If you have tried conservative treatments for hyperhidrosis and not had the level of success you had hoped for, your doctors may recommend surgical treatment, known as a sympathectomy or sympathotomy. A sympathectomy is removal of the sympathetic nerve; our doctors at Johns Hopkins prefer to cut the nerve instead of removing it. That is why we refer to the surgery as a sympathotomy.
If you have not had your sweating for a long time, (arms, hands and feet), you will not be a surgical candidate for a sympathotomy. If you have truncal hyperhidrosis (sweating on your body or groin), you may also not be a good candidate for surgery.
For treatment of hyperhidrosis, surgeons used to have to open the entire chest to locate and cut the sympathetic nerve, the nerve that controls the sweating reaction in people. Now we have VATS, which stands for Video Assisted Thoracic Surgery. Your surgeon makes a small incision in your underarm and using a small camera and light, is able to locate the sympathetic nerve and make the appropriate cuts. The increased magnified visualization of the sympathetic nerve offered by VATS eliminates the need to open up people’s chest.
VATS gives our surgeons an amazing amount of precision, so they can localize the exact place on the nerve where the cut should be made.
Surgeons also used to clip nerve with the idea that clip removal would make the surgery reversible: what they now know is that clipping is irreversible. To date, the best evidence suggests that clipping and cutting the nerve are fairly interchangeable although larger studies are needed to evaluate the two techniques head-to-head.
