It is known that a certain segment within the sympathetic chain which is within the chest cavity is responsible for the excessive sweating. Eliminating that segment will cause cessation of the excessive sweating. The elimination can be done with electrocautery, ultrasound dissection, excision or clamping of that segment.
The surgery itself:
The operation is done under general anesthesia and in many places its being done on a outpatient basis. Outpatient basis means that the patient does not have to spend the night in the hospital and in most patients they go home 2 to 3 hours after the procedure was done. Once the patient is asleep the camera is inserted into the chest cavity and the sympathetic chain is identified. Then depending on the technique used the sympathetic chain is either ablated (resected or coagulated) or clamped with titanium clips. Depending on the surgeon the technique varries. The operation is done on each side of the chest in one setting. This is an improvement because in the past it used to be done one side at a time with two separate surgeries being needed. Once the procedure is completed the patient is transfered to the recovery room where and hour to an hour and a half later chest x rays are being taken to make sure that no air or blood are found within cavity. (Hemothorax or Pneumothorax). Pioneer surgeon Dr. Reisfeld based out of Los Angeles at the Center For Hyperhidrosis has an informative site that also shows visitors a walk through of the actual procedure. See his page on hyperhydrosis for more information on the condition.
Over the last 10 years few refinements came about and those are with regard to the scope of the operation as well as to the instruments used to treat hyperhydrosis. Tremendous progress was made with regard to the quality of the pictures as well as the ability to be more precise with regard to the amount of nerve segment that should be dealt with. The traditional and the most time tested approach is to perform T2 sympathectomy. This means that the segment between the second and the third rib is being ablated with whatever preferred method the surgeon uses. This is used to cure hand sweating, facial sweating, and facial blushing. Recently another theory was brought to light by Dr. Lin and Dr. Telerantra with regard to performing the sympathectomy at different levels. This is still a theory which needs more clinical trials to be proven.
At present at the center for hyperhidrosis the surgical approach is to do the clamping method at the level T3 to T4. This particular surgical variant showed to have as good of results as the T2 sympathectomy but with less amount of cases with severe compensatory sweating. Other benefits to this lower sympathectomy level are less interference with heart rate and keeping upper body sweat in tact.
Another finding that came after comparing the different methods of doing the sympathectomy is the almost disappearance of gustatory sweating after performing the T3-T4 sympathectomy. Dr. Reisfeld believes that this happens due to the fact that there is no interference between the sympathetic-para sympathetic relationship which are more closely connected at the upper chest region (T1-T2 area).
Lumbar Sympathectomy was added as an option for patients who suffer severely from plantar hyperhidrosis. Plantar hyperhidrosis can appear with palmar hyperhidrosis and the success rate to alleviate the excessive feet sweating while performing thoracic sympathectomy is about 50% or less.
In order to achieve a very high success rate for excessive feet sweating lumbar sympathectomy can be performed. The operation is done in the flank regions of the abdomen (the side walls of the abdominal cavity). It is done under general anesthesia and can take up to 2 hours. It can be performed endoscopically assisted or via an open approach with basically the same end results and the same hospital stay. The operation is very effective and a patient should keep this possibility not before conservative measures such as drysol, drionic and even botox should be tried.
One of the first surgeons to perform this procedure in the U.S. is Dr. Reisfeld in Los Angeles. To learn more about this procedure please visit the sweaty feet section of his website.