Thoracoscopic Sympathectomy
Hyperhidrosis is a debilitating, common condition that affects
nearly 1% of the population. It is characterized by excessive
sweating that is socially embarrassing and may be disabling.
The sweating commonly involves one or more parts of the body,
including the hands, feet, axillae or, less often, the face. The
most common presentation is excessive wetness of the hands,
making it difficult to shake hands, write or work at a computer.
The cause of hyperhidrosis is not well understood, but it is
known that the sympathetic nervous system is important in the
control of sweating. There are a number of treatments for
hyperhidrosis — prescription strength topical antiperspirants,
orally administered anticholinergic medications, and iontophoresis,
for example — but these are each successful in only a fraction
of patients, and none are without side-effects. Botulinum Toxin
injections often are successful, but they provide only short-term
relief, are very costly, and may become less effective over time.
Now that sympathectomies can be
done using minimally invasive techniques,
many more patients are being offered
this procedure, 95-98% of hyperhydrosis
patients will be cured.
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Surgeons have known for many years that dividing the sympathetic
chain in the upper chest can provide a long-term cure for
hyperhidrosis. Since this procedure — sympathectomy — can
now be accomplished with minimally invasive techniques, the
number of patients offered the operation has dramatically risen.
Thoracoscopic (VATS) sympathectomy treats hyperhidrosis with
an extremely high degree of success and
patient satisfaction. Other problems that
can often be successfully treated with this
operation include Raynaud's phenomenon
and reflex sympathetic dystrophy.
Under general anesthesia, two 2 mm incisions
are used on each side to pass a
tiny video camera and a single dissecting
instrument into the chest. The sympathetic
trunk is visualized and divided at
the levels appropriate to the patient's problem
area. Nearly all patients go home the same
day and suffer only very minor discomfort
for a few days postoperatively.
Although
many patients experience a mild increase
in sweating in other parts of their body,
this is problematic in only a few patients,
and 95 to 98% of patients will be cured of
their excessive sweating. Penn surgeons have
performed approximately 75 VATS sympathectomies
in the past two years (Chart 1),
representing a significant commitment to the
care of patients with hyperhidrosis.
Chart 1
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