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Patient Information -  Thoracoscopic Sympathectomy

1. What is a thoracoscopic sympathectomy?
The nerves that supply the sweat glands in the armpit and palms can be cut to reduce the amount of sweating. These nerves lie deep in the neck, close to the spine and the traditional operation to divide them, using a neck or armpit incision, left a sizeable scar and were often accompanied by complications. The operation was therefore only done in very severe cases. However, thanks to the development of "keyhole" surgery the nerves can now be destroyed through 2 or 3 tiny holes in the chest using special instruments. This procedure is called a thoracoscopic sympathectomy.


2. How is a thoracoscopic sympathectomy carried out?
You will have a general anaesthetic for the operation. When you are asleep, a small hole is made in the arm pit and then just below your collar bone. The lung, on the side being operated upon, is allowed to collapse a little to make some working room. Meanwhile your other lung is capable of doing all the work. A camera on a thin telescope is then put into the chest to find the nerves which are to be divided One other small hole is made to put in the instruments that divide the nerves. The lung is then re-expanded and the instruments removed. Very rarely, a small drain (plastic tube) is left in the chest for a few hours to make sure all the air is removed from the chest cavity. It is usually possible to do both left and right sides at the same operation if required.


3. How long do I have to be in hospital?
Although it is possible to have this operation as a day case, in most cases you will be kept in overnight after the operation. Occasionally, if the lung takes a bit of time to expand, you may have to stay in a bit longer. Rarely, a small drain (plastic tube) is needed to help the lung expand. 

 

4. How successful is thoracoscopic sympathectomy?
This operation usually gives a satisfactory reduction in sweating in over 90% and stops facial flushing in up to 98% of patients. In nearly all cases the results are permanent.  Sometimes the palms are so dry after the operation that moisturising cream is needed to prevent cracking of the skin.  The operation dries up the hands and sometimes the armpits and may result in extra sweating elsewhere in your body. This "compensatory" sweating commonly occurs on the back below the shoulder blade.

 

5. Are there any special complications of thoracoscopic sympathectomy?
Pain: Sometimes the ribs where the telescope was inserted into the chest are sore for a few weeks and hurt on breathing in deeply or coughing. This is due to bruising of the ribs and gradually improves. Taking nurofen can help.

Neuralgia:  Nerves near the ribs can be damaged and cause numbness or pain. This usually gets better.

Horner's Syndrome:  The only particular complication is a drooping of the eyelid on the side of the operation due to damage of the nerves in the root of the neck. This is rare with thoracoscopic sympathectomy (less than 1 in 50) and usually recovers.

Thoracotomy: Very rarely, there is bleeding in the chest and a large cut has to be made in the chest to stop the blood loss. Very rarely the lungs fail to inflate properly and people need a cut in the chest to stick the lung back up (pleura-adhesis).

Treatment failure: In about 20% of people TECS may not work if you have sweaty armpits. If this happens then Mr Braithwaite may be able to treat you with BOTOX.

It is important that if you have any problems after a thoracoscopic sympathectomy you should contact Mr Braithwaite to discuss the problem. Some doctors do not understand the technique and may give inappropriate advice.