The Thoracic Center
(732) 235-7802 • (732) 235-8150 (fax)
Sweat glands underneath the skin’s surface produce sweat that is carried to the surface of the skin by ducts. People sweat when the environment temperature is warm, when a fever is present, and when they are nervous, under stress, or exercising. Those with excessive sweating, known as hyperhidrosis, tend to sweat even without these circumstances. Although excessive sweating may affect any area of the skin, it is most commonly present in the palms of the hands, soles of the feet, face, and armpits. Facial blushing can also be associated with hyperhidrosis.
Hyperhidrosis is often debilitating and causes individuals affected by the condition to avoid everyday activities like shaking someone’s hand, playing a musical instrument, and playing sports.
Robert Wood Johnson University Hospital offers the latest surgical approach to obtain permanent relief from this chronic and troublesome condition. When hyperhidrosis becomes disabling and other treatments prescribed by a doctor do not work, video-assisted thoracic sympathectomy should be considered. This involves surgical cutting of the sympathetic nerves that lead to the sweat glands that produce sweat. The procedure takes about 30 to 45 minutes. Patients leave the hospital the same day or next day and can return to normal daily activities in a few days. Patients experience minimal postoperative pain that is relieved with over-the-counter medications. Results are usually immediate. Patients often awake from surgery with dry palms.
Causes and Symptoms
People with excessive sweating should be evaluated by a doctor since there are medical conditions (e.g., disease of the thyroid gland) that can cause excessive sweating. Hyperhidrosis surgery would not be the treatment for such conditions.
A problem with a part of the nervous system that controls sweating can also cause excessive sweating. The body’s sympathetic nervous system does not stop the sweat reflex the way it should. Hyperhidrosis surgery benefits those with sweating from problems with the sympathetic nervous system.
Excessive sweating is often present on the palms of the hands, soles of the feet, face, and armpits. Physicians will rule out thyroid problems or other direct causes of excessive sweating.
Medical treatment usually involves evaluation by a dermatologist who may prescribe lotions or powders to keep the palms and armpits dry. The surgical option is called video-assisted thoracic sympathectomy. Patients undergoing a video-assisted thoracic sympathectomy receive general anesthesia. The surgeon makes two very small incisions under both armpits. The incisions are approximately one centimeter in length (one centimeter = 0. 4 inch). A small amount of carbon dioxide (referred to as “air”) is inserted into the chest cavity to move the lung away from the operative area. The surgeon inserts a fiber-optic camera and instrument to locate the sympathetic chain that is responsible for signaling the sweat glands in the upper limbs and face. It is the second ganglion in the chain that controls sweating in the palms and face, as well as facial blushing. The 3rd and 4th ganglion control armpit sweating. Your surgeon will discuss surgical options for you based on the type of sweating you are experiencing. The surgeon uses several surgical techniques to locate, clamp, and remove the sympathetic ganglion. The removal is called “sympathectomy.” Once the procedure is completed, the surgeon removes the air and closes the incision. The procedure leaves two very small scars hidden in each armpit that are almost invisible.
Success Rate and Results
Video-assisted thoracic sympathectomy has a success rate of 98%-100% for hyperhidrosis of the hands with a recurrence rate of 7%. The initial success rate is also high for hyperhidrosis involving the axilla but has a high rate of recurrence.
Surveys have shown that approximately 94% of patients are satisfied with the results of the surgery and would have the surgery again.
Risks and Complications
Risks for this procedure are minimal and should be discussed on an individual basis with your surgeon. Even when complications occur, they are usually of minor importance and require one or two more days of hospital stay to address. They include:
- Pneumothorax: a small amount of air may remain after the procedure or there may be minor leakage from the lung. This usually reabsorbs on its own and there is no need for treatment. Rarely, a patient requires suction drainage for a day or so to remove the air.
- Horner's Syndrome: a slightly smaller pupil and droopy eyelid are caused by damage to the upper ganglion (called the ganglion stellatum) and is extremely rare. A plastic surgery procedure to shorten the upper eyelid, called a blepharoplasty, is required to correct a droopy eye.
- Bleeding: excessive bleeding is a rare occurrence and is easily controlled by the surgeon. Please discuss risks with your surgeon.
After surgery, patients can experience compensatory sweating. This means that other parts of the body, such as the trunk or thighs, may experience more sweating than usual. Most patients consider compensatory sweating to be more acceptable than hyperhidrosis. Compensatory sweating is more frequent when the surgical procedure corrects armpit sweating than for sweating on the palms, or face, and facial blushing. Compensatory sweating has a tendency to decrease within the first six to twelve months. Heavy compensatory sweating occurs in approximately 7% of patients.
Increased sweating when smelling or eating spicy food, sour foods, or foods with strong odor may also occur and is rarely a problem for patients. This is known as gustatory sweating.
There are only a few individuals who are not eligible for the procedure because of difficulty accessing the ganglion. They include patients with severe pleural disease and infections such as pleuritis, and severe pulmonary insufficiency. Patients with untreated hyperthyroidism are also not eligible since this may be the reason for excessive sweating. Please talk to your doctor about a referral to The University Thoracic Surgeons to see if you are a candidate for thoracic sympathectomy.
Video-Assisted Thoracic Sympathectomy is performed at Robert Wood Johnson University Hospital by Dr. John E. Langenfeld. Please call (732) 235-7802 to schedule an appointment.
"I would like to thank Dr. Langenfeld and his caring staff for helping me make the decision to have this surgery. I have noticed a remarkable difference since my surgery in October 2004. I am more confident in social settings and I don't pull away when someone may want to hold my hand. I do have some compensatory sweating, however it is not unbearable. I am very pleased with the results and highly recommend Dr. Langenfeld."
"I am absolutely thrilled with the results... having this operation is truly one of the best life decisions I ever made. I feel like a normal human being with more confidence in meeting people in social and professional settings. Now it's my turn to be the "first" to extend my hand in a handshake. I'm just sorry that I didn't know about this procedure sooner. I am deeply grateful to Dr. Langenfeld and his kind staff. I could go on and on…"
"I had my surgery on March 8, 2005, and it was life changing. Being in sales with dripping wet hands is not good! The entire experience was extremely positive and convenient. I was prepared to go to New York to have this surgery, so to have it done so close to home was great and I could recover in my own bed. I was fortunate to see the surgery on the web cast and that answered many questions that I had. I went in with peace of mind about the entire procedure. Having the same day surgery at Robert Wood was positive; everyone I met cared and treated me with kindness and professionalism."
"Dr. Langenfeld, thank you for dry hands for the first time in 46 years of life!"
"Having the hyperhidrosis surgery was a wonderful thing for me. Now I haven't sweated since the surgery under my armpits. The surgery was a Godsend. No more embarrassing moments. I would recommend anyone who needs surgery for this problem to have it done. Dr. Langenfeld God bless you and your staff."
"Receiving thoracic surgery has been one of the best decisions of my life. I am more confident in all aspects of my life and would recommend undergoing surgery to anyone with hyperhidrosis."
Many health insurance companies will cover the surgical procedure, but check with your company for details.
(732) 235-7802 • (732) 235-8150 (fax)