Therapy for Sweaty Palms
Thoracoscopic Sympathectomy for Hyperhidrosis

Sweaty palms (Hyperhidrosis) though a harmless condition, can be a source of embarrassment for some patients. Fortunately with the advance of technology, this problem can be resolved through a minimally invasive surgical procedure called Thoracoscopic Sympathectomy.

The information in this webpage is in a simple Q & A format, it aims to provide some some common questions and answers that patients have about the condition and the treatment options available.

1. Why do I perspire and where does perspiration come from?
2. What is hyperhidrosis or sweaty palms?
3. What causes sweaty palms?
4. What are the common treatments for sweaty palms?
5. What is Thoracoscopic Sympathectomy?
6. How successful is Thoracoscopic Sympathectomy?
7. What are the complications and side effects?
8. What does Thoracoscopic Sympathectomy involve?
9. What can I expect after the operation and how long do I have to be warded?
10. When can I resume my normal lifestyle?

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1. Why do I perspire and where does perspiration come from?

   Perspiration (or sweating) is a mechanism used by the body to cool down. Perspiration is produced by thousands of little glands found in the skin and the amount produced depends on both environmental conditions and the individualÕs body. More sweat is produced when the environment is warmer as a result of increased stimulation of the sweat glands by the nerves that supply them.

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2. What is hyperhidrosis or sweaty palms?

   Hyperhidrosis is a pathological condition of over-perspiration caused by excessive secretion of the sweat glands, the etiology of which is unknown. The excessive sweating can occur in the hands (palmar hyperhidrosis), underarms (axillary), face and/or feet (plantar). This disorder affects a small but significant proportion of the young population all over the world.

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3. What causes sweaty palms?

   In hyperhidrosis, the sympathetic nervous system that, controls involuntary responses such as sweating, blushing, and salivation, fails to regulate sweating in the body’s extremities. The cause of sweating is believed to be over-stimulation of the sympathetic nerve which supplies the offending sweat glands.

   Consequently, people with hyperhidrosis often experience sweating so severe that it becomes a source of embarrassment, making them reluctant to shake or touch hands. It can also interfere with everyday activities such as writing, driving, taking tests, making presentations or even holding or grasping objects. Patients used to be told that little could be done for the condition and that they had to live with it.

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4. What are the common treatments for sweaty palms?

   With the advances in medicine and surgical techniques, patients today have a variety of treatments to choose from.

   Non-surgical treatment methods include:
   • Topical anti-perspirants: eg. Aluminum chloride can be effective but can cause chapping and cracking of the skin.
   • Oral medicines: Anticholinergic drugs are used to block nerve sites. In people with hyperhidrosis, this leads to decreased sweating ability. Some psychotropic drugs (drugs that affect mental function), like amitriptyline, have also proven effective against hyperhidrosis.
   • Lontophoresis: This involves applying low-intensity electrical currents to the hands or feet while they are immersed in an electrolyte solution. When used daily, it can decrease the problem or even solve it temporarily. However, the procedure is time-consuming and can be mildly to moderately painful.
   • Botox: This substance, a derivative of the deadly botulism toxin, is injected into the affected area. While this usually works, its effectiveness wears off after six to 12 months. Therefore, patients have to undergo periodic injections.

   While these treatments can help many people with hyperhidrosis, some may not find them effective. Over time, their effectiveness may also decrease. Consequently, many people are now considering the minimally invasive surgical treatment known as Thoracoscopic Sympathectomy.

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5. What is Thoracoscopic Sympathectomy?

   Thoracoscopic Sympathectomy is a minimally invasive procedure used to cut the nerves that supply the sweat glands (in the armpit and palms) to reduce the amount of sweat. These nerves lie deep in the thorax and are close to the spine.

   

   In Thoracoscopic Sympathectomy, two or three tiny incisions are made in the chest through which special instruments are inserted to cut and divide the nerves. This procedure leaves less scarring than conventional surgery.

   
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6. How successful is Thoracoscopic Sympathectomy?

   This operation usually gives a satisfactory reduction in the sweating in over 90% of patients. In nearly all cases, the results are permanent. This operation is usually more successful for sweating of the palms than of the armpits.

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7. What are the complications and side effects?

   In most cases, patients no longer suffer from sweaty palms and there was additional relief of plantar (feet) hyperhidrosis. The most common side effect is the compensatory truncal sweating in 50% of patients. Some patients may also experience very dry palms and moisturizing cream is needed to prevent cracking of the skin.

   A small number of patients may have residual pneumothorax but this does not require intervention.

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8. What does Thoracoscopic Sympathectomy involve?

   The surgery itself takes about an hour and occasionally requires an overnight stay in the hospital. Patients can choose to have it as a day surgery case (90% of patients prefer this option) or as an inpatient.

   Patients will undergo bilateral (left and right sides of the body) sympathectomies for better results. They will be put under general anesthesia. The surgery involves making one or two 3mm - 5mm holes in the upper chest. An endoscope is then inserted into the incision to identify the second and third nerves and they are divided subsequently.

   

   After the surgery, a small drain (plastic tube) may be left in the chest for a few hours to ensure that the air is completely removed from the chest cavity. However, this is uncommon.

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9. What can I expect after the operation and how long do I have to be warded?

   After you awaken from general anesthesia, you should be able to sit up and walk within hours. You are encouraged to cough and breathe deeply to expand your lungs fully. This helps to prevent infection and collapse. Some pain will be felt after the surgery and you can request for pain relief medication to alleviate the discomfort.

   Although you may have chosen this operation as a day surgery procedure, you may need to be warded for observation. If your lungs take longer to expand, your ward stay may be extended.

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10. When can I resume my normal lifestyle?

    Most patients can resume their usual activities within a few days after surgery. The stitches will dissolve under the incision so there is no need to return to the clinic to remove them.

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Information in this webpage is given as a guide only and does not replace medical advice from your doctor. Please seek the advice of your doctor if you have any questions related to the surgery, your health or medical condition.

Information is correct at time of publishing (October 2003).