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 Although alternative treatments such as oral medication, BOTOX®, Drysol® and Drionic® are available, the only long-lasting, effective treatment is to surgically stop the signal transmissions of the sympathetic nerve impulse to sweat glands. Basically, this can be achieved for all locations in the body such as palms, face, armpits, and feet. This procedure is known as Endoscopic Thoracoscopic Sympathectomy (ETS).
The surgrical procedure and technique
The best person to perform Endoscopic Thoracic Sympathectomy (ETS) is a highly trained, experienced, thoracic surgeon.
The operation is performed on an outpatient basis while patient is under general anesthesia administered by a board-certified or board-eligible anesthesiologist. The sympathetic nerves are located along the back, just behind the ribs. The surgeon uses a scope with magnification and illumination provided by the camera to view the sympathetic nerves. The vascular surgeon cuts or clamps the sympathetic nerves of the ganglion through two small incisions (5 to 10 mm) below the armpit area on each side of the chest.
In the cutting method, the nerve is simply cut. These nerves are cut to stop or reduce the body's ability to produce sweat in those identified problem areas. Our surgeons prefer this method over the clamping method. In the clamping method, metal clamps are applied on the nerve to stop the sweating from a particular section of the nerve; the success rate for this method is low. The procedure is performed bilaterally in the same session. After patients wake up from the anesthesia, they are moved to a recovery room, where they are carefully monitored, before being discharged to go home. Patients can return to work or school within several days. The procedure is extremely effective for palmar and axillary hyperhidrosis. The endoscopic technique is very safe and is curative in 98% of patients.
Results
The primary indication for surgery was palmar hyperhidrosis (PH) in 302 of 309 patients (97.7%), although in 7 patients (2.3%) axillary hyperhidrosis (AH) was the primary indication. A family history was elicited in 74 of 132 (56.01%) and a provocative response to hand lotion was present in 101 of 132 (76.5%). Thoracoscopic sympathectomy afforded almost instantaneous cures for PH, with marked improvement in 100% for whom the sympathectomy was done. Of 180 patients prospectively questioned in detail, 173 (96.1%) had some degree of plantar hyperhidrosis. Of these, 148 (84.4%) had some improvement, with 70 (40.5%) achieving complete relief of the plantar hyperhidrosis. In 98 patients who had some complaints of AH, 68 (69.4%) were completely relieved with the AH, while 25 (25.5%) were relieved but not completely cured. In 7 patients, the primary indication for sympathectomy was AH and of these, 3 (42.9%) had complete relief, 2 (28.6%) had partial relief, and 2 (28.6%) had no relief. Of the entire series of 309 patients, 4 (1.3%) developed severe compensatory hyperhidrosis (CH). In 180 prospectively questioned patients, CH was present in 81 (45%).
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