves in the sympathetic chain, this condition causes decreased facial sweating on one side, drooping of the eyelid, and constricted pupils. This complication is very rare and is unlikely to happen when an experienced surgeon performs the procedure.
• Pneumothorax – After chest surgery, air or gas can enter the chest cavity, which may cause the lung to collapse. In most cases this does not pose a major problem and resolves on its own. Occasionally it may require chest tube placement and hospitalization if the patient is short of breath. Pneumothorax temporarily prohibits someone from flying, so this potential side effect should be taken into account when travelling to a distant medical center for an ETS.
• Pain – Pain may be caused by surgical instruments pressing on nerves along the ribs during surgery. Most people find that the pain is tolerable and resolves fairly quickly.
• Very rare complications, but ones that are risks of any surgical procedure, include excessive bleeding or injury to the surrounding organs and tissues.

For most people with severe hyperhidrosis, the benefits of having a sympathectomy far outweigh the risks. However, there are certain cases in which the surgery should not be performed. People who have severe heart or respiratory disease, a currently active infection, or an extremely low heart rate may not be able to undergo ETS. Also, people who have had prior chest surgery are generally not good candidates for the procedure.

Contact Us

To make an appointment with the University of Maryland Division of Thoracic Surgery, please call 410-328-6366.