A sympathectomy is surgery on the sympathetic chain, which controls sweating, and the only known permanent solution for excessive sweating. Unfortunately, the sympathetic chain lies within the chest cavity making the operation difficult for both patient and surgeon. The development of endoscopic surgery within the past 15 years, has made reaching the sympathetic chain with minimal invasion a reality. Endoscopic thoracic sympathectomy became the standard to treat excessive sweating.
Even though sympathectomy has been performed for the last 50 years, it was not popular among physicians and patients because of its extensive nature of the procedure. Sympathectomy also took a long time to recover from. When fiber optics became available in medicine and surgery body cavities could be entered without large incisions. This cut down the amount of time and trauma a patient experiencing sympathectomy had to endure.
Over the last ten years endoscopic sympathectomy has been refined. Sympathectomy was minimized to affect only those areas of the sympathetic chain responsible for excessive sweating. A few methods exist to destroy this sympathetic chain segment including electrocautery, excision, ultrasound dissection and destruction, and a clamping method. The sympathectomy clamping method, however, can be reversed if the patient is dissatisfied with its results.
Beside the number of sympathectomy approaches, differing opinions regarding
the exact level of sympathectomy surgery also exists. Most of the surgeons
eliminate the second to the third sympathetic ganglia, but a trial now exists
to lower the sympathectomy level to the fourth ganglia.