Thoracoscopic (VATS) Sympathectomy for Hyperhidrosis

Hyperhidrosis is a debilitating condition that affects nearly one percent of the population. It is characterized by excessive sweating that can be socially embarrassing, career restricting, and in some cases may even be disabling. Patients with hyperhidrosis suffer from excessive sweating that commonly involves one or several parts of the body, including the hands, feet, axillae (underarms), or less often the face. It can be triggered by exercise, stress, and/or embarrassment, but most commonly it is completely without obvious triggers. Hyperhidrosis most commonly presents itself as extreme—even dripping—wetness of the hands, rendering the patient too uncomfortable to shake hands, making paperwork and writing difficult, and often leading to uncomfortable skin conditions.

The cause of hyperhidrosis is not well understood, but it is known that the sympathetic nervous system (responsible for the fight-or-flight response when under stress) is important in the control of sweating. This system may for some reason be overactive in patients who suffer from hyperhidrosis.

There are a number of non-surgical treatments for hyperhidrosis, including, but not limited to:

• prescription-strength topical antiperspirants
• orally administered anticholinergic medications, which may partially block the transmission of nerve impulses that have become problematic
• iontophoresis, which uses water and a very mild electrical current to microscopically thicken the outer layer of the skin

However, these treatments are successful in only a small fraction of patients, and none are without side effects. Botox injections often are successful, but they provide only short-term relief, are very costly, and may become less effective over time.

Surgeons have known for many years that dividing the sympathetic chain in the upper chest can provide a long-term cure for hyperhidrosis. Since this procedure, known as a sympathectomy, can now be accomplished with minimally invasive techniques, the number of patients offered the operation has dramatically risen. Thoracoscopic (VATS) sympathectomy treats hyperhidrosis with an extremely high degree of success and patient satisfaction. Other problems that can often be successfully treated by this operation include Raynaud’s phenomenon (a condition resulting in pain and discoloration of the fingers and/or the toes after exposure to changes in temperature or emotional events) and reflex sympathetic dystrophy (a chronic pain condition).

Under general anesthesia, two 2mm incisions are used on each side to pass a tiny video camera and a single dissecting instrument into the chest. Because of the way we perform this procedure at Stanford, the incisions are so small that this is sometimes called "needlescopic surgery." The sympathetic trunk is visualized and divided at the levels appropriate to the patient's problem area. Nearly all patients are discharged home the same day and suffer only very minor discomfort for a few days after the operation. Although many patients experience a mild increase in sweating in other parts of their body, this is rarely problematic, and 95-98% of patients will be cured of their excessive sweating when the appropriate levels of the sympathetic trunk are divided. Patient satisfaction has been outstanding.