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Primary hyperhidrosis
is a poorly understood entity with severe social, professional, and psychological influences.
Neither the incidence nor the etiology of the disease is known.
Many patients go untreated for years because few physicians are aware of the diagnosis, much less the fact that
a highly effective form of treatment exists.
Most patients have suffered with the symptoms of excessive sweating of the hands and feet for many years.
Symptoms often begin in early adolescence and persist into adulthood.
Excessive sweating is spontaneous, but any situation provoking anxiety severely worsens the problem.
Patients frequently search out treatments which can include a variety of topical agents, local injections, relaxation therapy, and even hypnotherapy.
All these interventions have proven to have minimal affect on this disease.
Surgical sympathectomy
is the gold standard of treatment for this disease, by which all other treatments must be judged.
Upper thoracic sympathectomy has been performed for many years as therapy for hyperhidrosis and several other diseases.
There are various surgical approaches available.
Prior to the advent of endoscopic transthoracic sympathectomy (ETS), these approaches involved either painful back or neck incisions with possible risk of brachial plexus, or phrenic nerve injury.
The introduction of ETS for excessive hand and facial sweating has revolutionized the treatment of this disease.
The success rate is in excess of 98%, with very few side effects or serious complications.
We perform bilateral sympathectomies under general anesthesia.
A 5-mm. endoscope is used to identify the second through fourth ganglia.
The branches to the main sympathetic chain at each level are identified and divided, then the main chain is removed.
After completing one side, the opposite side is done. We feel that division of these branches is critical to preventing recurrent symptoms years later.
We have performed over 100 procedures in the past two years with excellent results.
All patients have had complete relief of palmar hyperhidrosis, and, for most, additional relief of plantar hyperhidrosis.
The most common side effect, compensatory truncal sweating, occurred in about 50% of patients.
Several patients had a small pneumothorax postoperatively, but none required any intervention, and all patients left the hospital within 24 hours.
Endoscopic sympathectomy is a highly-effective treatment for patients with palmar or facial hyperhidrosis.
ETS allows simultaneous treatment of both sides with a very low risk of complications.
Attention to surgical detail is important to achieve excellent long-term results.
We continue to lead the New York metropolitan area in minimally invasive thoracoscopic procedures, and especially ETS.
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