MedClinic > Blog > Algology > Thoracoscopic sympathectomy


Thoracoscopic sympathectomy is a minimally invasive surgical procedure. It is used to treat hyperhidrosis (increased sweating), to relieve pain in the extremities, reduce swelling and inflammatory processes in soft tissues. The main advantages of the technique over other treatment modalities are 100% positive result, no risk of injuring surrounding soft tissues or organs, as this can happen during abdominal surgery.

Indications for surgery

Thoracoscopic sympathectomy is carried out quickly, on average, within 15-30 minutes. The essence of the operation is the disruption of the trunk of the sympathetic nerve, along which the spinal cord transmits impulses to the glands that produce sweat. The nerve is removed completely or pinched with a special clip. The second method is preferable since there is a chance to carry out reverse operation.

Although that the method of sympathectomy allows you to completely get rid of the manifestation of pathological processes, there is a risk of side symptoms. There may be a problem of excessive sweating, the so-called compensatory hyperhidrosis. As a rule, it is easier for patients to tolerate than the main reason for the operation and does not require additional treatment measures. In some cases, the reverse operation is performed to release the nerve from the clip. If the nerve has been completely removed, it is not possible to restore it.

Indications for performing it are:

  • obliterating endarteritis;
  • aortoarteritis;
  • atherosclerosis;

How is it performed?

The skin is pierced in the armpits. Through one puncture, a special instrument is introduced – an endoscope equipped at the end with a very small camera that transmits the image to the monitor. The doctor will not be afraid to damage the soft tissue surrounding the nerve by working blindly. With the development of atherosclerosis, sympathectomy is auxiliary, the operation is performed to relieve painful symptoms.

In the presence of pain in lower extremities, due to the development of atherosclerosis and other pathologies of the circulatory and nervous system, it is possible to completely stop the symptom, relieve swelling and restore blood circulation. The doctor makes 2 small punctures in the chest area (or lower back), most often in the armpit.

An endoscope with a miniature camera is inserted into one cavity, another puncture is used to introduce surgical instruments with which the doctor excises the nerve, or installs a clip. After surgery, simple stitches are placed. Despite the apparent simplicity of this operation, when carelessly performed by an inexperienced surgeon, complications can occur.

Advantages for thoracoscopic sympathectomy

Unlike full-fledged, open operations, which required a long hospitalization of the patient, after a sympathectomy a person can go home on the same day, in rare cases it is necessary to establish observation for another 1 day. Punctures, which the doctor makes in the armpit, heal quickly, in some time they cease to be visible to others and  the operated patient.

Thoracoscopic sympathectomy has virtually no contraindications, except of severe diseases in chronic stage. Surgery can also be done for elderly people. There is always a risk of complications arising after a thoracoscopic sympathectomy, and they are associated with the individual characteristics of the body.

Compensatory hyperhidrosis occurs in 5% of cases. This pathology may be temporary and after a while the body’s work will normalise, and the signs of increased sweating will pass without any intervention. But in some cases, the compensation effect does not pass by itself, and if excessive sweating interferes with the person’s life, the reverse operation is performed to remove the clip.

One of the innovative, non-surgical methods of treating hyperhidrosis that guarantees a quick and lasting effect is radiofrequency ablation of the sympathetic ganglia. The essence of this procedure is that the sympathetic ganglia are processed by high-frequency electric pulses, which are directed through a special radio-frequency cannula, with the aim of destruction or modulation of these structures.

The procedure is carried out:

  • in an outpatient setting;
  • under local anaesthesia;
  • under the control of an electron-optical converter;
  • the duration of the manipulation is 20-30 minutes;
  • fast and lasting effect;
  • can be performed repeatedly (which is needed extremely rarely).

At the end of the procedure, the patient is under medical supervision for an hour and then returns to his normal lifestyle, without any restrictions.

The radiofrequency cannula under the control of EOC is introduced to the location of the sympathetic ganglion at the thoracic level. The procedure can be performed with palmar hyperhidrosis after an unsuccessful sympathectomy performed in another hospital.