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da Vinci ® Thoracic Sympathectomy (Sweaty Palm Surgery)

The da Vinci thoracic sympathectomy is the most advanced surgical technique for treating hyperhidrosis (sweaty palms) and a number of other related conditions. The nerves involved in excessive hand sweating and those that constrict the blood vessels in the extremities are located deep inside the chest along the spine. Severing or cauterizing these nerves blocks the impulses that cause uncomfortable and unpleasant symptoms. This treatment may provide long lasting relief for patients with disorders of the parasympathetic nervous system.

Prior to the introduction of endoscopic thoracic sympathectomy (ETS), the procedure was done using an open approach that was highly invasive with extensive incisions and a lengthy recovery time. The risk of complications sometimes outweighed the benefits patients received from treatment. Minimally invasive ETS changed this procedure into an outpatient surgery with most patients returning home the same day or with just an overnight stay. Complications are now quite rare for this surgery. Today, the da Vinci Surgical System offers an even higher level of accuracy while operating on the delicate nerve fibers in the chest cavity.

Who Is a Candidate for da Vinci Thoracic Sympathectomy?

Patients who experience malfunction of the sympathetic nervous system that does not respond to other therapies may be advised to consider this surgery. Hyperhidrosis is the most common problem for which sympathectomy is recommended. Patients with this condition experience constant and copious sweating from the palms of their hands. Feet and armpits may also be locations with excessive sweating. This disorder can cause embarrassment and interfere with social interactions. Individuals with hyperhidrosis may also have difficulty with activities that involve handling paper because the sweat soaks the pages. Most non-surgical treatments are only effective in a small percentage of patients and may become less effective over time. In contrast, more than 90 percent of patients with hyperhidrosis respond well to surgical intervention. About one in three experience higher levels of sweating on their trunk after the procedure. However, many patients find this easier to deal with than sweaty hands.

Other conditions that have been successfully treated with da Vinci thoracic sympathectomy include:

Raynaud’s Syndrome: This condition causes the blood vessels in the fingers, toes, and other extremities to constrict upon exposure to even mildly cold temperatures (such as from a fan or air conditioning) or in response to stress. The sensation can range from uncomfortable to painful and can increase the risk of frostbite for patients who live in cold climates. Sympathectomy prevents this unwanted constriction of the blood vessels. Raynaud’s can sometimes have other underlying causes such as poor circulation rather than a problem with the nervous system. For these patients, sympathectomy is not as likely to be effective.

Excessive Blushing: This is another disorder that can be socially awkward. Patients with this condition flush bright red in the face in response to a range of different emotions (happiness, anger, excitement, embarrassment, affection). This condition may occur in conjunction with excessive sweating since the same area of the nervous system is involved with both. The outcomes for treating facial blushing have not been studied as much as the outcomes for hyperhidrosis. This means the success rate for sympathectomy is not as well established for these patients.

Complex Regional Pain Syndrome (CRPS): This condition sometimes occurs after a nerve injury when the site does not heal correctly. It can cause substantial pain (usually in the arms or legs) including burning sensations and extreme sensitivity to touch. Persistent swelling, skin inflammation and excessive sweating are additional symptoms. CRPS is chronic and may seriously decrease quality of life. If a nerve block provides temporary relief, a sympathectomy may be recommended to provide a more permanent solution.

Benefits of da Vinci Thoracic Sympathectomy

Not all patients are candidates for ETS (conventional or with da Vinci equipment). Sometimes, a patient’s anatomy or other factors make an open surgery the only option. However, those who can have the minimally invasive procedure typically enjoy:

  • No hospitalization required
  • Less bleeding
  • Fewer complications
  • Minimal pain
  • Smaller scars
  • Faster return to activities


With the exception of CRPS, most of the conditions treated by sympathectomy may not be worth undergoing a highly invasive thoracic surgery. Because of this, many patients simply chose to live with their symptoms in the past. Now, the surgery is much less scary (although it does still have risks). The use of da Vinci robotic technology helps skilled surgeons operate with a higher level of precision than ever before, giving patients more peace of mind.

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