Thoracoscopic sympathectomy at Nuffield Health at St Bartholomew's Hospital

It can also treat facial flushing. Your consultant may recommend this procedure if your hyperhidrosis does not respond to conservative methods of treatment.

What happens during thoracoscopic sympathectomy?

Thoracoscopic sympathectomy is usually performed under general anaesthetic and can take up to 2 hours.

The sweat glands in your hands, face and armpits are controlled by nerves in your chest called the thoracic sympathetic nerves. There are two chains of nerves each controlling one side of your body so your surgeon may need to perform the operation on both sides of your chest.

The operation is done using a thoracoscopic method (keyhole surgery). They will make 2 or 3 small incision (cuts) in the upper part of your chest wall near your armpits. They will insert tubes into these incisions along with a telescope. Your sympathetic nerves are located lay along your ribs close to your vertebrae. They will move your lung aside and then cut or clamp the nerves.

To confirm the sympathectomy is successful a finger probe is used to measure your skin temperature. Successful division of the nerves causes an increase in temperature. The incisions will be closed with stitches or staples.

You will be taken to a recovery area and then to a ward. Our healthcare team will give you medication for pain relief. Be sure and let us know if you are still in any discomfort.

You will have a chest x-ray to confirm if your lungs are fully expanded. In some cases any second x-ray may be needed the day after your operation.

Going home after thoracoscopic sympathectomy

You will need to stay in hospital at least one night. You will not be able to drive so please arrange for someone to take you home on your day of discharge.

Continue to take your pain relief medication as prescribe. You may feel sore or bruised or have discomfort when you breathe. These symptoms should ease within a few days.

Our healthcare team will give you instructions on how to care for your surgical wounds.

You may feel tired for several days. This is normal following general anaesthetic.

Be sure and discuss any return to work with your surgeon. 

Most people make a good recovery from thoracoscopic sympathectomy. As with any surgical procedure there could be complications including:
Reaction to general anaesthetic

• Pain
• Bleeding
• Infection
• Blood clots (deep vein thrombosis – DVT)

Specific complications of thoracoscopic sympathectomy may include:

• Collection of air in your chest cavity (pneumothorax)
• Infection in the space around your lung
• Reduction in heart rate
• Nerve damage
• Compensatory sweating – other areas of your body sweat to compensate for less sweating in the areas treated