Video Assisted Thoracic Sympathectomy

To treat hyperhidrosis, the sympathetic nerves that cause the excessive sweating must be treated. The thoracic sympathetic chain ganglia is located along the vertebra of the spine inside the chest. The T2 segment, located on the side of the upper spinal column, is specifically responsible.

To cure hyperhidrosis, the responsible segment of the nerve is removed. At Cedars-Sinai, the surgeon removes the 2nd and 3rd ganglion from the chain, as well as the 4th one, if necessary, to treat armpit sweating. Removal of these ganglia typically produce no side effects. With Cedars-Sinai's leading-edge surgical techniques, the procedure takes 30 to 45 minutes, and often patients go home the same day without sweaty hands.

About the Surgery

Under general anesthesia, the surgeon makes 2 small incisions (less than ½ inch in size) in the chest. Through one the surgeon places an endoscope (slender tube with a camera on its tip) and through the other, a harmonic scalpel. The procedure uses a harmonic scalpel, which vibrates at high speed, generates no heat and is capable of laser precision. Viewing the inside of the chest on a TV screen, the surgeon removes the ganglia. After the incisions are closed, the patient is recovering and on his or her way—with dry hands.

Endoscopic surgery is less painful (minor discomfort), has fewer postoperative complications, can be done on an outpatient basis and requires very little recovery time (normally, a couple of days).

Outcomes, Risks and Side Effects

Almost everyone is a candidate for video assisted thoracic sympathectomy, except those with a history of severe cardio-respiratory disease, pleural disease or untreated thyroid disease. Also, patients who have undergone a prior chest surgery or with certain infections, such as lung/chest abscesses, may be excluded from having this procedure because access to the sympathetic nerve is obstructed.

Complications are infrequent. Sweaty palms are cured in over 98 percent of cases. At Cedars-Sinai, our surgeons have performed sympathectomy surgery since 1977 and helped pioneer the endoscopic procedure in 1995.

The surgery can cause side effects, which may vary in occurrence and severity. Compensatory sweating is perhaps the most bothersome possibility. If this occurs, patients may experience excessive sweating on the back, stomach, thighs or lower legs—instead of the hands.

Be sure to discuss all potential risks and side effects with your surgeon before you proceed.