Saturday
Dec192009

Endoscopic Thoracic Sympathectomy

Sympathetic Chain, cut during endoscopic thoracic sympathectomyWhat is Hyperhidrosis?

Hyperhidrosis is the medical term used to describe excessive sweating.  Hyperhidrosis can be effectively treated with surgery, a procedure known as Endoscopic Thoracic Sympathectomy (ETS).  ETS has been shown to reduce increased sweating in the majority of patients who receive the procedure.  In one study of 850 patients, 98% of the patients said that the results of the surgery were satisfactory (1), while another study of 233 patients showed satisfactory results in 95% of patients (2).   In both studies, there were no major adverse outcomes.

How Does Endoscopic Thoracic Sympathectomy Decrease Sweating?

Sweat is regulated by the by a system of nerves known as the sympathetic nervous system.  This specialized group of nerves has primarily evolved for the purpose of responding to fear.  The sympathetic nervous system also controls about five million sweat glands in the body, and about half of these are located in the hands.  The signal to produce sweat originates in the brain in an area known as the hypothalamus.  This signal then travels behind the heart and lungs in a large bundle of nerves that is easily visible to the naked eye, known as the sympathetic chain.  By disrupting this system of nerves, excessive sweating can be decreased.

Since the sympathetic chain is located in the chest, a cardiothoracic surgeon is the ideal surgeon to perform the surgery.  Historically, chest surgery involved opening the chest through a large incision and was generally thought of as a "major" operation.  With advancements in chest surgery it is now possible to use small incisions to complete the surgery.  This is known as video assisted thorascopic surgery, where a camera is placed through one small incision and instruments are used through a separate incision to complete the surgery without having to open up the chest wall (known as a sternotomy).  This has made surgery for excessive sweating more practical, with less pain and an easier recovery for the patient.  Our lung surgeons have extensive experience with this type of surgery.

Preparing for ETS Surgery

All patients will meet with a surgeon before ETS surgery.  During this meeting, the surgeon will review the patient’s records and discuss the sympathectomy procedure.  All questions regarding the surgery will be addressed during the consultation.  A full evaluation is completed to minimize unseen problems during surgery, including laboratory tests.  Please bring a list of all medications to your appointment before surgery.  You will be given specific instructions on which medications to stop prior to your surgery and more details on what to do prior to surgery.

The Endoscopic Thoracic Sympathectomy Procedure

On the day of surgery, you will meet with an anesthesiologist.  The anesthesiologist is responsible for controlling pain during surgery, and may "put you to sleep" with general anesthesia if necessary.  The anesthesiologist ensures that you will not feel pain or remember the events during surgery.   The patient’s vital signs are continuously monitored throughout the operation with a continuous EKG machine.

The surgeon will start by making two small incisions, approximately 5 to 10 millimeters in length, in each armpit.  The lungs are gently moved away from the location of the sympathetic chain by placing carbon dioxide in the chest cavity. The lungs function normally during the operation but they are moved slightly away from the operative area to allow the surgeon to work.  The endoscope (instrument with a camera at the end) is then inserted into the chest to visualize the sympathetic chain.  The surgeon will then use an instrument through a separate incision to cut the sympathetic chain.  The equipment is removed and the incisions are closed, often without sutures. 

Once the sympathetic chain is disrupted, excessive sweating is typically relieved with immediate results.  Most people are ready to recuperate at home after spending a few hours in the hospital recovering from the effects of the anesthesia.  Under most circumstances, a full recovery is made in a few days.

Side Effects of Sympathectomy for Excessive Sweating

In a study study of 850 patients, the main side effects included development of a hemothorax (blood in the thoracic cavity, behind the lungs) in 1% to 2% of patients and recurrence of symptoms in 2% of patients (1).  Another common side-effect of endoscopic thoracic sympathectomy is increased sweating in other areas of the body.  This is known as compensatory sweating.  The studies above found compensatory sweating in 55% and 67% of individuals, which was primarily located on the trunk.  Of note, only 2% stated that this side-effect was as bad as the original hyperhidrosis.

Risks of Endoscopic Thoracic Sympathectomy

There is a small risk of serious adverse outcomes from endoscopic thoracic sympathectomy.  The main risks include bleeding, infection, breathing problems, and drug reactions.  Your surgeon will discuss these and other risks with you before your operation.  Fortunately these risks occur in a very small percentage of patients undergoing ETS surgery, and our surgeons use many techniques to ensure that these risks are minimized. 

More Information on Sympathectomy


  • 1. Endoscopic transthoracic sympathectomy: An efficient and safe method for the treatment of hyperhidrosis
  • 2. Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limbs
  • Information on Excessive Sweating from Hyperhidrosis

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