Jho Institute for Minimally Invasive Neurosurgery Department of Neuroendoscopy

Spine Diseases
     Brain Diseases

Hyperhidrosis Surgery, Sweating Treatment: Dr. Jho's Endoscopic Transthoracic Sympathectomy, T2 Sympathetic Ganglionectomy

Dr. Jho's Minimally Invasive Endoscopic T2 Sympathetic Ganglionectomy

Professor & Chair,  Department of Neuroendoscopy
Jho Institute for Minimally Invasive Neurosurgery

Summary of Dr. Jho's endoscopic T2 sympathetic ganglionectomy
     Surgery is performed under general anesthesia.  One or two small skin incisions are made near the armpit area (axilla).  One or two 5-mm trocars are placed into the chest cavity.  Through these trocars, the T2 sympathetic ganglion is excised under direct endoscopic visualization.  The use of a chest drain is not necessary postoperatively.  Postoperative discomfort is minimal.  Average hospital stay is overnight.  Patients can resume full functional activity in daily living immediately after surgery.  However, surgical recovery takes 4 to 6 weeks.

    Hyperhidrosis palmaris et facialis is a relatively uncommon condition that consists of excessive sweating in the hands, face, armpits, and feet.  Excessive sweating can occur in particular parts of the body or throughout the entire body.  The most common symptoms are excessive cold sweating, difficulty in wearing make-up, difficulty in the use of the hands (especially during typing or writing), and difficulty in socializing due to these symptoms.  Particularly, young adults with this disorder often encounter frustrations in their social life.
     Treatments consist of medical treatment with sympathetic blocking agents or surgical treatment.  Surgical treatment consists of thoracic sympathectomy.  Sweating is controlled by the sympathetic nervous system.  Overactivity of the sympathetic nervous system produces coldness from the shrinkage of blood vessels and excessive sweating.  The control center for excessive sweating of the face and hands is the second thoracic (T2) sympathetic ganglion.  Therefore, surgical treatment focuses on removal of the T2 sympathetic ganglion (sometimes including T3).
     Although it can be performed via various techniques, an endoscopic transthoracic technique is one of the best surgical techniques.  The endoscopic transthoracic technique utilizes a 4-mm endoscope via one or two small incisions near an armpit while the patient is under general anesthesia.  Surgical risk is minimal and often only requires an overnight hospital stay.  Although it is possible to perform a bilateral (both-sided) thoracic sympathectomy in one setting, a unilateral (one-sided) operation is usually performed first then the other side is operated on a few weeks later.  This is because each side requires its own incision and may be regarded as two operations.  The procedure is generally designed to effectively reduce symptoms in the face, hands, and the body above the nipple line.  Patients may experience compensatory excessive sweating below the upper chest postoperatively.  However, 40% of patients may experience the effective reduction of sweating in their feet as well.
     Note that endoscopic transthoracic sympathetomy can also be performed for disease conditions such as reflex sympathetic dystrophy, causalgia, Raynaud syndrome, etc.

For referral information or appointment for consultation contact:
                            Practice Manager:  Robin A. Coret
              e-mail : Drjho@ahn.org
                                       Tel : (412) 359-6110
                                     Fax : (412) 359-8339

         Address : JHO Institute for Minimally Invasive Neurosurgery
                            Department of Neuroendoscopy
                               Sixth Floor, South Tower
                               Allegheny General Hospital
                               320 East North Avenue
                               Pittsburgh, PA 15212-4772
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