Treatments for hyperhidrosis

Endoscopic Thoracic Sympathectomy

Endoscopic Thoracic Sympathectomy (also known as a Thoracoscopic Sympathectomy) is a minimally-invasive surgical procedure named a Sympathectomy. The surgery is normally performed on hyperhidrosis patients who have excessively sweaty hands and sweaty armpits, generally it is more successfully at stopping sweating on hands than armpits. The way that this surgery works is that it cuts of the signals which tells the sweat glands to produce sweat, thus the excessive sweating to the hands cut off completely or greatly reduced.

How does sweating work?

The sympathetic nervous system, which is a part of the vegetative nervous system, pushes electrical signals to the sweat glands on the surface of the body when the body thinks that it needs to be cooled down. The peripheral nerve fibers begin with small nodes of ganglia located sequentially in a chain passing along the side of the spine, this makes up the sympathetic trunk. With excessive sweating these signals are being sent when they are not needed. It is unknown as of yet exactly why this is occurring.

What does the Endoscopic Thoracic Sympathectomy procedure involve

A general anaesthetic is administered for the operation. When the patient is asleep, a small opening is created in the upper chest. The lung, which is on the side being operated upon is collapsed to give more room to work. Then a camera on the end of a telescope is inserted into the chest to track and find the nerve which are to be cut. Once it has been found up to two other holes are made so that the cutting tools can be inserted. Once this has been done the tools are removed and the lung is expanded. To ensure that all the air has been removed from the chest cavity a plastic tube may be left in so that any air trapped in the chest cavity can escape. The operation is then repeated for the nerve on the other side. The surgery generally takes about thirty minutes. The operation is mostly an overnight operation, and a longer wait may be required if the lung expansion takes longer.

Side effects of Endoscopic Thoracic Sympathectomy

  • The operation can lead to excessive dryness of hands, such that moisturising cream must be applied to avoid the skin cracking.
  • Compensatory sweating often occurs on other places. This sweating generally occurs on the back, and also can be on the feet and legs. Also there may be sweating on the side of the face when eating. Compensatory sweating tends to occur more frequently with and operation to fix axillary hyperhidrosis.
  • Gustatory sweating may occur, this is the increase of sweating when smelling specific foods which are strong, spice or sour.
  • Neuralgic pain.
  • Drooping of the eyelid due to nerve damage, this usually is temporary. If this occurs then a plastic surgery procedure called a blepharoplasty is required.
  • Ribs may be sore and painful during breath while coughing, this is normally temporary.
  • Artery damage
  • Nerve damage
  • Several more effects were also reported.
  • Inability to control body temperature
  • Inability to raise the heart rate and thus work out physically


Given the large number of potential side effects of this surgery, it is important to consult with multiple doctors as well as talk to patients who have had the surgery and to note that ETS is banned as a procedure in certain countries. Also to potentially try out other treatments for hyperhidrosis first.