Endoscopic Thoracic Sympathectomy for Underarm Sweating

Axillary hyperhidrosis, or excessive underarm sweating, can interfere with everyday life, leading to stained clothing, body odour anxiety, and limitations in both social and professional settings. For those who have not found success with topical or temporary solutions, Endoscopic Thoracic Sympathectomy (ETS) may provide permanent relief.

ETS interrupts the sympathetic nerve pathway responsible for overactive sweat glands in the underarm area. Clinical evidence shows significant quality-of-life improvements after ETS in well-informed patients. However, about 2–4% may regret the operation due to unwanted side effects.

As with any surgical procedure, the choice to undergo ETS must be based on a personalised discussion of potential benefits and risks.

Conventional ETS Surgery

This minimally invasive procedure is done under general anaesthetic. Two tiny incisions (around 0.5 cm) are made under the armpits. The sympathetic nerve is divided, and the wounds are closed with dissolvable stitches. The surgery lasts about 40 minutes. A chest X-ray post-surgery ensures the lungs have fully re-expanded.

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Contraindications to Surgery

ETS should not be performed in:

  • Elderly individuals

  • Patients with cardio-respiratory conditions

  • Those who are obese

  • Anyone with significant past chest disease or prior chest operations

The effects of ETS are generally irreversible. The nerve does not regenerate, regardless of whether it is cut, clipped, or cauterised. Only about 20–30% of cases may potentially be reversed.

Post-Operative Course

Some patients experience mild pain around the surgical area or upper back in the first few days, which settles quickly. Many return to work within 2 days, though recovery varies. Full physical activity can resume within two weeks.

Complications and Side Effects

Although no life-threatening complications have occurred at our centre, the procedure is performed in the chest, so bleeding may occasionally necessitate chest opening. A rare air leak from the lung may require a suction drain.

Other possible complications include:

  • Rare, prolonged pain or numbness in the arm

  • Temporary Horner’s syndrome (less than 1% incidence)

  • Minor wound or chest infection (under 5%)

  • Excessive dryness of the hands

  • Compensatory sweating on areas like the abdomen, legs, or feet — significant enough to cause regret in about 1 in 50 patients

Gustatory sweating (sweating triggered by taste or smell) may occur in up to 30%, but most do not find it problematic. Though some feel a sense of general tiredness post-op, studies show no decrease in exercise capacity, even with a modest heart rate reduction of around 10%.

How Can Treatment Help?

These conditions can be significantly improved through highly selective nerve treatments, such as endoscopic thoracic sympathectomy (ETS). This minimally invasive procedure interrupts nerve signals responsible for blushing and sweating, reducing or stopping symptoms and improving quality of life.

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