Hyperhidrosis Treatment – Sweaty Hands

Endoscopic Thoracic Sympathectomy (ETS)

ETS is an operative procedure using minimally invasive techniques producing excellent results in patients with hyperhidrosis and facial blushing. Here at North Western Vascular, we have received many favourable testimonials from patients who have undergone ETS.

Many patients report having tried medications, acupuncture, injections, and expensive deodorants with limited success or short-term results. Contact us to book an appointment or to find out more information about ETS today.


What are the benefits of Surgery?
If successful, the operation will stop sweating and prevent further blushing episodes. This can help to ease negavtive emotions related to excessive sweating and blushing.
The success rate following sympathectomy for sweaty hands is very close to 100%. Importantly the benefit is permanent. For patients undergoing a sympathectomy for facial blushing, the success rate is over 90%. The response for blushing of the neck and upper chest is a little less predictable. For axillary hyperhidrosis, the success rate is about 70%.and for that reason miraDry is a much better option for these patients.
We will do everything to make this procedure as safe as possible. However, complications can occur. These fall into 3 groups. 1. Anaesthetic related, 2. General complications, 3. Specific to ETS. Compensatory sweating (CS). This is where you now sweat more in another area of your body. This is common, but generally mild. However, in one in 50 cases, CS can be troublesome, equal to or worse than the original problem. Unfortunately, it is very difficult to predict. Horner’s syndrome occurs when the sympathetic nerve supply to the eye is damaged. This will occur if the Stellate ganglion is inadvertently ablated. This results in a droopy eyelid and constricted pupil. This occurs rarely, one in 1000 cases. Gustatory sweating is where you sweat on your face following eating, particularly in response to spicy foods. This occurs in about 3% and is generally mild. Chest complications such as pneumothorax or chest infections are unusual, but can occur. It is common to experience heaviness in the chest and sharp pain often at the back, particularly with coughing and sneezing in the first week. A small number of patients (less than 5%) notice a marked difference in temperature between the upper torso and lower torso. In rare cases, it can become somewhat disconcerting.
Most patients stay overnight and are discharged the following morning. If the procedure is performed early in the day, I am happy for patients to go home the same day, as long as a responsible adult is at home to care for the patient.
I recommend a week off work, especially if the work is of a physical nature. Sharp chest and back pain is common in the first week, and often requires anti-inflammatory medications such as Nurofen to control the pain. A number of patients return to work earlier and seem to manage quite all right.
This is of particular interest to interstate patients. All patients have a post-operative X-ray to exclude a pneumothorax (residual air in the chest cavity). This is rarely of any consequence and settles spontaneously, but if present, I caution against flying until the pneumothorax has resolved completely. Without a pneumothorax, I usually recommend waiting 4 to 5 days before flying.
Troublesome CS, which is uncommon (about one in 50 cases) is the complication I fear most for my patients. In most cases, CS decrease with time, but this cannot be guaranteed for all. There is no surgical treatment for rebound sweating. Certain medications with anti-cholinergic properties (eg Ditropan) can be helpful in this setting.
There are many ways of performing a sympathectomy, including cutting the nerve, clamping the nerve, excising or ablating the nerve. I choose ablation (by electro-cautery) as it is safe and effective.
Most of the costs are covered by Medicare and your private health fund. There is an out-of-pocket expense which varies depending on your fund and level of cover. With no private health cover, it will be an expensive undertaking. Please download more details of prices here
I perform thoracoscopic sympathectomies (ETS) at 3 hospitals: John Fawkner Private Hospital in Moreland Road Coburg; Monash Medical Centre (Jessie MacPherson Private Hospital) in Clayton Road, Clayton; Cabrini Private Hospital in Wattletree Rd, Malvern. All hospitals deliver top class facilities supported by excellent Nursing Care. There are minor differences with regard to fees and out-of-pocket expenses, which you should discuss with my staff.
It is not uncommon for patients to have both sweaty hands and sweaty feet. It is more frequent for the hands to be more problematic, though this is not always the case. I usually recommend treating the hands first, as this is more often the more troublesome. In 70% of patients, there is an improvement in the feet following ETS.
Absolutely. A lumbar sympathectomy (performed laparoscopically or by an open procedure) will interrupt the sympathetic nerve supply to the lower limbs, thereby cutting off the nerve supply to the sweat glands in the feet. Performed as an open procedure, it involves incisions on each side of the abdomen in order to approach the sympathetic chain. The operation takes approximately one hour, is performed under general anaesthesia, requires 2 to 3 days in hospital, and a 3 to 4-week recovery. The success rate is very high (greater than 95%), and complications are rare.