Hyperhidrosis can be effectively treated with surgery. The procedure is known as Endoscopic Thoracic Sympathectomy (ETS).
Sweat is regulated by the sympathetic nervous system, a specialized group of nerves with a primary purpose of responding to fear. When the sympathetic nervous system is stimulated, the heart rate increases, the eyes dilate, and blood flow is shifted to the brain and other organs that are key to what is known as the "fight or flight response."
The sympathetic nervous system also controls about five million sweat glands in the body, and about half of these are located in the hands. The signal to produce sweat originates in the brain in an area known as the hypothalamus. This signal then travelsthrough the thoracic cavity (behind the lungs) one major group of sympathetic nerves to control sweating in the body. This bundle of nerves is known as the sympathetic chain. Since the sympathetic chain that produces hand, feet and facial sweating is located in the chest, a thoracic or chest surgeon is the medical specialist that performs the surgery. Historically, chest surgery involved opening the chest through a large incision and was generally thought of as a "major" operation. Today advancements in chest surgery using small incisions and a scope or camera to see inside the chest make surgery for hyperhidrosis more practical.
The Procedure
Before the surgery starts, the patient is placed under general anesthesia. Two small incisions, approximately 5 to 10 millimeters in length, are then made in each armpit. The lungs are gently moved away from the location of the sympathetic chain by placing carbon dioxide in the chest cavity. The lungs function normally during the operation but they are moved slightly away from the operative area to allow the surgeon to work. The endoscope is inserted in the chest, which includes a fiber-optic camera and a surgical instrument. The sympathetic chain is located on the rib and removed. Once the surgery is completed, the carbon dioxide holding the lungs away from operative area is removed, and the lung is expanded. The equipment is removed and the incisions are closed, often without sutures. Documentation of the ganglion (nerves) are made at the time of surgery by the pathology department.
Once the sympathetic chain is disrupted the excessive sweating is gone. The results are immediate! Most people are ready to recuperate at home after spending a few hours in the hospital recovering from the effects of the anesthesia. Under most circumstances, a full recovery is made in a few days. Please see our section on surgical treatment for excessive sweating for more information on results and side effects of the procedure.
