Modern Advancements, Minimally Invasive Sympathectomy for Hyperhidrosis
For more than a century, thoracic sympathectomy has been utilised as a surgical procedure; however, the indications have changed drastically. The technique for performing the operation has also evolved in recent years, with minimally invasive procedures now commonplace. Currently, ETS is often performed via thoracoscopy, with positive, permanent results in most cases.
Hyperhidrosis is an unusual condition that manifests from moderate to severe perspiration of the hands to extreme palm sweating. Treatment of sweaty hands in the past involved a large incision in the spine and carried a risk of not being successful. With the advent of new, innovative technologies, thoracic surgeons can surgically treat the socially debilitating disorder effectively with a minimally invasive endoscopic technique.
Within the past century, surgical techniques have evolved alongside a greater understanding of the physiology of the autonomic nervous system. As such, indications for ETS have increased significantly in the treatment of primary palmar hyperhidrosis.
“Video-assisted endoscopic thoracic sympathectomy is an incredibly safe, cost-effective and minimally invasive way to disrupt the sympathetic nerve to relieve patients with sweaty palms,” explains Dr Harish Mithiran, managing thoracic surgeon of Neumark Lung & Chest Surgery Centre and senior consultant thoracic surgeon at Gleneagles Hospital, Singapore. He continues, “Endoscopic thoracic sympathectomy side effects are minimal compared with the benefits and quality of life improvements we see in our patients”.
Video-assisted sweaty palm operations provide a permanent treatment for excessive sweating in the hands. At Neumark Lung & Chest Surgical Centre, our surgeons perform minimally invasive thoracoscopic sympathectomy via video-assisted thoracoscopic surgery (VATS) for palmar hyperhidrosis. A video scope is placed between the ribs, and the affected nerve is cauterised.
The Science of Evolution behind Cauterising the Sympathetic Nerve Chain
You may assume that lung diseases and chest conditions, from chronic obstructive pulmonary disease to collapsed lungs and even the unfortunate diagnosis of cancer, are the only scope within a thoracic surgeon’s purview. But a simple but prevalent chronic condition that affects 3 percent of the general population (and a higher incidence at 6% in Asians) can be effectively treated by a thoracic surgeon.
Our ability to thermoregulate through sweating plays an important role in shaping modern human survival. As a result of the body’s response to evolution, the gene expression of the Engrailed 1 (EN1) transcription factor in the skin is most likely upregulated to help us adapt to stressors and as an evolutionary protection mechanism.
Recent findings indicate that EN1 plays pivotal, widespread roles in embryonic development of cells throughout the body, including in our brains, skeletal muscle, and limbs, and in the formation of eccrine sweat glands, which regulate the mechanism by which humans dissipate body heat by inducing sweat to evaporate from our skin.
Natural selection plays a formative role in defining the unique characteristics that make us human; yet, the genetic basis for many of these traits remains largely unknown. This is also true for patients with sweaty hands. The precise physiological cause of primary hyperhidrosis remains unknown, as the disorder does not appear to be directly related to abnormal eccrine sweat glands in some patients, which function normally in people affected by the condition.
In primary hyperhidrosis, excessive sweating is often localised to the hands, armpits, or feet, beginning in early adolescence and persisting into adulthood. In secondary hyperhidrosis, sweating is not the underlying dysfunction. It manifests during adulthood likely as a result of metabolic disorders, such as obesity, hyperthyroidism, hematologic malignancies, neurological diseases, or medication-induced to treat disorders, such as anxiety disorders.
Several clinical treatments are available for primary hyperhidrosis. Oral medications, antiperspirants, topical applications, and even BOTOX® are non-surgical, palliative treatments. However, they are not permanent solutions, as the symptoms will relapse once the therapeutic approach is stopped. Eventually, most patients require surgical intervention via permanent endoscopic thoracic sympathectomy for palmar hyperhidrosis, the definitive treatment for excessive palm sweating.
Video-Assisted Endoscopic Thoracic Sympathectomy (ETS)
Surgery for palmar hyperhidrosis has been performed for more than seven decades. Initially, the procedure was highly invasive as surgeons incised the chest to spread the ribs apart, with only one side of the body being treated at any one time. Hospital recovery time was long and often painful.
Fortunately, this is no longer the case. Surgical interventions are now minimally invasive procedures that can be carried out on an outpatient basis. There are numerous options available when it comes to surgery for hyperhidrosis, such as severing the nerve, clipping it or completely resecting it from the body.
ETS can be effective for patients in adolescence or adulthood, provided the space between the ribs and the thoracic cavity is large enough. CT scans and X-rays can help determine treatment adequacy. ETS surgery disrupts the transmission of nerve signals from the spinal cord, inhibiting signals that activate the sweat glands.
Since VATS is minimally invasive, recovery is very rapid. Most patients are able to return to work on the same day as their appointment, and normal exercise can be resumed within one week. Patients may, however, feel some pain in their underarms for a few days following surgery.
If sweaty palms surgery is elected, our surgeons will make a small (less than 3 millimetres) incision to cut the nerve using video-assisted thoracic sympathectomy to remove the overactive part of the nerve. One or both procedures may be performed during the same surgical procedure, which typically takes 1 to 3 hours.
Benefits of Sympathectomy for Palmar Hyperhidrosis
The benefits of a sympathectomy approach include less postoperative pain, shorter recovery time, and virtually no complications in the majority of cases. Its long-term side effects are negligible, and success rates are high in providing lasting relief from excessive sweating.
Results are almost immediate, and patients report a very high satisfaction rate following the procedure, as the surgical technique essentially ends your battle with feeling self-conscious about your sweaty hands.
The cost for endoscopic thoracic sympathectomy may be covered by your insurance. For questions or to schedule a consultation with Dr Harish Mithran, senior consultant thoracic surgeon at Gleneagles Hospital, Singapore, WhatsApp us at +65 9726 2485 or book an appointment online.