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BCM - Baylor College of Medicine

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Cardiothoracic Surgery

Endoscopic Thoracic Sympathectomy

To surgically treat sweaty palms or underarms, a small part of the sympathetic nerve responsible for excessive sweating (hyperhidrosis) is removed. In the past, this required a large incision in the chest. Many muscles were cut and ribs separated to expose the sympathetic nerve chain. Recent surgical advances have produced less invasive procedures, such as the endoscopic thoracic sympathectomy.

This procedure requires general anesthesia and typically takes less than one hour to complete. Once the patient is asleep, the surgeon makes two or three small (1/8 inch to 1/4 inch) incisions below the armpit. Through these tiny holes, a miniature video camera is used to locate the sympathetic chain. The surgeon uses special instruments, inserted through the other incisions, to interrupt the chain at a specific level. The same procedure is then performed on the opposite side of the patient's body.

The patient usually remains in the hospital for only a few hours following surgery. Most patients experience mild postoperative discomfort requiring oral pain medication. This usually goes away after 7 to 10 days. The success rate for this type of procedure is above 90 percent with very few severe side effects and a very low failure rate. Most people who undergo this procedure are permanently cured.

Side Effects

The most common side effect is compensatory hyperhidrosis. Compensatory hyperhidrosis occurs when the patient experiences excessive sweating in other areas of the body, such as the chest, back, and legs. Although this is a very common side effect, it is usually mild and thus most patients find this condition to be manageable and remain satisfied with the results of the surgery. In rare cases, the compensatory sweating can be severe and create long-term problems and dissatisfaction with the results of the procedure.