CDTVProceduresHyperhidrosis Printer Friendly Page

Everyone perspires. It’s nature’s way of cooling the body. But some people have excessive sweating of the palms, the underarms, the feet, the trunk, or the face that severely impacts their lives. A simple handshake can be an embarrassment to someone with palms that are often wet.

This condition is known as hyperhidrosis. It is caused by an overactive sympathetic nervous system, the part of the body that regulates perspiration. Hyperhidrosis affects between 0.6 percent to 1 percent of the population, and it usually begins during adolescence. While hyperhidrosis can be caused by another condition, such as hyperthyroidism or menopause, it more commonly occurs by itself.

Treatment Options

Initially, patients may be treated for hyperhidrosis by a dermatologist. There are several remedies used to provide temporary relief from hyperhidrosis:

Specially formulated antiperspirants can be applied to the affected area, usually two or three times a week. However, they may irritate or discolor the skin and lose their effectiveness over time.

A process called iontophoresis, applications of low electrical current to the hands or feet, can be effective. It is a relatively expensive treatment that may result in skin burns, tingling, and skin irritation. Iontophoresis cannot be used for hyperhidrosis in the trunk or facial areas.

Psychotropic or anticholinergic drugs are sometimes prescribed, but may produce dry mouth and other side effects.

These nonsurgical remedies help many patients contend with light to moderate hyperhidrosis. However, for patients with a highly overcharged sympathetic nervous system, these measures may not be enough. The temporary natures of iontophoresis and antiperspirants and the side effects of psychotropic or anticholinergic medications may make these treatments undesirable for patients severely afflicted with hyperhidrosis.

The "open" surgery, dorsal thoracic sympathectomy, is a long procedure with high complication rates that often has a painful and lengthy recovery time.

A new minimally invasive surgical procedure, thoracoscopic sympathectomy, is permanent, highly effective, and has a low complication rate. Thoracoscopic sympathectomy interrupts the nerve impulses sent to sweat glands. This technique offers the advantages of small incisions and minimal post-operative discomfort and recovery. The surgery is most effective in treating hyperhidrosis of the hands, with a success rate of more than 95 percent. It also resolves facial sweating about 90 to 95 percent of the time.

How Thoracoscopic Sympathectomy is Done

Thoracoscopic sympathectomy is performed as an outpatient procedure at the Center for Diagnostic and Therapeutic Videosurgery at University Hospital. With the patient under general anesthesia, small incisions (between 1/4 inch and 1 inch) are typically made below the underarm on each side for insertion of a thin, telescope-like instrument attached to a camera and specially designed surgical instruments. The videosurgeon locates the T2 ganglion of the sympathetic nerve chain, isolates it together with the T3 and T4 ganglia, and removes them. The procedure is then repeated on the patient’s other side.

When the patient awakens from the anesthesia, the hands are warm and dry. The primary post-operative complication, compensatory sweating, generally resolves itself in time. Other complications may include those associated with anesthesia, and rarely, excessive bleeding and Horner’s Syndrome, a condition that can cause dropping of the upper eyelids and eye dryness. With the tiny incisions, scarring is kept to a minimum.

Patients experience little post-operative pain, and most are able to resume their regular activities within a few days.

Candidates for Thoracoscopic Sympathectomy

Hyperhidrosis patients in overall good health may be able to have thoracoscopic sympathectomy. Conditions such as untreated thyroid disease, pleural disease, and severe cardio-respiratory illness may preclude patients from having the procedure done, but at the Center for Diagnostic and Therapeutic Videosurgery, each patient is evaluated as an individual. Many insurance companies will cover thoracoscopic sympathectomy.

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