The sympathetic chain is an array of specialised nerves that travel to the side of  the spine and are responsible for performing many specialised functions such as bowel function, gland function and sweating. In the case of hyperhidrosis, a state of abnormally increased sweating, the sympathetic chain stimulates the sweat glands excessively and inappropriately therefore patients tend to sweat unexpectedly (even in the absence of heat or physical activity). Most patients tend to have isolated sympathetic over-activity and suffer with hyperhidrosis in specific parts of the body. The commonest sites are the face, armpits, hands and soles. These patients can be helped/cured of their unpleasant sweating by means of selectively destroying the parts of the sympathetic chain that supply the sweat glands to the face, armpits and palms (T2/T3 ganglia) without any other significant side-effects. As sweat glands receive nerve supply additionally from other nerves, patients can still sweat in response to exercise and heat but no longer inappropriately. These patients get the additional beneficial side-effect of warm hands.  This selective destruction of certain parts of the sympathetic chain is called Endoscopic Transthoracic Sympathectomy or ETS.

Please note that there are TWO sympathetic chains. One responsible for functions on the left side of the body and one on the right. The same parts of the sympathetic chain must be destroyed on both sides in order to stop over-sweating on both sides. Some patients with hand sweating choose to have the procedure done only on one side eg their dominant side or on the right hand they use to shake hands.

The procedure is performed under General Anaesthesia as follows:

The patient is firstly anesthetised using a special anaesthetic tube that allows either of the lungs to be ventilated. This provides a clear operative field to the surgeon on the side he is operating. The patient's arm is placed at a 90 degree angle to allow access to the armpit.

The surgeon then makes two small incisions (2cm or less) underneath the armpit of the side to be operated. An endoscope (an instrument with a tiny camera at its end which transmits pictures to a TV in theatre) is inserted through the first incision to allow the surgeon full view of the chest cavity. The sympathetic chain is then identified via the endoscope. An electrocautery instrument (used to destroy and seal tissues) is then passed through the second incision and the correct part of the sympathetic chain (T2/T3) is cauterised (destroyed by heat) for a few seconds. This destroys the nerve beads, known as ganglia, responsible for blushing, and sweating. The cautery is then removed and some surgeons then insert a small drain called a chest tube to allow the lung to fully expand again. The endoscope is removed last and both of the incisions are stitched.

The operation is all over. All in all it takes about 15 minutes from the start of the operation. The patient is then returned to the ward. Patients are observed overnight and are allowed to return home in the morning, although many patients choose to go home later in the evening.

In our unit we do both sides at the same time (left and right) although some patients opt to have only the more toublesome side done

Please click on the button below to watch a short video of the procedure

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For more information and answers to many commonly asked patients' questions please click here.