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Surgical treatment of primary hyperhidrosis is indicated after conservative medical treatment has failed or patients cannot tolerate the treatments. The surgical procedure involves interrupting the sympathetic nerve supply to the sweat glands in the hands, armpits and face. The procedure is called Sympathectomy. Sympathectomy is not a new procedure, but the minimally invasive or Endoscopic approach to sympathectomy is relatively new. “Endoscopic Thoracic sympathectomy”(ETS) for the relief of Hyperhidrosis became popular in the mid to late 1990s.
Endoscopic Thoracic Sympathectomy (ETS) is presently the definitive treatment for intractable Hyperhidrosis affecting the hands, armpits and face. ETS is also used to treat Reflex sympathetic dystrophy (RSD), Raynaud's disease and symptoms associated with Social phobia. The procedure is usually recommended for patients who have incapacitating sweating that severely impairs their quality of life. Bilateral Endoscopic Transthoracic Sympathectomy (ETS) is now considered the surgical gold standard to treat primary hyperhidrosis, as it is safe, very effective, with minimal side effects.
The Surgery is performed under general anesthesia. The surgeon makes two (1 cm) incisions near the armpit on both sides. A 5mm diameter Endoscope with a 3-chip camera and a light source at its tip is inserted via one of the ports and the sympathetic chain identified. Through a second port an ultrasonic instrument “Harmonic Scalpel”( use of ultrasound as a cutting tool). An X-ray is obtained to identify the appropriate level on the thoracic spine for interruption of the sympathetic chain. The surgeon then divides or clips the sympathetic chain at the appropriate levels depending on the patient’s presentation. The use of the ultrasonic instrument minimizes heat spread, reducing complications. We measure the patient’s finger tip temperature throught the procedure. With the interruption of the sympathetic chain there should be an immediate rise of the finger tip temperature on the same side by 1 or 2 degrees. Each side takes approximately 20-30 minutes; the whole procedure including anesthesia time usually takes about 2 hours. Absorbable stitches are placed deep to the skin, with no stitches outside. After completion of the procedure the patient is transferred to the recovery room. Patients stay in the hospital overnight and the next day they are discharged.
Patients are provided with a PCA (patient controlled anesthesia, given intravenously) this encourages patients to breathe deeply in the post-operative period. Chest x-rays are obtained in the morning, if satisfactory patients will be discharged from the hospital.