Sweaty palms (Palmar hyperhidrosis) is a physical condition with uncontrollable excessive hand sweating. It may cause severe psychological, social and/or professional disability. Problems such as difficulties handling paper, pens, buttons, tools, electronic equipment, as well as the need to avoid handshakes force many people to seek treatment.
The pathophysiological cause for the excessive sweating is still unknown but the condition is related to over-activity in the so-called “sympathetic nervous system”, a system of nerves over which we have no control. Emotional stimuli seem to have a stronger effect on the sweat glands in certain individuals.
For severely affected individuals in whom standard medical treatments have failed, surgical treatment for the problem is an option.
This involves cutting a short segment of the “sympathetic nervous system” which lies in the thoracic cavity. There are several ways in which the operation can be done.
Please remember that the effects of cutting this short segment of the sympathetic nervous system is the same irrespective of how it was done, and cannot be reversed.
Endoscopic Transthoracic Sympathetomy
Endoscopic Transthoracic Sympathetomy is a reliable and simplified operative technique to completely eliminate severe hand sweat. During the procedure, the surgeon simply cuts a short segment of the “sympathetic nervous system” which lies in the thoracic cavity. This procedure uses an endoscopic (keyhole) technique to interrupt the sympathetic nervous system. This surgical procedure is performed under general anaesthesia and requires only one to two nights stay in the hospital.
The operation is done with the patient on his/her side through 1-3 small (5-10 mm) incisions in the armpit region. The endoscope is inserted and the lung is collapsed. A short section of the sympathetic nervous system is exposed and cut. The instruments are removed and the lung is allowed to re-expand. A “chest tube” is inserted to ensure that air in the thoracic cavity will be completely removed and the lung is able to re-expand fully. The skin incisions are closed with stitches and then covered with sterile dressing. Then the patient is turned and the procedure repeated on the opposite side. After the operation, the chest tubes are then removed.
The hands become dry immediately after the operation. Complications from endoscopic transthoracic sympathectomy are low. Thousands of procedures have been performed world-wide by various surgeons in recent years. The reported success rate is close to 100%.
As with any surgical procedure, endoscopic transthoracic sympathetomy is associated with some degree of risk, but is overall a very safe procedure with few severe side effects. The risk-benefit assessment of the procedure needs to be done in the context of the original condition. The results presented below refer to the largest published study of more than 1,000 patients who had endoscopic transthoracic sympathetomy performed by various experienced surgeons.
Air-leak from the lung occurs in approximately 1% of patients. Treatment is by a chest drainage tube placed between two ribs and connected to a suction device for 1-2 days. The patient has to stay in the hospital until the tube is removed. Severe bleeding in the chest during the operation, although rarely reported, could necessitate opening of the chest.
A specific complication is called Horner’s Syndrome. This refers to the slight drooping of an eyelid and a slightly smaller pupil, without visual impairment. This occurs in approximately 1% of patients, and disappears spontaneously without specific treatment in about half of these patients. There is a very small risk that the nerves can regrow after they have been cut but this is less than 1 in 1,000 cases.
There are few adverse effects of the operation. The so-called “compensatory sweating” of the legs and trunk is noticed to some extent by most patients, but considered a major problem by only about 2%. Compensatory sweating might be experienced in a hot environment or when eating spicy foods.
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