What Is Endoscopic Thoracic Sympathectomy?

Recent surgical advances have produced less invasive procedures to treat hyperhidrosis or excessive sweating. Endoscopic thoracic sympathectomy is one such treatment and offers relief from palmar hyperhidrosis (sweaty hands) or axillary hyperhidrosis (sweaty armpits). As many as 1 out of every 500 Americans suffers from these conditions.

What Is Hyperhidrosis?

Excessive sweating of the hands or armpits can be very upsetting. Many individuals with these conditions are limited in their job choices. They may be unable to operate a computer keyboard or manipulate papers. Most are reluctant to shake hands, and many even avoid social contact. The degree of sweating varies and may range from moderate moisture to dripping. Most patients notice that their hands not only feel moist, but are also cold.

Hyperhidrosis is not a temporary condition, and most people have suffered with it since childhood.

What Causes Hyperhidrosis?

The exact cause is unknown; however, 4 out of 10 patients also have relatives with the problem. The reason patients experience symptoms relates to increased activity of certain nerves that are triggered under certain stressful situations such as job interviews, special occasions, or test taking can aggravate the sweating.

The human body has two different sets of nerves: the voluntary (somatic) nervous system and the involuntary (autonomic) system.

The voluntary nervous system contains nerves that give us sensation (pain, heat and touch) as well as muscle control. Many of our bodily functions occur without thinking such as breathing, the beating of our heart, and sweating.

The involuntary nervous system is made up of two components: the sympathetic and the parasympathetic systems. It is the sympathetic nervous system that controls the sweating throughout our bodies. Some people have over-active sympathetic nerves that cause the sweat glands to produce too much sweat inappropriately so that the person with this condition may be embarrassed by having sweaty hands and armpits in certain situations.

What Does the Surgery Involve?

Endoscopic thoracic sympathectomy 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.

Are There Any Side Effects to the Procedure?

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.

Additional Treatments

There are medications such as Drysol®, an astringent, which can be used to dry up the sweat glands. Drysol® is reported to work in 8 out of 10 people who use it to decrease excessive sweating. It is applied at bedtime and then washed off in the morning. Generally, the medicine is repeated nightly until sweating is under control. Thereafter, it can be applied once or twice weekly or as needed.

In addition to Drysol®, many oral medicines have also been prescribed with varying success. These include both sedatives and medications that prevent the sympathetic nerves from stimulating the sweat glands. One of the most recent treatments is an injection of botulinum toxin (Botox®) into the area of excessive sweating. Botulinum is a toxin that affects nerve endings and decreases the transmission of the nerve impulses to the sweat glands. This results in decreased sweating. It generally requires several injections in the palms or underarms and it remains effective from one to six months. Repeated injections are nearly always required to maintain an adequate level of dryness.

Unfortunately these treatments are only temporary, so the patient may have to take the medications for a very long time. Additionally, these treatments often have side effects. These side effects include dizziness, blurry vision, urinary retention, and flu-like symptoms. Some patients find that taking the medications is not worth the side effects.

Another treatment involves electrically stimulating the sweat glands. Patients place their palms into a water bath through which an electrical current is passed. The mild electric shock tends to "stun" the sweat glands. This treatment has been known to decrease sweating for periods of six hours to one week.

A family practitioner or internist often begins initial treatment for hyperhidrosis. Cases not responding to simple treatment regimens are often referred to a specialist such as Dr. Joseph Coselli or Dr. Scott LeMaire to discuss surgical options.