For the last few decades surgery has been the only lasting solution for this problem. Unfortunately the location of the sympathetic chain which is within the chest cavity made the operation difficult for both the patient and the surgeon. The minimally invasive approach became a reality since about 1990. Since then endoscopic thoracic sympathectomy (ETS) became the standard to treat excessive sweating of the hands (Palmar Hyperhidrosis). Later the same minimally invasive approach created an ability to treat excessive foot sweating (plantar hyperhidrosis) in a very efficient way that could be done on an outpatient basis.

Open sympathectomy was done for the last 50 years. It was not so popular among physicians and patients because of the extensive nature of the procedure as well as the long time it took to recover. In the last 15 years fiberoptics became available in medicine and surgery opening the way to enter body cavities without the need for large incisions. This in turn cut down the amount of trauma and enabled patients to go back to their normal activities within a short time. For example knee surgery used to be done in an open approach which crippled the patient for a long time. Now a days arthroscopic surgery enables athletes to resume their activities within a very short time. The same applies to sympathectomy.

Even the endoscopic sympathectomy underwent refinements over the last ten years. The extent of the sympathectomy was minimized in order to affect only those segments of the sympathetic chain responsible for the excessive sweating. There are a few methods available to destroy the segment of the sympathetic chain. This can be done with electrocautery, excission, ultrasound disection and destruction as well as the clamping method. From those above mentioned techniques the last one does have the posibility of reversal in case the patient is unhappy with the operative results.

Beside the refinements in the surgical approaches there is also debate with reguard to the exact level of the sympathectomy. Most of the surgeons are eliminating the second to the third sypathetic ganglia and there is a trial now to lower the level of sympathectomy to the 4th ganglia. For further information it is always recommended that you consult your physician.